Tuesday, June 19, 2012

On physician-assisted suicide and euthanasia.

Apparently, the BC Supreme Court has legalized physician-assisted suicide, leading inevitably to a mass slaughter of everyone over the age of -- let's say -- 50.

Yeah, there's a lot of bullshit being tossed around about the decision. Without going into the nitty-gritty -- because I really don't have time or inclination to read a lengthy legal document -- here are some useful distinctions which might actually inform the debate. Although, gods forbid we have an informed debate about an important issue; let's just be partisan and sling mud!

(Too much Sun News is really, really bad for you, BTW.)

So, first point: physician-assisted suicide (PAS) is not equivalent to euthanasia. It's a form of euthanasia, but not the only one. Euthanasia, strictly, is the killing of a person who is otherwise going to die from some progressive illness. (Some folks want to expand the definition beyond that, but I tend to think that's just garden-variety suicide or murder. Possibly justifiable in both cases, but not euthanasia.) Euthanasia is usually divided into active and passive forms (there are some other distinctions, but this one is crucial). Active euthanasia involves actually doing something in order to hasten someone's death. Passive euthanasia involves refraining from doing something in order to hasten someone's death. So, administering a fatal overdose of a drug is active euthanasia; allowing someone to refuse nutrition is passive euthanasia.

I think most people don't object to active or passive euthanasia, when they're administered by the person who is dying. That is, when they are strictly suicide. We can all sort of understand being in terrible pain and seeing little point to prolonging it; even if we might decide differently for ourselves, it seems reasonable to allow people to make this decision on their own, without interference from others.

The sticky point comes when you get someone else involved. That's where PAS comes in. PAS, and other forms of assisted euthanasia, involve a third-party helping a dying person to kill themselves. So, when the dying person can't, because of physical or cognitive limitations, actually go through with euthanasia, the physician -- or whomever -- gets involved, and helps carry out the person's wishes. This could be passive, technically -- by ensuring that the dying person is not provided with treatment or nutrition, for example -- but is usually active.

Now, again, I don't really see any serious objections to this. I quite understand if individual physicians, or whomever, may not want to assist someone in dying. (Although, that said, maybe they should go and talk to vets, who do it all the time, about whether it's kinder to let someone suffer or to ease them on their way.) I wouldn't suggest that anyone be forced to assist in euthanasia. However, if the assistant is okay with it, and it's a clearly-expressed wish of the person being euthanized (so, no coercion, clear mind, etc., etc., the standard set of conditions for determining if someone really wants something or not), I see no important objections to assisted active euthanasia.

What I'm noticing, though, is that people who object to the court's decision have failed to distinguish the above form of assisted active euthanasia, where an assistant, often a physician, helps a dying person fulfill a clear request, with a slightly different form of euthanasia, which is much more problematic. This is active, assisted euthanasia where the dying person's wishes are unclear, coerced, or simply unexpressed; in other words, where the physician, or whomever, substitutes his or her judgement for that of the dying person.

Often, we are okay with this, legally and, I think, ethically. When someone is not capable of making important medical decisions for themselves, we expect those who are close to them -- or officially-appointed delegates -- to take on the burden of making those decisions. So, I don't see the problem if that's the case: if the physician, or other assistant, has been given the power to make medical decisions for the dying person, and decides that now is the time for euthanasia, either active or passive in form.

If we're dealing with a case where a person has clearly stated they do not wish to be euthanized, then there is equally no problem. This person should not be euthanized, at least not actively. Passively is a different story; given that medical resources are always scarce, there comes a point where it is, I think, legitimate to remove scarce resources from a dying person and provide only palliative care.

The only problematic case that I see is where the decision-making power is ambiguous or not delegated, and/or where the person's expressed wishes are unclear.

But. It's nonsense to say that all cases of euthanasia are like this one. Not all cases are active. Not all cases are assisted. Not all assisted cases are cases where the dying person's wishes are unclear.

It's nonsense to say that we should make broad, sweeping laws in order to deal with narrowly-defined cases. This is a general point, but it's worth repeating: laws can be crafted more carefully; trying to deal with difficult issues requires precision, not brute force.

It's nonsense to say that seniors will be butchered by uncaring physicians, because in most case of euthanasia, we're dealing with people who have clearly expressed a wish to die (or, equivalently, have given the power to decide that to someone else, who expresses such a wish). This one's actually very bad, as it's a general slander on physicians who work with the dying; I've yet to run into even one who wants a patient, even a difficult one, to die.

And it's nonsense to say that it is clearly wrong to euthanize someone where it's not clear that they wish to be euthanized and/or it's not clear who has the power to make that decision. The point of such a case is that it's not clear. There's no general principle to appeal to here; nothing you can use to make the decision easier. This is the hardest of hard cases, where you have to collect as much information as possible and make the best decision on that basis that you can, allowing that you might get it wrong. For laws to get in the way and dictate that decision one way or the other strikes me as frankly juvenile.

(Oh, and, the less said about Margaret Somerville's recent nonsense the better. I now know that she is philosophically informed, so the fact that she spouts such foolishness is clearly a result of inclination, not ignorance.)

No comments: