MacDonald on Assisted Dying

I hadn't intended to turn this into assisted dying week, but that's how it's turning out.

After his recent debate with Christian apologist William Lane Craig, Sean Carroll expressed frustration that the debate followed a certain pattern. Craig would make an argument, then Carroll would rebut it, then Craig would simply repeat the same argument as though nothing had happened.

That's how I felt reading David Klinghoffer's latest contribution to our discussion about assisted suicide. He merely repeats the same nonsense from his previous posts, this time tricked out with an impressive amount of incoherence. Permit me a few brief replies:

At Evolution Blog, Jason Rosenhouse offers “Replies to Smith and Klinghoffer,” meaning Wesley and myself on assisted suicide versus the idea of life's sacredness. Rosenhouse insists that “Human origins have no implications for the value of human life.”

The source of his confusion seems to be that in writing about the “value of human life,” Rosenhouse and I are talking about two different things. I'm referring to the idea that a human life per se has an exceptional value, a sacredness, which demands that it be regarded with awe. Hence empowering or compelling doctors to hasten death cannot be readily countenanced. Instead, give maximum comfort to a patient in pain and where appropriate seek to arouse the spark, the awareness, of purpose and meaning in him that many of us believe resides in every human soul. Give love rather than a lethal injection or, in the case of the ghoulish defrocked physician Philip Nitschke whom Wesley wrote about earlier, the suicide bag.

No, we're talking about the same thing. I agree completely that human life per se has an exceptional value. But it doesn't follow at all from that, not even a little bit, that empowering doctors to hasten death cannot be countenanced. The actual situation is precisely the opposite, for reasons I explained in my original post. A human life is more than just a heartbeat.

In his first reply to me, Klinghoffer objected that I called him callous. But what else can I think when he refers so casually to “a patient in pain”? We're not talking about people in pain, for heaven's sake, and we're not talking about people who are feeling a little down. We're talking about people who have been reduced to complete physical and emotional helplessness, and who will linger in that state indefinitely, without the slightest remediation, until their heart finally gives up. In such a situation, it is an act of love to give that person a lethal injection. By contrast, forcing the person to persist in that condition is an act of sadism.

Rosenhouse evidently has in mind something different: that the experience of living a life of a certain quality or comfort has ultimate value. Hence in the absence of that level of comfort, it may be humane to kill or help someone kill himself. If a person is uncomfortable, whether from physical or emotional causes, and says he wants to die, kill him.

Truly it's hard to believe that anyone would think Klinghoffer is being callous. It boggles the mind that he can look at people being ravaged by cruel, horrible diseases and think the problem is merely that they are uncomfortable.

My position follows from the observation that life gives evidence of purposeful intent, and that the cosmos seems to be designed with us in mind. That is an awesome thing to consider, and it demands that human life be respected. Jason's stance follows from the opposite view, that biology arose by chance and offers no evidence of objective purpose or meaning, other than the meaning we choose (arbitrarily) to give it.

It's remarkable. Every part of that is wrong.

His position does not follow from his belief (not observation) that life gives evidence of purposeful intent. Nor does my stance follow from my acceptance of evolution. You could believe that a loving God created us and still not believe that a person should always be forced to live until his heart stops on its own. This, indeed, is why so many religious people have no moral problem with assisted suicide. And you could believe that life arose by chance and still think that assisted suicide is morally wrong. As has already been explained to Klinghoffer, our origins have no implications whatsoever for questions of meaning and purpose.

And of course life has only the meaning and purpose we choose to grant to it. That's true regardless of whether or not we were created by God, unless Klinghoffer thinks that “objective purpose” is just synonymous with “the purpose for which God created us.” God might have had a purpose in mind for us, but that in no way implies that we are morally obligated to honor that purpose in our lives. Just for the sake of argument, though, let us grant that we are created by a loving God for a purpose, and that we are morally obligated to honor that purpose. What follows? Does Klinghoffer have some way of discerning what that purpose is? How does he know that the purpose was to keep our hearts beating for as long as we possibly can?

He's not even right to say that if we choose our own meanings, then those meanings are arbitrary. It's pretty interesting, don't you think, that despite the tremendous cultural and religious differences among people, we all manage to converge on the same few things as sources of meaning and value? Love, family, friendship, work, community. There's nothing arbitrary in that. Biology, at least, can shed some light on why these commonalities exist. It is religion, by contrast, that provides a foundation of sand. You must first hypothesize God into existence, then further suppose you have some insight into what He wants from us, and then explain why we should care what He wants, and on and on.

There's a little more to Klinghoffer's post, so go read it if you want. But I'm coming up to the thousand word mark and I haven't yet gotten to the main point of this post.

For a far more sensible take on assisted suicide, let me direct you to this post by Eric MacDonald. You should go read the whole thing, but the part that is most relevant to our discussion here is the opening:

Since someone has asked a question about this (in a comment on my last post — from as long ago as March!) I thought it might be worthwhile commenting on what is taking place in England and Wales, where the Falconer Bill on assisted dying is now before the House of Lords, and upon which a decision will be made this Friday (I believe). In the run up to its consideration a former Archbishop of Canterbury has expressed his support for the bill and for assisted dying, and has argued (correctly in my view) that Christianity should be able to accommodate assisted dying, since, quite apart from the church’s responsibility of care for the living, it has an equal responsibility to enable the dying to die with some comfort and dignity. This seems so obvious to me that I wonder what it is that keeps Christian leaders in the opposing camp. Indeed, so opposed are they that they are prepared to trundle out any possible argument they can lay their hands on in order to oppose passage of such bills.

The main objection to the bills has to do with the bills' danger to the so-called vulnerable. This is a red herring, as a brief study of those jurisdictions where assisted dying has been legalised would show. It is surprising that the argument continues to be made nonetheless. The reason that these arguments are being made, I believe, is that the religious know that religious arguments in and of themselves are irrelevant to the consideration of public policy, so they are consigned to using the weakest arguments around, arguments which have been disproved again and again by the practice of assisted dying where assisted dying is legal. One of the things that the Church of England has never faced head on is that the Swiss have had a very permissive law regarding assisted suicide in their Penal Code since 1941, and no one has yet shown that this law has been misused in the way that Church of England clerics continue to argue that even more stringent laws would be abused if the Falconer Bill were passed.

The Falconer Bill is modeled directly on the assisted suicide bill in the state of Oregon in the United States. It would apply only to those who are terminally ill and have (in the opinion of expert medical opinion) at most six months left to live. Of course, such prognostications are highly fallible, and doctors are today usually reluctant to make such claims. Nevertheless, the use of the bill in Oregon has not shown the slightest degree of misuse, whatever its detractors may say, and it is very doubtful whether it will be misused any more in England and Wales than in Oregon. So the constant harping on such possible misuses is simply a misleading way of expressing the religious objection to assisted dying bills tout court.

MacDonald's post did make me realize that I might have been too casual about something in my earlier writing. He makes the point that the issue is not really being “terminal.” Rather, the issue is intolerable conditions of life. One can persist for many years in a state of horrifying physical degradation. When I was writing about the morality of assisted suicide, I think I was clear that this was my standard as well. However, in a comment to an earlier post I commented that I thought Oregon's approach was very sensible, but apparently it only applies to people with no more than six months to live. Perhaps Oregon's approach is too restrictive after all.

For me, the moral question is easy, and there is simply no merit at all in the views expressed by Klinghoffer. The public policy question is far more difficult.

More like this

Just for the sake of argument, though, let us grant that we are created by a loving God for a purpose, and that we are morally obligated to honor that purpose. What follows? Does Klinghoffer have some way of discerning what that purpose is? How does he know that the purpose was to keep our hearts beating for as long as we possibly can?

This seems self-evident to many of us today because we're the heirs of intellectual development that occurred since the end of the Middle Ages--when the obvious answer was, "The priest, the rabbi, the Imam, shall decide this and inform us, the lay member of the tribe or fellowship." Jewsih, Christian--i.e. the Catholic Church of Rome (or Constantinople)--and Moslem religious authorities asserted this as their province.

Since protestantism--for Christians--and civil emancipation for Jews and Moslems, the right to read and interpret sacred texts has placed such a prerogative in the individual worshiper. But some haven't made that intellectual journey and cling to the formerly-claimed central authority of the Church, synagogue or mosque.

It is only the vestigal deference which civil society still pays to religious doctrine that prevents secular society from taking the obvious next step along a path of greater humanitarian civilisation. But that has typically been the case through history. Nearly always, though not absolutely always, it has been secular society, with its practical needs and concerns, which has dragged the religiously doctrinaire, kicking and screaming, toward more humane social practices.

Nothing new going on here.

By proximity1 (not verified) on 01 Aug 2014 #permalink

Craig would make an argument, then Carroll would rebut it, then Craig would simply repeat the same argument as though nothing had happened.

Reminds me of so many other similar circumstances.

Your arguments here are complete, I think, since you've already effectively reduced the arguments of Smith and Klinghoffer to polemical equivalent of rubble.

Now, for you to do more or to expect more from your interlocutors--as in the way of an honest admission that your case is made and theirs is lost--is a vain exercise or hope. These people (Smith and Klinghoffer) are not, after all, engaging you with open minds on these matters. Once you've made your case as you have, you may fold up your briefcase and leave the stage.

By proximity1 (not verified) on 01 Aug 2014 #permalink

Klinghofffer:

I’m referring to the idea that a human life per se has an exceptional value, a sacredness, which demands that it be regarded with awe. Hence empowering or compelling doctors to hasten death cannot be readily countenanced.

I'm reminded of a point in the Screwtape Letters where Wormwood is all excited about killing one of his humans and Screwtape tells him, no, don't do it. The human is Christian and so killing him would be a victory for God. Screwtape infoms the young Wormwood that the demonic thing to do is keep that human alive, because then you always have the possibility of convincing them to turn away from faith.

Given modern fundamentalism's infatuation with C.S. Lewis as an apologist, you'd think they'd actually pay attention to his arguments. I guess you'd think wrong.

Eric MacDonald:

The main objection to the bills has to do with the bills’ danger to the so-called vulnerable. This is a red herring, as a brief study of those jurisdictions where assisted dying has been legalised would show. It is surprising that the argument continues to be made nonetheless.

I am not surprised and frankly EM shouldn't be either. Not everybody knows about the situation in Oregon and Switzerland (and probably a few other places I don't know about...see the point?), so they don't know what the data shows, and I think without the empirical data the fear of abuse/misuse/mistake is perfectly reasonable.

Secondly, not all public policies scale evenly. For example, local communities often use direct democracy to make decisions, but we don't use it at larger scales because it doesn't work as well. A policy that works for a collective of a million people may not work as well or the same way in a collective of a hundred million people. Oregon has 4 million people, Switzerland 8, the UK 64, and the US 316 (or so Google tells me). Now in this case, I think the policy will scale up without any major issues, however, were I UK policy czar, I would probably throw some heavy monitoring in place for the first 5-10 years to make sure of that, because there is a real possibility that the order-of-magnitude larger size of the community you're implementing it on may result in some unintended consequence.

To be clear, I'm pretty supportive of bills like this (I haven't read the UK one so don't feel qualified to opine on it specifically). But I think EM is brushing away some valid concerns, some good reasons why we should be cautious about implementation of these sorts of policies. At the very least, the choice to go forward with such a policy (or not) should be accompanied by a public education campaign that allows the populace to see the results in Oregon and Switzerland, so that any democratic choice on the matter is the best informed it can be.

@ 3
Speaking of Britain,

I Don't know whether you post from (experience in) Britain or not but, if not, you should beware of supposing that, if Oregon and Switzerland do well with assisted suicide, then we may safely extrapolate that experience to Britain and assume that it, too, could and should do as well. My experience tells me that Britain is manifestly incompetent to assist the most vulnerable of the living and there is simply no reason to suppose that authorities would spend more time or attention or, least of all, resources, on the most vlunerable dying. As it now is, the most vulnerable in Britain are left to live or die as their own personal means happen to demand or permit.

I think that If there's anything of which we may be very assured it's that, in Britain--- most of all in Britain--- the life and health of "the most vulnerable" (whatever the condition of these may be) is clearly the very last thing that authorities, especially secular, and too many religious authorities too, give any damn at all about, much less regard as sacred. Most claims to the contrary are, I contend, just so much hypocritical bullshit.

In Britain, "assisted"-anything is a dirty word, a thing of concern only to those who lack the means to pay their own way to whatever the matter may be, gilded life or gilded death. The authorities have made it abundantly clear that those who can't afford it simply don't matter and so they, the authorities, simply don't care.

If assisted-dying does come to Britain, it's going to be adminstered by what shall be damnably called the "ADT", the "Assisted-Dying Trust."

By proximity1 (not verified) on 01 Aug 2014 #permalink

What Sean Carroll experienced with William Lane Craig, and you with Klinghoffer -- you present arguments that they ignore and they merely repeat what you refuted -- is common among the religious. I've debated on religious topics for 22 years on various online forums, and it's always the same.

I think that the very sameness in actions by the religious shows how people in general react when for emotional reasons they want a belief to be true, but have no justifable reasons (religious teaching is not justifiable) for holding the belief.

By Alan Feuerbacher (not verified) on 01 Aug 2014 #permalink

My brother had been injured. He spent a week in intensive care and several weeks thereafter. He had a living will that said if a feeding tube had to be installed, to not do it. His wife countermanded his wish. He was looking at years of very expensive treatment. When he was able, he checked himself out of the hospital, went home and shot himself.
Thanks to his action, his wife is living a much better life with the resources he saved. The family is better off.
I don’t understand all the arguments about the useless individual. What about the family? What about the progeny?

Why do people want to include doctors in the death or starve or die of thirst? Why does the government have to be involved? Shooting is fast and I guess painless although messy.

"You must first hypothesize God into existence, then further suppose you have some insight into what He wants from us, and then explain why we should care what He wants, and on and on." Actually, much less than that is needed. All one has to do is believe life means something beyond itself to conclude that enduring to the end, even if painful, is worth it.

All one has to do is believe life means something beyond itself to conclude that enduring to the end, even if painful, is worth it.

You also need to be able to realize, and accept, that not everyone wants to believe and act the same as you, and that you don't have the right to enforce what you would do their situation on them. Is that so complicated?

John (#6), the most important words in your story are "When he was able". In many cases, such as Jason's example in A Human Life is More Than Just a Heartbeat, the unfortunate victim of enforced living is not able to terminate their life with little pain and with dignity.

By Jim Roberts (not verified) on 01 Aug 2014 #permalink

The "Two Doors Challenge" shows how far removed from reality it is possible to be. Does he really believe that the facts given are relevant to making a choice? And even if they are that it would be rational to agree with his conclusion?

Once again, I ask why is Bill Gates giving money to a think tank that employs individuals like Klinghoffer? Shouldn't he and every other donor be running in the opposite direction?

By Michael Fugate (not verified) on 01 Aug 2014 #permalink

dean,
"You also need to be able to realize, and accept, that not everyone wants to believe and act the same as you, and that you don’t have the right to enforce what you would do their situation on them. Is that so complicated?"
Suicide has never been recognized as a universal or human right. The issues of temporary weakness or subtle coercion are too real for prudence to permit a change, recognizing that moral imprudence is the mantra of the day.

"Actually, much less than that is needed. All one has to do is believe life means something beyond itself to conclude that enduring to the end, even if painful, is worth it."

Really? Why?

By Michael Fugate (not verified) on 01 Aug 2014 #permalink

All one has to do is believe life means something beyond itself to conclude that enduring to the end, even if painful, is worth it.

The way you're using the phrase "means something beyond itself" sounds like a euphemism for something you'd rather have left unstated, or at least you don't seem to want to say anything about what you think life means. And a huge amount depends a lot on what you think that meaning is. Someone could just as easily conclude that, for instance, sacrificing humans to a creator god is the highest expression of praise and acknowledgement of human worth, and could therefore conclude that volunteering to be sacrificed gives one's life more meaning than it could possibly have by dying in old age. Or, more likely in today's world, volunteering to die in battle for a cause -- this is a kind of suicide, of course, that is almost universally praised.

By Another Matt (not verified) on 01 Aug 2014 #permalink

Jason: "God might have had a purpose in mind for us, but that in no way implies that we are morally obligated to honor that purpose in our lives."

That becomes more obvious if we imagine discovering that we were made by a sadistic god, for the purpose of seeing us suffer. Would Klinghoffer then consider himself morally obligated to make it his purpose in life to make the people he loves suffer? Of course not.

I think this confusion arises from conflating two different senses of "purpose". When we talk about the purpose of an artefact, like a hammer, we are referring to the intentions of the artefact's maker or user. When we talk about the purposes of people, we are normally talking about those people's own intentions, e.g. "his purpose in selling his car was to pay for medical treatment". If you talk about people as designed artefacts, you may (if you're unwary) conflate these two senses, and fail to see that there are two separate "purposes" involved: the (alleged) purpose for which we were designed, and our own purposes. There's no reason why these two different types of purpose should necessarily correspond.

By Richard Wein (not verified) on 02 Aug 2014 #permalink

rigadoon
FALSE
“Suicide has never been recognized as a universal or human right.” False.

Isolated societies that maintained sustainability have embraced suicide and other currently abhorrent practices (see “Collapse: How societies choose to fail or succeed”- Jared Diamond). Other successful societies have had practices we consider abhorrent such as infanticide of the weak or excess people (Moses was sent down the Nile); abandoning or killing elderly people (Moses was abandoned before crossing the river); facing periodic starvation, high child death rates; and living in fear of imminent attack. It is a necessary practices for success.
Having excess food to support the weak or infirm that have little hope of ever contributing to others is rare. Food production is a high technology endeavor. The U.~S. has adopted practices that reflect a rare and fleeting condition in nature. If we fail to change, nature will select against us when an ice age returns, when food availability is reduced, when the population becomes excessive, or when competitors use resources better.

Michael,
If life has meaning and worth beyond itself, to prematurely cut off life is to delete some of that with no gain other than a temporary avoidance of pain.

Matt,
The meaning and value of life is disputed but what should not be disputed is that life has meaning and value. We do not have a right to assume that anyone's life has no meaning or value.

rigadoon (#17)
We do not have a right to assume that someone else's life has no meaning or value. (FIFY)
Or that someone else's life does retain meaning or value.
I do have the right to decide that my life no longer has meaning or value.

By Jim Roberts (not verified) on 02 Aug 2014 #permalink

Rigadoon, does it have meaning beyond itself? And if so, what are you referring to God perhaps? or friends and family?

You are being very cryptic.

By Michael Fugate (not verified) on 02 Aug 2014 #permalink

Jim (#18)
"I do have the right to decide that my life no longer has meaning or value."
Then we run up against the matter of a temporary weakness or various kinds of coercion. As a society, we should recognize that the danger is too high to normalize suicide.

rigadoon wrote

Then we run up against the matter of a temporary weakness or various kinds of coercion. As a society, we should recognize that the danger is too high to normalize suicide.

Did you miss the discussion of Switzerland and Oregon above? Data trump (false) belief.

RBH, you should look at the Netherlands which has the most experience. For example: "We all independently concluded that guidelines established by the Dutch for the practice of assisted suicide and euthanasia were consistently violated and could not be enforced." "Practicing assisted suicide and euthanasia appears to encourage physicians to think they know best who should live and who should die, an attitude that leads them to make such decisions without consulting patients..."
http://www.actionlife.org/index.php/life-issues/euthanasia/assisted-sui…

I see mostly anecdotes in that reference, and anonymous authorities appealed to--"a few foreign researchers"--but no systematically gathered data. There are suggestions that the restrictions within which assisted suicide is supposed to operate have been violated, to be sure, but no indication that it is an insuperable concern. There's no evidence of a slippery slope, just a collection of anecdotes.

There's mention of "palliative care," as though that could solve the issue. It doesn't, not least because the kinds of patients Rosenhouse's posts refer to are past palliation. "Palliation" for them would have to be continuous deep sedation--no consciousness, just a heartbeat.

I find it curious that the most recent publications mentioned (but not appropriately referenced) in that article are from 2001. Is there nothing more recent? A brief look at Google Scholar yields over 11,000 hits for "assisted suicide" AND Netherlands. A great many of them date from the 1990s, but there are much more recent publications. A search of PubMed on "assisted suicide" yields over 5,000 hits, many from the 2010s. For example, from the abstract of a 2014 publication: "Our study does not support the notion that unmet palliative care needs are related to [assisted suicide]."

Assisted suicide is a much more complex issue than just saying "yes, you may" or "no, you cannot." Consider the terminally ill people who voluntarily starve themselves in the absence of a state regulated/governed assisted suicide opportunity. What is the duty of a physician then? Are they to be forcibly fed? See here for some implications of that question.

So I don't see it as a two-valued proposition--"yes" or "no"--but a multi-valued question that requires thought, not knee-jerk reactions. And after five surgeries and a bunch of chemo, I know what I am going to do when the time comes.

I'm not surprised there are plenty of references -- I just picked one at random. Let's not be naïve about a society in which many or most people expect to die by suicide. That is rightly called a culture of death -- one in which death is seen as a way out of meaningless life. Such a culture is itself dying, unless it can be revived by a sense of the wonder and greatness of life.

Here is a 2013 comparative review covering the Netherlands, Belgium, Oregon, and Switzerland. It concludes

We conclude that the evidence suggests that individuals who receive assisted dying in the four jurisdictions examined do so on the basis of valid requests and third parties who assist death do not act unlawfully. However, further research on the elements that may undermine the validity of requests for assisted dying is warranted. More research on the reasons why requests for assisted dying are refused is also desirable.

Once again, it's not a simple issue.

rigadoon wrote

Let’s not be naïve about a society in which many or most people expect to die by suicide.

What bollocks. "Many or most"? Bullshit.

And this?

Such a culture is itself dying, unless it can be revived by a sense of the wonder and greatness of life.

Unutterable bullshit. One can fully appreciate the wonder and greatness of life and still know that there are circumstances in which that wondrous life is no longer worth living.

Rigadoon, you are making many assertions, but little else. The problem of coercion is in the law already. If someone tries to coerce another person to commit suicide, then the coercer is punished. It is a crime.

How exactly does one find the sense of wonder and greatness if one is in excruciating pain or if one is under heavy sedation?

By Michael Fugate (not verified) on 02 Aug 2014 #permalink

Isn't the great value we place on human existence best illustrated by ensuring that all humans die a dignified death?

Michael,
"How exactly does one find the sense of wonder and greatness if one is in excruciating pain or if one is under heavy sedation?"
If you've visited someone in the hospital in such a condition, you know how they appreciate having others there. Even those who are dying can appreciate it, too, though they will not recover. The last thing to go is the hearing so one should always expect they can hear words from loved ones.

That is a sense of wonder and greatness? You are talking anecdotes - everyone appreciates, everyone?

Come on address the issues rather than just a string of clichés. Why do you believe that assisted dying should be unavailable?
This is not about depression and abandonment - it is not about coercion - it is not about moral decay or whatever that is.

By Michael Fugate (not verified) on 03 Aug 2014 #permalink

The issues of temporary weakness or subtle coercion are too real for prudence to permit a change,

Except, as has been pointed out (and ignored by you), in locales where systems are in place there has been nothing of the horror you insinuate.

But an even simpler point is this: what I might or might not decide to do in such a situation is no fucking business of
righteous little busy-bodies like you.

@ 3 :

... and I think without the empirical data the fear of abuse/misuse/mistake is perfectly reasonable.

And I'd agree that such concern is warranted--

and it's especially warranted in morally-wretched contemporary Britain, where (pardon the citing of the Daily Mail as a source--which should never be taken at face value) we learn that it's alleged that nurses are now using National Health Service questionnaires during home visits to elderly which pose the question of whether or not the elderly person concerned would (ever?) like doctors to refrain from efforts to resuscitate him or her. The paper cites the question this way,

" ‘If you ever need cardiopulmonary resuscitation do you agree to do not resuscitate’ "

Read more: http://www.dailymail.co.uk/health/article-2729332/Do-want-let-die-Quest…

The problem is that experience shows that under the circumstances in Britain, public authorities cannot be trusted to abstain from abusing their power over the most vulnerable to prey upon them---typically through the denial of vital aid, even where there is a legal right to it. Thus, as the questionnaire report indicates, if accurate, U.K. authorities are morally inept, unable to recognise where their cost-saving impulses, which now run rampant, pose clear and unacceptable moral conflicts of interest as both responsible for the aministration of medical care to the elderly and actively seeking ways to eliminate whatever may be rationally considered a costly burden upon the NHS resources.

In Britain, not surprisingly, there is the worst of "both worlds" : neither a legal right to assisted euthanasia where it is really just and necessary nor an effective protection from a National Health Service which is financially strapped and "on the make" for any and all cost-and-corner-cutting means.

By proximity1 (not verified) on 19 Aug 2014 #permalink