The right to death

Alan Fox asked me for my thoughts, as an ex-GP, on the question of euthanasia, assisted suicide and whatever. I can probably do no better than to link to the submission I made to the relevant House of Lords Select Committee in 2004. For completeness here’s a link  to the 1982 article I quote there.

Just a couple of additional thoughts. The first is that, despite my submission, the House of Lords Committee agreed with my position that a change in the law would be against the public good, as has every parliamentary committee commissioned to investigate the issue. European Court rulings have also established that there is no such thing as a right to death. In an age ruled by the ethical concept of “autonomy” such judicial caution is noteworthy.

And yet the interesting thing is that the media campaigns continue unabated, and hard cases are always reported by the news as if it were only a matter of time before the old inhumanity gives way to what is “obviously” right. I think this teaches us mostly about how activists have discovered how to change national worldviews by stealth, rather than by any kind of intellectual or political process. It teaches us little about the morality of euthanasia.

My second thought is that Alan raised this issue in the context of pain relief. As my submission shows, this is far from being the core issue in the euthanasia question, but is the “poster child” of the campaign, since severe pain is understood by all of us to be a terrible thing, whereas other issues like “being too unhappy to live” or “being a burden on relatives” are morally more equivocal.

I was fortunate enough to meet Dame Cicely Saunders, founder of the hospice movement, twice at medical school. I started my career, therefore, with a clear idea of the most advanced insights on terminal care. Applying those insights in practice was most often hindered by professionals’ own inability to come to terms with death (basically). Surgeons used to taking radical action to save lives often felt emotionally compelled to distance themselves from their “failures” by tucking them up in a side room with the less-than-effective “Brompton Cocktails” when the pain got too much. There were psychological barriers against actually learning from the hospice movement’s approach.

Opposition also came from nurses – the clinical haematology team of which I was a houseman was, despite my lowly status, happy to initiate my regime of titrated 4-hourly opiates for a poor child dying of leukaemia. But the nurses on the ward, despite careful discussion, proved incapable of overcoming their own aversion to giving “addictive drugs” to a kid.

But times have changed, the hospice movement has burgeoned, and a whole new discipline of pain management has grown out of anaesthetics. Chronic pain teams usually exclude cancer from their remit (for the sake of workload), knowing that the terminal care guys have things pretty well covered. But their insights have filtered out and helped revolutionise the treatment of neuropathic pain, that intractable variety that resists the opiates so helpful in somatic pain.

For example, with the guidance of the pain consultants I became adept at managing neuropathic pain with drugs in the back clinic I ran during my last two years, and helped spread the methodology to GPs in the district served by the clinic. Terminal care doctors attended the same masterclasses as myself. The net result is that the management of pain has never, ever, been better and is advancing all the time. Bearing in mind that two centuries ago laudanum was all there was, the noteworthy thing is that whilst nobody then argued for euthanasia, pressure for it has increased in direct proportion to the effectiveness of pain treatment. That is evidence, to me, that it is the superficial appeal of the essentially unworkable liberal establishment’s dogma of moral autonomy, rather than pressing clinical need, which is driving the whole show.

Lastly, the hospice movement has shown beyond doubt that “bad death” has to do more with fear and ignorance than with symptoms. Making the time to engage with dying people, as people, can make their last days times of emotional healing, family bonding and completion. I met many people who learned what it is to be human when they were dying. I myself certainly learned much about life from the mystery of death. And it is a mystery, as I found when I led the funerals of my own family members – never have I seen ordinary people more serious about life.

I’ve not alluded much to theology, but it’s lurking behind a lot of what I’ve said here. The hospice movement was rooted in a profound spiritual truth, and was responding to a fear of death that arises from the same source. The ethical dilemmas for doctors, too, silently have the same unspoken assumption. And my own thought and practice has been acutely conscious of it. And that truth is that we are created in the image of God who gave us life, and will have to give an account of every human life taken to him.

Jon Garvey

About Jon Garvey

Training in medicine (which was my career), social psychology and theology. Interests in most things, but especially the science-faith interface. The rest of my time, though, is spent writing, playing and recording music.
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44 Responses to The right to death

  1. Alan Fox says:

    Thank-you for this, Jon. I’ve printed it off together with your submission. I will not pick up on abortion as I regard that as a separate issue, which, being male, I don’t feel I have the right to pontificate on. It may take me a little while to comment in depth. Just one question. Are you aware of Eric MacDonald, ex Anglican priest and his blog, Choice in Dying?

  2. Jon Garvey Jon Garvey says:

    “Are you aware…”

    To be honest, John, after 40 years defending Hippocratic ethics, I’m pleased to pass that baton on to others now.

    I wouldn’t want to extend the discussion to abortion either – it just seemed a relevant consideration in that submission. But I’m intrigued to know where the limits of participation in discussions on morality are. If only women can join the discussion on abortion, should that exclude women who’ve not had unwanted pregnancies? Do abortionists have nothing to contribute? Or a male who’d survived a late abortion?

    In the euthanasia debate, it would seem necessary to leave legislation in the hands of those who’d actually looked after terminally ill relatives incapable of decision making. Are only children qualified to comment on child abuse?

    Actually in every other species of ethical deliberation, it’s common humanity coupled with wisdom that is the criterion, and I’m not sure why that should be overturned in particular cases.

  3. Alan Fox says:

    Or a male who’d survived a late abortion?

    I’ll demonstrate how unqualified someone can be on a subject by breaking my own rule! Here in France, the “morning-after” pill is available without prescription and free to minors. Along with better health education and contraceptive advice, I would hope that late abortion could become an intervention necessary only when the life of the mother is threatened. I see 90% of TOPs are carried out before the 13th week in UK and abortion on demand in France is available only until the12th week. There is no compulsion for anyone to carry out an abortion against their conscience and I fail to see how the right of a woman to terminate an unwanted pregnancy before the foetus is sentient can be limited by moral objections from third parties.

  4. Alan Fox says:

    As in abortion, so in euthanasia, the devil is in the detail. It is very straightforward to adopt the moral stance that all human life, potential or on the brink of death, is sacred. Progressing from that to a “slippery slope” argument where the legitimate rights of individuals to make decisions only about their own lives are brushed aside via the simplistic world view does not convince me. This is why it so important to me that government and legislation should be secular

    Our personal decisions, when they do not impinge on the rights of others, should be respected. The judicious use of opiates as death approaches, in my experience (my grandfather, father, wife’s grandfather, George V -though this one was arguably murder) seems a routine that is quietly adopted on a regular basis. I am surprised your experience of hastening death with large morphine doses was so limited.

    At the very least, an honest and open discussion is called for, rather than the lofty approach of George V’s physician, who ensured he died at a time when it could be reported in the more sober morning papers rather than the scurrilous evening press.

  5. Jon Garvey Jon Garvey says:

    Alan

    Your comments about both abortion and euthanasia are interesting, because we do have a secular government and legislation, which have decided (repeatedly) that the first case should be subject to the strict medical regulation of an otherwise illegal act, rather than being associated with a right to terminate an unwanted pregnancy. And that in the second case the individual has no right to decide that another shall end their life. Perhaps we need a less secular, more ideologically pure, government to enshrine these rights?

    It’s questionable whether the “straightforward” stance of complete moral autonomy is any less simplistic, or less ideological, than the sanctity of life argument. It is certainly more open to abuse – my submission was not speaking in vain about the emotional pressure brought to bear on pregnant teenagers to terminate.

    Example 1 (not unique): a mother well known to me comes in with contraceptively delinquent pregnant daughter. Usual long discussion about issues, and usual opportunity given (and accepted) to discuss at length with specialist counsellor before final decision (organisation set up partly by me, became respected enough to be used by local DGH until it was bypassed by the PCT). They leave. I’m half an hour late. Mother returns to say, “Thanks so much for taking it seriously – I’ve never told anyone about the abortion I had when I was her age. There isn’t a day when I haven’t regretted it and wondered what that baby would be like now.”

    I didn’t say, “Well, you exercised your legitimate right to choose, so don’t come back with your simplistic moral regrets now.” Though I did have patients who had had almost that response from their doctors. That’s the common reality.

    The commercial clinic that took on our PCT’s terminations had a stance that was simplicity itself: ask and you shall receive. Their counselling was next to non-existent, and consisted of reassurance that it was certainly for the best. I’ve done too many hundreds of hours with real patients to respond well to “simplistic.”

  6. Alan Fox says:

    Perhaps we need a less secular, more ideologically pure, government to enshrine these rights?

    I see things differently. The main cause of human strife and misery seems to be the fanaticism that often follows from ideological purity. Leo Igwe describes consequences of religiously inspired bigotry that is happening today in Africa.

  7. Jon Garvey Jon Garvey says:

    I think your irony detector was off, Alan. I was pointing to the fact that a secular, non-ideologically pure government has so far agreed that euthanasia is a bad idea.

    Now if that changes, and euthanasis becomes legitimized, the question will be why. Moral viewpoints only change because of changing worldviews, which encompass changing ideologies. It will therefore be an ideologically more pure government that can shift the consensus away from the existing viewpoint to a new one that favours euthanasia.

    It’s an ideological stance, for example, that can make any connection whatsoever between the phenomenon of witch-hunts in Africa inspired by syncretistic fusions of traditional beliefs with imported western religion, and the ethical arguments in Britain against euthanasia.

    You might as well argue that there is connection between Hitler’s introduction of euthanasia in medicine in the 1930s as a first step towards a wholesale eugenics policy, and the pro-euthanasia campaign in Britain today. Come to think of it though, I read an article about that once in the “Ethics and Medicine” journal… here’s a link to a similar one (the E&M isn’t online) http://www.bordeninstitute.army.mil/published_volumes/ethicsvol2/ethics-ch-14.pdf

  8. Alan Fox says:

    I was pointing to the fact that a secular, non-ideologically pure government has so far agreed that euthanasia is a bad idea.

    Excuse my lack of irony appreciation but are you referring to the UK government? Not sure if ‘secular’ is an accurate description.

    With regard to euthanasia, there appears to be a rather fuzzy line between what is legal and what is not. My anecdotal experience is that medically assisted suicide (in one case, in particular, it could be described as involuntary) is available “on the quiet” from sympathetic health professionals. I am still unsure what your position is. Do you regard the maintaining of life in all circumstances as unquestionably right? Can anyone rightly make a prior personal request that they not be resuscitated nor receive medical attention that only prolongs existence without chance of recovery? Does the religious belief that all life is sacred trump the personal wish of one individual to have some choice about the manner of their death when they are terminally ill?

    You mention Hitler and eugenics. Strangely, on a somewhat random path of links while surfing on another subject, Harold Shipman (would clear legislation on assisted dying have hindered or helped him?) I came across this paper which makes harrowing reading. It struck me that the Nazi régime apparently had no difficulty in recruiting medical personnel.

  9. Alan Fox says:

    By the way, I don’t object to the appellation ‘ideologue’. Ideology is not the problem per se. Enforcement of one ideology which results in the oppression of minorities is the issue.

    Just going back to abortion for a moment. I made a distinction between early and late termination and suggested that it should be a goal to eliminate late abortions except where the life of the mother is threatened. Are you opposed to abortion ideologically or do you see a distinction, say, before 12 weeks?

  10. Alan Fox says:

    Not so random!

    I had a few pages open and I must have gone back to the page you linked in the middle of following other links (I have a slow internet connection), forgetting where I originally got it from. So thanks for the link, Jon!

  11. Jon Garvey Jon Garvey says:

    “With regard to euthanasia, there appears to be a rather fuzzy line between what is legal and what is not.”

    Not at all. Just as there’s no fuzzy legal area on VAT regulations. If medical practitioners take the law into their own hands, they are breaking the law. GMC guidelines concur. We do, of course, live in a society of ethical diversity even as regards keeping laws we disagree with, as well as the ethical issues themselves. My own position should be clear already.

    “Involuntary medically assisted suicide” (if that’s a right interpretation of your anecdotal experience) rather makes the point for a slippery slope. As does the less anecdotal information about the experience of involuntary euthanasia in Holland following liberalisation.

    The Nazi episode has some very serious, if indirect, lessons to teach. As that paper shows, the profession was deeply influenced by social darwinist eugenics (not surprising if you read almost any early German evolutionary literature from Haeckel onwards*) which for all the reasons in the article morphed into a support for (and guding of!!) the Nazi agenda. There are occasional scientists still hinting at eugenics, but it’s pretty unknown in the medical profession, so we won’t see a replay of the German scenario.

    What is a danger, though, in my view, is what started off the German medical slide – the sidelining of the Hippocratic tradition (as assimilated into the Western Christian medical tradition). I saw that begin in my career, very clearly in the abortion business, but more subtly in the subordination of the 1-1 doctor-patient relationship to the demands of “the good of society” and via that to societal economics and the elevation of management considerations over the direct good of the person in front of you.

    The Nazi experience shows that it’s harder than you’d expect to keep an ethical medical profession intact.

    * I did a piece on that at: http://potiphar.jongarvey.co.uk/2011/11/23/the-river-of-ideas/

  12. Jon Garvey Jon Garvey says:

    “Just going back to abortion for a moment…”

    Yes, there’s a clear, but not absolute, difference in late abortion, akin to those ethical dillemmas about whether it’s better to knock over an old man or a young mum. The first clause of the 1967 was “risk to the life of the mother”, which is commonsense, but rarely invoked.

    But not everyone sees a distinction, because there are different opinions on what constitutes humanity, sentience, life etc, and it’s always a flexible continuum if “human life” is not the sole definition. I can’t remember the details now, but only this year an ethicist was seriously suggesting that, since we abort on grounds of abnormality up till birth, there was no ethical reason not to resort to infanticide where that fails. He has a point, of course, if “informed consent” becomes the criterion.

    A baby has no rational will to live, so the greater rights of the parents or of society can be argued, provided the child were despatched humanely – and that would be guaranteed by your doctor doing the deed.

    One of my personal anecdotes in that vein was the Methodist mother who came back to show off her second baby after she’d moved away – I’d managed the first baby and most of the second pregnancy. And they were slightly tricky, because she was wheelchair bound with spina bifida, though her husband and she managed fine. The situation only arose because she was born some years before they introduced routine screening and counselling for spina bif. “That kind of thing” doesn’t happen now, which must be an odd feeling for “someone like her.”

    Ah – here’s the reference: http://www.telegraph.co.uk/health/healthnews/9113394/Killing-babies-no-different-from-abortion-experts-say.html

    Oh yes – Shipman… since his game appears to have been a form of megalomania, he’d have felt challenged to evade any system in place, and would have succeeded: I was told by colleagues who knew him he was a very good doctor.

  13. Alan Fox says:

    …akin to those ethical dillemmas about whether it’s better to knock over an old man or a young mum.

    That”s a bit of a stretch. I recall an exchange with Vincent Torley where I said I wouldn’t want to share a lifeboat with him and a newborn. Do you really claim there is complete equivalence between an adult human and an embryo of 12 weeks? What about a newly formed human zygote? I often see it said that 30% of conceptions may not result in pregnancy.

  14. Alan Fox says:

    Not at all. Just as there’s no fuzzy legal area on VAT regulations. If medical practitioners take the law into their own hands, they are breaking the law.

    Well, that’s the precise issue that I would like to see clarified, with doctors and others being indemnified against charges of breaking the law by, for example, living wills. I don’t want to involve my family in ethical arguments with doctors. I’d like to make a clear declaration now that could be available at the appropriate time.

  15. Jon Garvey Jon Garvey says:

    “That’s a bit of a stretch.”

    Now, I said there’s a clear, but not absolute difference. You interpret that as my saying there’s complete equivalence between an adult and a 12 week embryo.

    Flip that on its head: let’s say there’s not only a clear, but an absolute difference. So an adult is a human, a 12 week embryo is not.

    Which position is more nuanced?

    Your “30% of conceptions” is amusing because only yesterday I quoted it to Roger Sawtelle on BioLogos as a common example of a spurious argument. In many countries (and this country only a century or two ago) many more than 30% of children did not survive to adulthood. What does that teach us about the moral status of children? (Clue – nothing).

  16. Jon Garvey Jon Garvey says:

    “Well, that’s the precise issue that I would like to see clarified.”

    No – you don’t want it clarified, because it’s clear already. You want it changed.

    Once you’ve indemnified the doctors, what do you about those whose own moral autonomy disallows them from taking life (and remember my submission, in which 2/3% of doctors didn’t want the law changed, and those who did would not necessarily want to be involved themselves)? They must, of course, be forbidden from entering into ethical arguments with patients, so it will be necessary to compel them, as in the abortion situation, to refer to a colleague (as per my 1982 article!).

    But that, of course, puts unnecessary pressure on the patient and relatives, who are being unfairly made, by virtue of the change of doctors, to see an ethical dilemma where they don’t. So perhaps it would be best for all if those with conscientious objections were not involved in certain branches of medicine, ie those in which patients ever die.

  17. Alan Fox says:

    You want it changed.

    I thought about this a bit. Is it possible to have a society that achieves the ideal balance between personal choice and personal responsibility? I”ll try reading your mind and suggest, for you, as a committed Christian, the answers are easy, just look in the Book. I’m still convinced that government should be disinterested in world views and its job (apart from roads and the aqueduct) should be to ensure fairness to all citizens, regardless of personal beliefs or lack of them.

  18. Jon Garvey Jon Garvey says:

    “Is it possible to have a society that achieves the ideal balance between personal choice and personal responsibility?”

    I don’t think so, though it’s the target around which good societies revolve endlessly! The idea of the government with a disinterested world view is the quest for the “view from nowhere” (God’s view, in philosophy). The nearest to that any individual gets is apathy, and those who think they’re nearest are bigots (“I am objective, you are subjective”).

    What approaches closest to the ideal in government is the resolution of the opposing views of interested rather than disinterested individuals into a workable consensus. So the debate we’ve been having, were we in government, is what will inevitably happen, inevitably be unstable, and inevitably be messy.

    As it happens, a significant part of what “the Book” says to Christians is to give due respect to governing authorities, refusing only what forces one against conscience. But in a democracy, of course, there is an additional duty and right to lobby for what you believe is the greatest good.

    However it pans out, freedoms will be limited. Clearly there is no room for part of society to operate under Nazi racial purity rules and part under liberal democracy. But the decisions made will affect the global worldview of society – Hitler’s “reforms” rapidly changed the unthinkable into the normal. If he’d won the war, those Oxford ethicists would have been unremarkable in equating newborns ethically with zygotes.

    Again, we clearly can’t have a society in which it’s both legal to commit infanticide and illegal to murder a baby. Assuming that we’d agree the former to be unacceptable (or if not that, then Hitler’s ethics), what is the moral process that will prevent their logic becoming thinkable, then acceptable, then inevitable?

    When I was writing in the most iconoclastic medical journal of the 80s (World Medicine) there was ONE doctor alone who lobbied for euthanasia (called himself a Christian, as it happens). So opinion has changed greatly since and bills are before parliament repeatedly. If opinion did move towards infanticide (the commonest Roman contraceptive method, opposed only by Jews and Christians, which is why it’s unthinkable today) would one be wrong to resist the trend?

  19. Alan Fox says:

    Disinterested secularism should ensure that all bigots are kept within the law. No-one should legislate against private thought. “I have no desire to make windows into mens souls.”

    I heartily agree that birth control by infanticide should be unthinkable, although there are still tragic cases apparently due to post natal depression. We can and have learnt a lot from the Romans. We might call it progress. Can we learn to adapt religious dogma?

    Leave a Reply

  20. Jon Garvey Jon Garvey says:

    Alan, you’ve missed the point about infanticide. It was unexceptionable, from the Roman point of view (that is, not only the Powers, but the people). As was euthansia, performed by your local doctor as a technician at your command (for a fee) – the grounds being decided by your own choice (eg being cught in a public scandal). Both arose naturally from the Roman view of life. As, presumably, did public immolation at the games.

    The Jews were the exception, because the sixth commandment was non-negotiable. That’s one reason their population growth outstripped the average. The Christians inherited this as axiomatic, their argument being exemplified by Tertullian around 180:

    “How many, think you, of those crowding around and gaping for Christian blood, – how many even of your rulers, notable for their justice to you and for their severe measures against us, may I charge in their own consciences with the sin of putting their offspring to death? …In our case, murder being once for all forbidden, we may not destroy even the foetus in the womb, while as yet the human being derives blood from other parts of the body for its sustenance. To hinder a birth is merely a speedier man-killing; nor does it matter whether you take away a life that is born, or destroy one that is coming to the birth. That is a man which is going to be one; you have the fruit already in its seed.” [Tertullian, Apologeticus, I.9, c200].

    That view prevailed because Christianity prevailed, but not in a vacuum – it was because accepting Christianity gave the sole rationale for changing the existing attitude to taking infant life. What progressed was not “dogma”, but worldview, and no ethics are self-evident apart from worldview. If ones worldview changes, every ethical change to match it will appear to be “progress”.

    Issues of doing evil because of mental incapaciuty are, of course, tangential to the discussion – though of course one presupposes a worldview that regards such incapacity as pitiable rather than punishable. What rationale is there for that?

  21. Alan Fox says:

    Not sure what point I missed, Jon. I was assuming that you agree that infanticide ought to be unthinkable. I am aware that infanticide was routine in some areas of Roman life. I recall the discovery of a graveyard consisting almost entirely of neonatal infants associated with what was most likely a brothel serving soldiers posted to Hadrian’s wall.

    Maybe we are talking past each other to some extent. I am getting the hint of a sub-text that suggests that atheists cannot be moral because they have abandoned the basis for moral behaviour. I suggest atheists are perfectly capable of being pragmatic. Any kind of moral order is preferable to anarchy. Modern liberal Christianity is a reasonable common ground to continue to build a society on, pro tem.

  22. Jon Garvey Jon Garvey says:

    Alan

    I wan’t having a dig at atheists, but just pointing out that the Romans had a basis for their moral order that was different from that for ours. I didn’t pick up from your previous comments that your only guiding priniciple for moral order is what is pragmatic.

    It’s the basis of the “oughtness” in your first sentence that I’m probing. You reply “modern liberal Christianity”, which is interestingly vague. Do I detect some kind of Kantian ethic?

  23. Alan Fox says:

    You reply “modern liberal Christianity”, which is interestingly vague.

    Do you mean my reply or “modern liberal Christianity”? If the latter, well of course! No hard choices for me!

    Seriously, I remarked before that Jefferson was on the right track with his bible. You don’t have to throw out the baby with the bath water. You can take the best elements and adapt them to a modern context. You don’t need to be hide-bound by ancient dogma.

    I am sure it is clear that I am no philosopher but quickly checking my “Philosophy for Dummies” it seem Kant agrees with me! If I read it right, Kant’s moral imperative, deriving moral restraints by analysing the consequences of actions by proposing them as universal laws and discarding the irrational while keeping the rational, seems to boil down to the Golden rule.

  24. Alan Fox says:

    I see Jerry Coyne has a thread on the issue.

  25. Alan Fox says:

    Guardian article on two active cases.

  26. Jon Garvey Jon Garvey says:

    Alan

    I meant the “MLC”. I’m not sure society benefits from interestingly vague ethics!

    I think you’re about right on Kant (your Dummies concur with my Roger Scruton). It seems to me (inasmuch as I’ve thought about it at all) that the Kantian approach is more dependent on the European tradition than he’d admit – it too, depends unconsciously on his version of modern liberal Christianity.

    As Scruton says (the page after I’ve got to in reading him, so I’ve not developed my thought enough to discuss usefully): “The weakness of the Kantian theory lies in the claim that reason is sufficient in itself to provide a motive for action. Hegel tried to supply the missing link… by showing how the rational being is constrained by the categorical imperative. But the story is obscure at best…”

    In real life I’ve been persuaded for decades that as the MLC basis declines in significance, the self-evident nature of rational morality becomes undermined. The extreme “scientific” ideologies of left and right in the last century exemplify where that can lead – it becomes rational to liquidate the kulaks or burn the kids alive in the death camps. How that happens is another matter, but I got some glimmerings of insight reading Solzhenitsyn. It’s a process Os Guinness called “The striptease of humanism.”

    Maybe we should return to this when I’ve finished Scruton!

  27. Jon Garvey Jon Garvey says:

    Postscript – Alan, though you may castigate Ed Feser on being no true atheist in his youth, he has written a very useful critique of libertarian morality, incorporating Kant, here: http://www.edwardfeser.com/unpublishedpapers/libertarianimpartiality.html

  28. Jon Garvey Jon Garvey says:

    Post postscript

    Alan, I’ve left your phrase “religious dogma” unmolested up to now, but I really ought to point out that what that actually means in this context is the flowering of Greek ethical philosophy in the last few centuries BC, that passed to, and was augmented by, Christian scholarship in the West up to the 5th century, and in the Eastern empire up until its eclipse by the Muslim expansion around 1000 AD, and thereafter the solid work of the western universities across Europe in both ethical philosophy and law for getting on for 900 years, before the Enlightenment jettisoned it all and decided it alone could reason.

    “Dogma” doesn’t seem to cover that process very adequately.

  29. Alan Fox says:

    When I used the word “dogma”, I was thinking of dogmatism as an unrealistic adherence to old myths in the face of facts and evidence. I delved into “Philosophy for Dummies” again, to check whether I might be a pragmatist. logical positivist or empiricist. Perhaps existentialism is a better fit for my personal philosophy.

    Thanks for the link to that article. I tried reading it but it’s a sit too warm here at the moment to concentrate! I do wish writers would consider their audience and make more of an effort at brevity.

    Back to topic. do you have any thoughts on the Tony Nicklinson case? He seems to be asking for an exceptional prior indemnification for a helper, not a blanket change in the law.

  30. Alan Fox says:

    bit not sit! And S is nowhere near B on my azerty keyboard!

  31. Alan Fox says:

    I just noticed I messed up that link to Jerry Coyne’s blog

    Coyne on assisted suicide

  32. Jon Garvey Jon Garvey says:

    Ah it is warm in the south of France in August! My daughter was in Toulouse for a year. At some stage I must recite you the poem I wrote about the town.

    I’ve not followed the Nicklinson case closely (as I said I’ve tried to retire from medical ethics), but there was an interesting twist on the radio today. A specialist in locked-in syndrome was saying that a survey of locked-in patients revealed they gave a generally higher score for quality of life even than average members of the public, which was a surprise. Of course she sympathised with Mr Nicklinson’s plight, with which she’s clearly more than usually familiar. She also mentioned that health staff involved rated LIS sufferers’ quality of life much lower than the patients themselves do.

    This raises some interesting ethical issues. If someone’s reaction to a medical situation is untypical, what are the ethics? Perhaps the wish to die is the result of depression in a particular case – would one regard depression as a valid reason for assisted suicide (it’s happened in Holland). It may change, even if the underlying condition doesn’t, and the person become happy.

    Would one grant a blanket right to assisted suicide on the simple basis that someone wishes to die, if a condition itself usually does not produce the wish to die? For example, someone healthy may wish to die becaused they’re tired of life, and be physically capable of suicide, but prefer a medical person to take responsibility for the act. If not, what are the objective criteria the law must follow?

    Are medical staff in any way qualified to make decisions for those who can’t communicate, since it seems they rate the sufferers’ lives lower than the sufferers do?

    You should write to Ed Feser and tell him hot climates demand short philosophy. I suspect he’d remind you where Aristotle lived!

  33. Alan Fox says:

    My cousin, now 68, was divorced from his first wife and subsequently lived with a woman who had two grown-up sons. My wife became friendly with her and they exchanged confidences. Her younger son got married to a very pleasant young woman and in due course they had a child, a boy. In 1999, he worked for a computer services firm that had a niche market in anticipating “millennium bug” problems for various computer systems in the public health sector. At the time, there was huge pressure to meet deadlines and I was told later he had a very demanding boss. One day, he went missing. He walked in front of a train. My wife told me later that is mother had told her she feared her son was getting depressed and she was really ashamed that mental illness had appeared in her family. She made my wife promise not to discuss her son’s depression with me. To both our subsequent deep regret, she complied. I don’t know what I could have done but I still feel guilty that I never got the opportunity to do anything that might have prevented such a needless tragedy.

    I do understand that not all suicides are personal choices that must be respected in all circumstances.

  34. Jon Garvey Jon Garvey says:

    A sad story indeed. Depression is a dreadful illness made worse by unaccountably persistent prejudices: shame in families, macho callousness in employers. That at least was one area in which one could fight for patients as a GP – especially in relation to the police force, for whom I did occupational health.

    I don’t know if the stigma is improving, or if it has to be fought for again in each generation – it’s not as if melancholia wasn’t well-known for at least 300 years as a condition to be pitied, not blamed.

  35. Jon Garvey Jon Garvey says:

    Alan – it looks like we’re both wrong about the path to better ethics: this is the way to build a moral society: http://www.telegraph.co.uk/science/science-news/9480372/Genetically-engineering-ethical-babies-is-a-moral-obligation-says-Oxford-professor.html

  36. Alan Fox says:

    Professor Savulescu is probably harmless unless he moves from academia into politics!

    I see Tony Nicklinson will have to resort to starvation as a solution.

  37. Alan Fox says:

    A quick search found this from 1995.

  38. Jon Garvey Jon Garvey says:

    Alan

    A sad case all round. As the court said. I’ve been looking at some of the surrounding news coverage.

    I gather Mrs N concurs with Tony’s wishes, but would feel unable to raise a hand against him herself: so her wish is for someone else (in the medical profession) to overcome any scruples of their own – on the face of it an issue for the physician’s autonomy more than hers.

    The news also said they’d turned down somebody’s offer of a trip to Dignitas. Maybe they fear prosecution – or maybe that’s another choice issue. The coverage didn’t make it clear.

    The BMA spokesman reiterated the fact that most of his profession don’t want a change in the law because they are committed to saving life, ameliorating suffering where possible, comforting where not (the Hippocratic tradition) rather than taking life. A change in the law for the profession, then, has issues not only for doctors’ autonomy, but for their professional ethic.

    No doubt the Nicklinsons could find (or have found) a doctor whose personal ethics would differ from the BMA line. But that, of course, would create public doubt about what medical ethics actually are – do they apply to the whole professional body, or might my doctor prefer to operate on his own code? What does that mean for me or my relatives? That’s a real issue from the evidence of this thread, which started with your common but erroneous assumption that most doctors have plenty of experience of easing their tricky patients on their way surreptitiously. You’d be surprised how much low-level suspicion the Shipman case caused even amongst my patients.

    Finally, as is usual in such cases, much more time was spent by the news in portraying the family’s emotional response to the court decision than in examining the ethical and legal reasoning behind it, or even airing alternative arguments. Maybe that was accidental.

  39. Alan Fox says:

    Listening to Nicklinson’s daughter interviewed on TV, I understood her to say her father was adamant in not putting anyone else at risk of prosecution for helping him commit suicide.

    I still wonder why there is not some way of giving specific immunity in individual circumstances. No law changes necessary. Immunity from prosecution is a well-known concept and already in use.

    Regarding media sensationalism; it sells papers and air-time. What can you do?

  40. Alan Fox says:

    In fact, weren’t some guidlines issued to the UK CPS redarding those helping relatives get to Dignitas?

  41. Jon Garvey Jon Garvey says:

    Bottom line – at some stage someone’s freedom is going to be limited by the law. Press sensationalsism has had its own few months in the sun regarding their assertion that they ought to have the freedom to hack people’s lives so that the public can have the freedom to snoop!

  42. Alan Fox says:

    I’m struggling to think of a law that doesn’t function by limiting someone’s freedom!

    So, do you think a specific one-situation immunity is worth considering?

  43. Jon Garvey Jon Garvey says:

    Well, I’m not a legal mind any more than a medical ethicist or a philosopher. But it strikes me that immunity from prosecution requires establishing some principle (a) for the legislation in the first place and (b) for the waiving of the legislation.

    From experience, I know that “judging each situation on its merits” (aka situation ethics), whatever its lofty merits or faults, in practice ends up meaning being swayed by factors other than justice, even when based (as in the original situation ethics) on the principle of love. But the criminal law of a pluralistic society needs something more testable.

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