A shift in tack today, prompted by the UK parliament’s current discussions on the euphemistic “assisted suicide” (meaning your doctor is ordered to kill you). I’ve actually lost count of the number of times this has been debated nationally. Certainly I made a submission to the House of Lords Select Committee in 2004, and during a previous incarnation of the bill I discussed the matter with my MP Simon Burns, then the Shadow Minister for Health (and later the real one), whose opinion was that there was no significant support at all for such a move in Parliament.
But however often Parliament or the British Medical Association rejects euthanasia, it keeps on turning up again – and here’s the interesting thing – each time it’s a little stronger than before. Today, I see, the bill’s proposer is determined he will eventually succeeed:
Lord Joffe, who has led the campaign for reform, says he will prevail however long it takes.
And I suppose he’s right, given the examples of ethical and legal change in abortion, redefining marriage, the acceptability of low wages and obscenly wealthy bosses and so on over the years.
Incidentally, did you notice that word weasel-word “reform” in the Independent’s article? To reform is to return something to its pristine or intended state when it has become corrupted. When was euthanasia last an ideal in British society? When the Druids were in charge, maybe?
The main interest, to me, lies in comparing this to the debates held with “skeptics” about moral absolutes. Most atheist participants in such discussions display an odd dysjunction between their stated belief that morality is either just programmed in by evolution, or that it is a matter of personal choice; and their personal convictions that certain things are absolutely wrong (like God creating suffering, Israelites killing Canaanites, or Christians opposing abortion). Linked to this is usually the claim that non-religious people are every bit as moral as religious (more so, in fact), morality being, as was said, something to do with evolutionary altruism having selective value for the individual.
Morality then, to these guys, is a biological given, which either correlates with, or is trumped by (as in Richard Dawkins’s “we can beat the genes” humanism), dispassionate scientific reason. Torturing babies (or any other less cartoonish wrong, such as killing whales, refusing to make cakes for gay weddings, etc) have always been wrong, and will appear so once biology is given free-reign and/or reason is properly applied. Religious moral foundations are an epiphenomenon, and a distraction.
That makes the recent “evolution” of ethical and legal changes like euthanasia hard to comprehend. There’s no doubt thinking has changed – but not under the influence of any fundamentally new ethical insights, nor any scientific or personal knowledge we haven’t possessed since the stone age. In 1982 I wrote a piece for my column in World Medicine (From WM’s correspondence pages) in which I suggested a slippery slope from abortion to doctors being co-opted into forced euthanasia of the vulnerable. The correpondence mostly poo-pooed the very possibility of even the first, “assisted dying”, stage. Indeed, at that time there was only one British doctor, a Dr Henderson, openly advocating euthanasia in the medical press.
Now if we ignore the moral philosophy of ancient times, and restrict ourseleves to the debates in the British Parliament, informed by consultations from academic bodies and folks like me, what is it that makes a vast majority in 1982 say, “Euthanasia is clearly wrong” and an increasing number, probably at some stage soon a majority, say “Euthanasia is clearly right”? These are, after all, discussions at the highest academic levels, not the changing face of cant down at the pub.
Is there any evidence that the rationality of the British establishment has increased over the years? Is there any evidence that human qualities like compassion have been invented since the eighties? Has there, perhaps, been a sudden burst of biological evolution? I venture to suggest there has not. So why is it that the same classes of people, discussing the same arguments under the same auspices, show an inexorable trend of change?
Looking at it another way, is there any principle that says the public morality prevailing in 2014 will be superior to that of 2004, or even 1814? What was wrong with those primitives of ten years ago? How do we know that they weren’t more moral than us? Or is it, after all, just a depressing question of fashion?
Well, in once sense it is. The fact that Joe Public can be adamant about the natural perversion of homosexual behaviour one year, and equally adamant about the natural perversion of homophobia a decade later is a sociological, more than a moral, phenomenon. But what informs the “movers and shakers” of those fashions is, surely, the intellectual basis of moral reasoning.
Once, what we have recently discussed from Athansius underpinned the ethics of euthanasia. Humanity as a creation – not just the individual, but the very physical species – bore the indelible image of Christ the Logos himself. To destroy a human being, be they fit, ill, fetal or senile, was in a sense to kill Christ himself – or at least, to destroy that which is the personal property of Christ. It was also to deny that Christ has providential care of his own property, and that we are entitled to arrogate to ourselves his prerogative as Creator to give and withdraw his breath (cf, analogically, Ps 104.29-30).
The echo of that moral foundation informed the sensibilities of those participating in the previous discussions of euthanasia, and to a decreased extent, as a morality of autonomy slowly replaces it, this one, though few would even recognise their debt to Christian thought.
Without that foundation, the principle of autonomy has logical consequences, as I said in 1982 and maintain still. It’s what Os Guinness aptly called “The Striptease of Humanism“, and the naked flesh is so pervasive now we don’t even remember there were once clothes.
I would think it likely that most doctors and nurses working in palliative care hasten the death of a patients as a secondary effect of increasing their morphine dose to achieve better pain control.
Knowing that this will happen, are they not arrogating to themselves Christ’s prerogative to withdraw his breath? And are they not, on the grounds of compassion, compromising on a moral absolute?
I share the ‘slippery slope’ concerns about legalising euthanasia (or assisted suicide), but it has to be acknowledged that it is already common practice, and quietly accepted as such.
Peter
Have you not seen the research done in hospice care that showed that morphine given under a proper palliative regime doesn’t shorten life significantly?
That said, intention is paramount, as not only modern medical ethicists say (cf the long-running Ethics and Medicien programme started by Nigel de Cameron way back) but the theologians who considered such things in ages past. Every official public discussion of the issue has, I know, been cognisant of the fundamental difference between relieving suffering, with accelerated death as an unavoidable consequence, and intending death in order to relieve suffering.
In wider criminal law it’s the same distinction that makes the difference between murder and the varying degrees of manslaughter down to misadventure.
Both the examples I observed in my 2004 submission were “back in the day”, and any “quiet common practice” was known then, and not considered a reason to change the law, or GMC guidelines. It’s also a fact that in a 12,000 patient practice over an entire career neither I nor my partners, nor the local hospice we helped set up, ever found any reason to fudge the law and Christian ethics.
Now it may be that over my lifetime it has become common practice – but that raises the same issues about what has changed attitudes as my OP. The better and more organised palliative care has become, the louder the calls for euthanasia, and the greater the emphasis on autonomy. When there was no effective care at all (I’m thinking Victorian times, perhaps), but killing patients was just as easy (overdo the laudanum or the bleeding), it was an absolute no-no. Doctors and relatives were no less compassionate then.
All slippery-slope arguments, it seems to me, hinge on the underlying ethical basis one holds. So if we’re both concerned about such a slope here, maybe it’s worth asking what the moral principle is that would lead campaigners to say, down the road, “We now have assisted suicide – now we want more… (whatever the next stage is).” As soon as your moral philosophy/theology changes, you’re already 75% down the slope, before you’ve even changed a single law.
Jon,
You report, ‘A proper palliative regime doesn’t shorten life significantly’ ….
It would have to read, ‘doesn’t shorten life at all’, to satisfy the moral absolute (which was your main interest).
We could, of course, swap URLs.
Here’s one: http://www.medscape.com/viewarticle/474834_8
Note the nurse’s comment in the last but one paragraph, “You know, I think we say that to make ourselves feel it’s okay”.
I don’t disagree with most of your observations and in particular I agree that motivation is paramount. I am, however, saying that there are circumstances in which it is acceptable to shorten a person’s life. I’m fairly sure I have have done so a few times over my practice life. My motivation was always compassion and my primary objective to relieve suffering.
Well Peter, the Wilson Article (Wilson WC, Smedira NG, Fink C, et al.: Ordering and administration of sedatives and analgesics during the withholding and withdrawal of life support from critically ill patients. JAMA 1992;267:949-953) seems to suggest that there’s no good evidence life is shortened by analgesia even when that’s the intention.
Perhaps tender consciences, in this instance, need to be reassured , if only to ensure adequate analgesia. One of my worst experiences was as a houseman, trying to give regular analgesia to a dying child using Cicely Saunders regime (I’d met her a couple of times) and having my prescribing totally ignored by nursing staff with muddled ideas that I was making him a junkie.
I was impressed with the literature review article’s contention: It is important to emphasize that there is no debate among specialists in palliative care and pain control on this issue. That certainly accords with the palliative care consultants at our hospice.
We’re agreed, though, that that doesn’t alter the ethical situation – when Cicely Saunders started the hospice movement, the research just didn’t exist and it was safe to assume that life was shortened by adequate analgesia. Only in the late 90s, as I remember, did the work at St Joseph’s in particular, reveal the actual situation. That was some years after I had done a course there.
The Dutch case is interesting regarding the “slippery slope”. Here is someone deeply involved who changed his mind (going the opposite way to Archbishop Carey, it seems), but of course the very fact of the “slippage” ensures that most people won’t change their minds: euthanasia becomes part of the landscape, as presumably infanticide did in Roman culture, or slavery in more recent times. The fact that there are increasing numbers just becomes a sign that the policy is welcome, just as the need for abortion is showed by the 180K (or whatever) annual rate here.
It’s rare for politicians and professions, or even relatives, to admit to mistaken policies that have killed people – and of course even harder to turn the boat round.
Generally speaking, I agree that values and moral judgement have diminished with the increasing belief that evolution explains it all, but I also think that these matters inevitably bring us to moral dilemma – one point that we may miss is the impact of knowledge and technology that enables us to lengthen our life span. These include finding cures for diseases, but also means by which people may live under circumstances that diminish their life (suffering, lack of any meaningful activity, and so on). These means and technologies are created by us, and yet we have not improved our moral wisdom to keep pace with such advances. This I feel, is an area that many avoid in such discussions – mainly because wisdom is not part of a capitalistic/material culture. No profit in finding out how to cure and also improve the life of those we care for.
I agree, GD, and am one of the first to wonder at the way we’ve come to the idea of treating diseases rather than people. Sometimes it seems we’re so afraid of dying we’re scared to live.
At the same time, I don’t think the moral dilemma is actually worse than it ever was: just more prevalent. The issue is about individuals rather than numbers (thank goodness – somewhere down the slippery slope is the argument “There are too many old and useless people taking up space”).
My mother, for example, suffered from dementia for several years, which as you can imagine was bad in many ways. And maybe she’d have died from something kinder in the days before modern medicine. But in fact, that apart, she was hardly ever ill – I suspect the same issues would have obtained had she lived a century before: there are, after all, plenty of such situations in Dickens.