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Assisted Suicide Bill – Resources

On 6 March the Edinburgh Solas Group, along with Kings Church Edinburgh, hosted a debate on Assisted Suicide.  The topic was the current Assisted Suicide (Scotland) bill put forward by Margo MacDonald MSP.  Ms MacDonald was unable to attend due to ill health and was replaced by a co-signatory on the bill, Liam MacArthur MSP from the Liberal Democrat Party. The full debate is now available on YouTube.

Solas CPC has recently published edition 2 of The Solas Papers, which also deals with the topic of Euthanasia and Assisted Suicide.  It is authored by Dr Peter Saunders, CEO of Christian Medical Fellowship.  You can purchase a copy here.

Finally, we also include a helpful synopsis and analysis of the debate from Richard Lucas:

Assisted Suicide
Playing the secularism card
Speaking on assisted suicide in the Scottish Parliament, Patrick Harvie MSP began his speech thus: “I could stand here and give a speech about my belief system, but, in a democratic institution, surely the point should be parliament should not privilege any one particular belief system and impose it on those who don’t subscribe to it. Religious belief or subscription to a doctrine can be the basis of a person’s moral life, but our society and this secular authority, parliament, must not become a means for imposing such a religious position on everyone. Our authority comes from the electorate, so I can only start this argument with the principle that a life belongs to the person living it.”

This is not an attempt to win the argument, but to side line opposing views, because they have a religious or personal element. However, everyone approaches moral issues from a personal ethical perspective, and if this isn’t a moral issue, I don’t know what is.

Patrick stated his underlying principle that “a life belongs to the person living it”, but is that even a coherent statement? Is a sentence in the form X belongs to X meaningful? What does it mean to say that something belongs to itself? Even if it is intelligible, the implications are far from clear? My car belongs to me, but that doesn’t mean I can do with it as I please. My left kidney belongs to me, but that doesn’t mean I should be free to sell it on the open market. So, it is not at all clear that Patrick’s fundamental principle is coherent, and it’s implications are unclear. So, Patrick’s central principle is doubly flawed, hardly a solid foundation on which to build a case for allowing assisted suicide.

But, he should have every right to offer his perspective in public policy debate, in parliament or anywhere else.

My ethical framework rests on different foundations: every person is of equal value, created in God’s image. This has roots in Christian theology, but accords with the intuitions of most people outside university philosophy departments and humanist societies. Human life has intrinsic value and we act against our intuitive sense of morality and the good of wider society by assisting suicide. If I thought that assisted suicide was immoral, but had no negative affects beyond the person killing themselves, I would not oppose its legalisation, but God has given us a conscience and moral guidance to protect us, individually and collectively, from harm. Morality is not a matter of arbitrary taste as

Patrick implied, but a crucial framework for a healthy society.

Patrick stated that “Our authority comes from the electorate” – and I’m part of it. I have a vision of a positive society in Scotland, informed by my Christian faith, and Patrick’s suggestion that my views should be set aside and his own made central to government decision making is nothing more that blatant special pleading.

Playing the secularism card should not stifle debate at Holyrood, or anywhere else.

The intrinsic value of human life
The intuition that every human life has intrinsic value is widely held, informing most people’s moral responses to a range of questions, but, in our increasingly secular society, few are able to articulate an intellectual foundation undergirding it. Inevitably, this leaves the principled high view of all human life vulnerable to erosion by competing philosophies.

The Hippocratic tradition dominated Western medicine for over a millennium (until the 1960s), because it complemented the Christian culture that predominated the profession. Killing patients, through abortion, euthanasia or assisted suicide, was anathema. Other societies, through the ages and currently, have different values, for example still abandoning unwanted babies to die.

The view gaining ground in our society is that the value of a human (or any other) life depends on its capabilities and characteristics: intellectual ability, independence, so called “quality of life”, age etc.. Peter Singer, Australian Humanist of the Year 2004 is at the forefront of this, and he claims that a new born infant is of less moral worth less than a cat because of its inferior capabilities. If you deign to disagree, he’d label you a “speciesist”: a person with a sentimental and irrational bias towards your own species.

On this view, it becomes an open question to ask, “how valuable is my life?” Or, “how valuable is his life?”

Belief in the fundamental value of every human life protects the vulnerable from mistreatment and motivates ongoing care and support for those who most need it.

I don’t agree with much that Hitler said, but he got this right: “In nature the law of the struggle for survival reigns. Everything incapable of life, everything weak is eliminated. Only mankind and above all the church have made it their aim to keep alive the weak, those unfit to live, and people of an inferior kind.”

I’m part of mankind, and part of the Church, and I do indeed oppose the killing of the weak, those (who some think are) unfit to live, and people of an (allegedly) inferior kind.

Slippery slope arguments
The Assisted Suicide (Scotland) Bill is designed to get over hurdle of introducing state endorsed deliberate killing while minimising objections, before extensions to its scope are sought later. I expected this point to be contested in debate, but the documentation associated with the Bill is explicit that this is the intention. A couple of quotations from the Policy Memorandum: “It is a matter of regret” “that assisted suicide will not be available to all those that the member would ideally wish to include.” This is a “price worth paying if it allows the Bill to secure majority support” and “there may be opportunity for further developments in the law that would offer hope to other categories of people seeking assistance to die.”

So, once the principle of state assisted suicide is conceded, what next?

Some seem to regard slippery slope arguments as inherently flawed, but it is a valid argument form and refutation requires more than labelling. There are three sorts of slippery slope argument: logical, where attention is drawn to the further implications of stated principle, empirical, where subsequent events are cited in cases where the crucial first step has been taken, and psychological/social/cultural, where further effects are predicted based on personal and interpersonal factors. I will use each form here.

Logical slippery slope:
If it is agreed that assisting people to kill themselves is a valid function of the state, why should this be restricted to the terminally ill? Surely a person in unbearable pain but not terminally ill should not be excluded? But why should it only be unbearable pain that is the criterion? What of the person who regards their loss of independence as rendering their life futile? Surely they also “own their own life”?

Surely mental anguish and ill health can be as debilitating as physical problems, so the mentally ill surely should also have the right to die? Should we discriminate against disabled and deny them the opportunity to kill themselves just because they can’t self-administer the lethal agent? Surely we need euthanasia as well.

Most in the Netherlands choose euthanasia not assisted suicide. Why should this option be denied to those who are able to kill themselves?
What about those judged to be not competent to make decisions about their health care? Universal practice is that others make decisions in their best interests on their behalf. Surely these people should not have to carry living when they are deemed to be “better off dead”, just because they can’t express the desire themselves?

Why should anyone have to jump off a bridge or use other distressing improvised suicide methods in the twenty first century? Surely we can do better than that?

The logical end points are suicide on demand on NHS, and euthanasia, including non-voluntary euthanasia. These conclusions follow from agreeing that a person owns their own life, and, therefore, can end it when they want to, and that, in some cases, being killed is a better option than continuing to live.

In addition to the logic, the fashionable discrimination/equality/rights language that can be employed will accelerate the progressions.

Empirical slippery slope:
Statistics and anecdotes relating to jurisdictions where assisted suicide and euthanasia have been legalised are freely available, so I’ll mention but few. In the Netherlands we see increasing numbers of euthanasia cases, including ever more non-voluntary and involuntary cases. In Belgium we see the scope constantly broadening, highlighted by recent cases of middle aged deaf twins being killed on request as they feared the onset of blindness, and a woman being killed following her dissatisfaction with her sex change process. Recently all age restrictions have also been lifted, to encompass children. In Switzerland, the founder of the Dignitas ‘clinic’ wants to “help” more mentally ill people.

Infanticide (the killing of new born babies) is now openly discussed in journals of medical ethics, and practiced in Belgium and Holland.

Psychological/social/cultural slippery slope
What effect would introducing assisted suicide (and its logical consequents) have on the ethos of our society?
In the Netherlands, some elderly people carry cards expressing their desire to live and not die, fearing euthanasia or lack of treatment if hospitalised.

In a society accepting assisted suicide, a person coming to terms with, for example, paralysis, is more likely to consider suicide as an option. Once this idea is planted in the mind, a person’s resolve to make the most of the rest of their life, however, difficult, will be weakened. If suicide is not seen as a valid option, a more concerted effort to overcome difficulties is likely.

Already we hear suicide being described as a “brave” in some cases. The inevitable corollary of that is that the decision to keep living must be cowardly in some cases. How does a person coping with a medical condition feel when they hear of a person with a similar condition committing suicide, and this being described as “brave”?

If continuing to live is regarded as a choice, caring for those in need will seem more like a choice as well, instead of a duty. Imagine two neighbouring married couples, Mr and Mrs A, and Mr and Mrs B. The two wives both become very dependent on care from the husband. Mrs A commits suicide. Mr A grieves, then goes about his new single life, pursuing his hobbies and socialising widely. Mrs B continues to live. Mr B cares for her intensively. Is it not inevitable that Mr B is more likely to resent his commitment to care for his wife in the light of his neighbour’s experience? Might he subtly communicate this to Mrs B, intentionally or otherwise? Is it not now more likely that Mrs B will feel guilty at “choosing” to need so much ongoing care?

The commitment of spouses, and other family members, to care for each other is a foundation of a sustainable and compassionate society. Assisted suicide would undermine it.

These effects may be unmeasurable, but are obviously inevitable. I have never read a peer reviewed, placebo controlled, double blind, randomised study showing a correlation between children playing on railway lines and accidents. But I don’t let my kids do it. We are only at the start of the project to unravel respect for the inherent value of human life. Give it a few decades or centuries, and the effects will be plain.
Lady Mary Warnock, influential medical ethics “expert” recently said, “If you’re demented, you’re wasting people’s lives – your family’s lives – and you’re wasting the resources of the National Health Service,” after writing an article called ‘A Duty to Die?’

If caring for a family member is “wasting” one’s life, what amounts to using one’s life meaningfully? Going on holiday and reading a good book? If some people are told that their care amounts to “wasting NHS resources” it clearly implies that their life is deemed worthless. Would you want to be treated by a Doctor with that view? If there is a “Duty to Die”, as some philosophers argue, how should NHS resource allocation reflect this?

If life is devalued, the most vulnerable will be left feeling insecure, guilty and unwanted.

Suicide generally
The Scottish government has a Suicide Prevention strategy, recognising the tragedy of suicide and seeking to help people move on from episodes of suicidal ideation. Most people who unsuccessfully attempt suicide do not make a subsequent attempt – so helping people through a suicidal phase often has lasting benefits. As Christian influence recedes and suicide becomes seen as a valid option, a clear cut suicide prevention policy will become untenable. The government line and the policies of charities will drift more towards a “help people make the right decision for them” approach.

Increasing acceptance of suicide as a valid solution to personal problems will follow from introducing assisted suicide. Each case will be discussed among friends and family, and a desire to avoid speaking ill of the dead will skew discussion towards approval and glorification of suicide. To express disapproval of assisted suicide in the context of people’s personal experiences will be regarded as grossly insensitive, so proponents will be emboldened and critics cowed. We already see this effect in media reporting where an emotional assisted suicide proponent tells their personal story and is cared for by a sensitive interviewer in the softest of tones, who then turns on the critic with their customary vigour.

The Werther Effect is well documented: wide exposure to accounts of suicide leads to a higher incidence of suicide. Also, the Papageno Effect refers to the opposite phenomenon. Those hearing stories of people overcoming suicidal thoughts are less prone to suicide themselves.

Assisted suicide invites the Werther effect on grand scale.

A family history of suicide is an important risk factor for suicide in future generations. With assisted suicide, within a few decades, many, if not most, families would have some history of suicide.

In debate on this issue, I asked Parick Harvie MSP and Liam McArthur MSP a question: if you were addressing a group of teenagers and one asked, “Is killing yourself self an acceptable option to escape personal problems?” what would you answer? Yes? No? Depends? I’d say “no.” I assumed Patrick and Liam would say either “yes” or “depends”. The question was not answered.

The act/omission distinction, and intention
It is sometimes claimed that the boundary of euthanasia is blurred. Doctors withdraw or withhold futile treatments. Patients can decline treatment life-saving treatments. Life support machines are turned off. Some patients lose consciousness until death through pain relief medication. Surely these amount to killing? Surely assisted suicide and euthanasia are no different?

There are complex cases and grey areas, relating to brain death, persistent vegetative state etc., but even in these cases I’m not comfortable with a person being declared, to all intents and purposes, dead while they are still breathing and their heart is still beating.

The act/omission distinction, though difficult to apply in some contrived hypothetical circumstances, is morally significant: failing to save a person’s life is not morally equivalent to murdering them murder.

However, the key feature of killing is positively acting with the intention of causing death. Being killed by an illness is quite distinct from being killed by oneself or a Doctor, and this is the only principled place to draw a line.

Doctors’ exemption on grounds of conscience
The currently proposed Bill attempts to bypass controversy by using “facilitators” to help with the killing (they must be at least 16 years old – so a suitable job for a school leaver?). Of course Doctors would still be involved with the approval process. If an assisted suicide is unsuccessful, surely Doctors will become involved in the aftermath and it is likely that some would prefer to be killed by their familiar doctor instead of an unknown facilitator. In the name of hospital efficiency, if nothing else, a case would be made to allow doctors to assist suicides.
The perfectly sensible abortion conscience clause is coming under increasing pressure, particularly from secularist campaigners, and it can be envisaged that an assisted suicide conscience exemption would be similarly attacked. The trend is towards expecting employees to act regardless of their personal principles. How long would it be before we heard, “Well, if she didn’t want to kill people, she shouldn’t have become a doctor in the first place.”

If a teacher expressed disapproval of assisted suicide, it can be envisaged (on the basis of parallel cases) that a complaint could be raised that a pupil was upset because a family member had had an assisted suicide and the negative judgemental comment was upsetting. Surely teachers should refrain from upsetting pupils by expressing their personal illiberal views.

The New Morality
The documentation relating to the Assisted Suicide (Scotland) Bill does not discuss the moral issue of taking life at all, but other issues, more reflective of contemporary moral priorities, are addressed. So, never mind about the principle of killing and helping to kill people, let’s get to the weightier issues.

Don’t worry: the Bill does not have a negative impact on “Equal Opportunities.” Though the elderly would be over represented in assisted suicide statistics, we are reassured that assisted suicide would be equally available to everyone over 16. If your main concern is that there would be a gender imbalance in assisted suicide cases, fear not: the evidence from abroad is that men and women are helped to die in roughly equal numbers. Assisted suicide is positively beneficial when it comes to benefitting people with low incomes, as going to Switzerland to be fleeced and killed at a Dignitas “clinic” can be prohibitively expensive. Needless to say, the Bill is also heralded as “enhancing human rights.”

Conclusion
God planted a conscience within us, giving us a sense of morality that protects society and the individuals in it from harm, promoting overall well-being, saving us from destructive social experimentation.

Personal autonomy is an important value, but is overridden in this case by the need to protect the most vulnerable in our society.

Richard Lucas March 2014