Autonomy's suicide - an argument against Physician-Assisted Dying

Correctly termed either euthanasia or assisted suicide, The Ethics Centre based in Sydney covered both sides of the debate. The case against is reproduced here with permission. 

At the Festival of Dangerous Ideas, The Ethics Centre's interactive art installation asked, what do you wish we could talk more about? Many people were interested in the right to die. Nigel Biggar believes passing assisted suicide legislation will give us more than we bargained for.

Let's be frank. There are dreadful ways of dying. For example, those who suffer from motorneurone disease might have to face the prospect of suffocating to death. People with obstructive tumours may spend their last days vomiting their own faeces.

But it's not only the dying who have reason to fear. Some of the living are burdened with lives that are terribly restricted and isolated. These include Alzheimer's patients, multiple sclerosis sufferers, quadriplegics, the conscious but paralysed and voiceless, the elderly and bereaved facing lonely decline... The list goes on.

Is human life under such conditions really worth perseverance? Surely compassion obliges the law to let us seek a swift and efficient escape through help in killing ourselves (assisted suicide) or someone else killing us at our request (voluntary euthanasia)?

Besides, don't we have a right to autonomy? After all, an individual's life is his own. Who is better placed to decide when it has become intolerable?

This argument echoes throughout the Western world. It was championed by The Economist this past June and won ground in the Netherlands and Belgium, plus U.S. states of Oregon, Washington, Vermont and - as of yesterday - California.

It's not enough to oppose forms of euthanasia by simply shouting, "All human life is sacred and inviolable". Only pacifists really believe that - the rest of us make exceptions. Even the law has long permitted killing in proportionate self-defence.

Nevertheless, a cogent case can be made against making assisted suicide or voluntary euthanasia legal.

If the law were to allow competent adults absolute autonomy over their own lives, it would have to permit consensual vivisection and killing. In other words, if a person consented to being mutilated and killed the law would have no objection.

In its eyes the individual would be master of their own life. If they choose to spend it in what other people consider a macabre fashion it would be their business and their's alone.

If this sounds just too grotesque to be worth considering, remember the case of Armin Meiwes. In 2004 Meiwes was tried in Germany for mutilating, killing and eating Bernd Brandes. Brandes had consented to Meiwes' actions. According to the judge, "he wanted to get the kick of his life".

Meiwes was convicted of manslaughter. This demonstrates the commitment of German law - as of all traditional Western law - to some concept of the objective value of human life independent of the preferences of individuals.

In spite of his consent Brandes' life had a value that both he and his killer violated, which is why Meiwes was punished. It follows that if any law wishes to uphold the objective value of human life it cannot grant individuals absolute autonomy over their lives.

Surely it could grant limited autonomy? Could it give individuals the right to assistance in suicide or to voluntary euthanasia under strict conditions? It could in principle but probably not in practice. Once we choose to breach the law's absolute prohibition of intentional killing we will then have to decide how to limit permissible killing.

We might well all agree that dying patients whose suffering is unbearable and beyond adequate relief should be eligible for the right to die. But there would still be plenty of room for disagreement among us about when suffering is unbearable and when relief is inadequate.

Some will remind us unbearable and irremediable suffering is not confined to the dying. Why should the chronically ill or disabled be denied the 'benefit' of merciful assistance in suicide or killing?

And some will rightly urge that one doesn't even have to be physically ill to regard life as an intolerable burden. What about the chronically and severely depressed? Don't they also deserve the right to escape misery via death?

This logical and political slippery slope is now evident in Belgium. Two years ago a Brussels doctor legally acceded to a request for a lethal injection by a forty-four year-old. The reason the patient wished to die was a series of unsuccessful sex-change operations. The same doctor had also overseen the legal euthanasia of forty-five year-old congenitally deaf twins who feared they were going blind.

Ethics professor Theo Boer used to be a supporter of legalised assisted suicide and euthanasia in the Netherlands. For nine years he served on a regional committee that reviewed over four thousand cases. Last November he hit the front pages of the press when he went public with his serious doubts about the Dutch experiment.

Assisted suicide started off as a last resort in cases of terminal cancer. It was now being offered as a solution to psychiatric problems or the difficulties caused by ageing. When I spoke with Boer recently, he explained:

The experience of pioneering countries has led me to conclude that a law permitting assisted dying in the long run undermines a society's resolve to prevent suicide in particular, and its respect for human life as an intrinsic value in general.

Weakening the law that currently prohibits intentional killing will tend, logically and politically, to undermine societal commitment to the objective value of human life. This would make for a libertarian society at the expense of a humane or liberal one. If human life loses its value how will human freedom retain it?

Nigel Biggar is Regius Professor of Moral and Pastoral Theology, and Director of the McDonald Centre for Theology, Ethics, and Public Life, at the University of Oxford. He sat on the ethics committee of the Royal College of Physicians (London), and is the author of Aiming to Kill: The Ethics of Suicide and Euthanasia. Follow him on Twitter @NigelBiggar.

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