EUTHANASIA - THE WAY AHEAD ?
APRIL 15th 2000
It is commonly supposed that euthanasia - be it voluntary, presumed voluntary or otherwise - is best presented as a solution to a problem; procured death is seen as a solution to the problem of the terminally hopeless and insufferable life.
This formulation is clearly vulnerable to assault on two fronts: it may be claimed that the problem is not so very serious and/or it might be claimed that the solution is worse than the problem ('the cure is worse than the disease' - thus, allegedly, identifying death as the ultimate cure for the ultimate disease that consists in a life no longer worth living).
The first assault can be to note that new analgesic medicines are so much more effectual than the former ones. There is a great deal of force in this assault and, given more pharmacological progress, the prospects for relatively painless terminal lives will improve.
The second assault can be to note that people living scarcely bearable lives without significant hope of improvement are open to be 'leaned on' by selfishly interested parties. ("Grandma, why not end it all; that would suit you and us too?"). There is some considerable force in this assault - the more so since family and other loyalties are perhaps (or so it is said) weaker than once they were. Moreover, if adequate hospices for the terminally distressed were generally available then the onerous burden of caring for Grandma might be lifted from the family - most especially from female members who are all too easily cornered into being the presumed carers.
The thesis presented in this essay is that there is, quite irrespective of the problem/solution approach, a great deal to be said for viewing voluntary euthanasia as a naturally laudable undertaking.
Unpacking this complex subject, we might make several general points:
1) There is such a thing as a life not worth living. The exact opposite of this - "that there is no such thing as a life not worth living" - was stated in a letter from a Catholic theologian to the press some years ago.
It is a matter of simple logic that the truth of an absolute statement can be discounted by just one authentic counter example; one pinprck will burst a balloon; the balloon is not burst the more thoroughly by any additional pinpricks.
It happens - and here I write from direct personal experience - that since 1975 I have been dependent upon a cardiac pacemaker. My natural pulse rate was then high enough to sustain normal life - but only on condition that I avoided major physical exertion. If I did exert myself, beyond a certain level, then, unlike other people's, my pulse rate did not increase; I simply fainted and, after a few minutes, regained consciousness. A pacemaker set to beat at a reasonable rate, and subsequently set to be demand-responsive, solved the problem. As a friend said of me, "Eric is a bionic man."
Periodically I go to the cardiologists to have my pacemaker tested and, if need be, replaced (I am now on my sixth installation). One of the tests is to switch the thing off, for a few moments, by remote control. The last time this happened, my pulse rate fell to about twenty-two or so. In those circumstances I was unable even to raise my head without fainting. I can say, quite categorically, that were I condemned to an ongoing pulse rate of twenty-odd then life would indeed be not worth living. I've been there, I've felt it and I know .... and all the theologians in the world could not persuade me otherwise.
So the first general point is that a life can be not worth living and that, in other words, survival, without hope of achieving anything but survival, is of no value.
We cannot escape from recognising the reality of that elusive thing called 'quality of life'.
2) A satisfactory quality of life is one in which you relate reciprocally with other persons to mutual advantage; quality of life consists in enhancing the lives of others at the same time as their enhancing yours.
3) It seems to me to be the case that the chance of dying at just the right time - be it by illness accident, suicide, murder or whatever - is very slight. The probabilities are that, in relation to deteriorating quality of life, you are likely to die either too soon or too late. 'Too soon' would be the case if people could say, honestly, that 'he or she had a few more months of good quality life in prospect'. In contrast, 'too late' would be the case if people could say, honestly, that 'he or she might as well have died a few months sooner for all the good these last few months of life have been - to anybody'.
4) So the issue for each of us boils down to .... would I prefer to die a little too soon rather than too late? My own answer is 'a little too soon, please'.
5) We now come to the meaning of the word euthanasia. The accepted meaning connotes 'a good death' and it seems to me that achieving a good death is as worthy an aim as achieving satisfactory friendships, marriage, parenthood, work and leisure, health and all the other things that we might wish to achieve satisfactorily.
So when I judge that I am in near danger of 'dying too late' in respect of quality of life ..... then is the time to call a party, of people dear to me, say my farewells and ask them to leave me in peace with the plastic bag, the Scotch and the barbiturates. They all might then, if so moved, not so much bewail my death as celebrate the fact that I had ever lived at all.
Of course it is often easy to identify what might be thought right action but it is often vastly more difficult actually to do it. I have no illusions as to my own guts and integrity in regard to an act of voluntary euthanasia as sketched above.
What I am doing in this article is not, so much, making promises about my last acts but, rather, personalising a desirable cultural shift from the 'problem/solution' view of euthanasia to a 'good death' view of it.
There is still a great deal of hard political graft needed at the 'problem/solution' level.
POST SCRIPT
There has arisen recently a significant case of possibly lawful euthanasia in the UK. The infamous child-murderer, Ian Brady serving a whole-life sentence for a series of horrible crimes some thirty years ago, has attempted to kill himself in prison by means of hunger strike. He was being fed forcibly by the prison staff and he took legal action to secure his right to die. He claimed the right to insist upon the forcible feeding being discontinued. The court ruled against him; his right to die was denied in law.
Irrespective of the ethics of this ruling, we have to assume that the court was identifying accurately the current state of British law in this matter. That is what courts are for.
This remarkable affair raises particularly sharply the question of people's control over their own ongoing survival. Surely Brady has a natural right to end what has long been a life burdensome to him. Had he been out of prison, he could undoubtedly have committed suicide; why on earth should he not be allowed to do so in prison? That seems, on the face of it, to be a quite simple question to answer - of course he should have that right. He was condemned to life imprisonment - not to involuntary survival.
But the problem of people being 'leaned upon' to end their lives - a problem thought to be real enough outside of prison - is particularly pressing for prisoners.
A prisoner's right to suicide (if such were enshrined in law) would be carte blanche for prison staff and fellow prisoners, who wanted to procure the death of a prisoner, to make his life so insufferable that he would be driven to exercise that hypothetical legal right. We would be allowing prison staff and fellow prisoners to do what no court in the land can do - actually to condemn a person to death.
Readers' comments, on this question of Brady's claimed right to starve himself, would be especially welcome.
E.S.
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