04 August 2009

The right not to be killed

Debbie Purdy is a woman suffering from multiple sclerosis who thinks she may, in the future, wish to commit suicide with the assistance of the Swiss euthanasia group Dignitas, and who says she would want her husband to accompany her on her trip.

The Director of Public Prosecutions has been ordered to clarify the factors which would be taken into account when deciding whether to prosecute someone for the crime of ‘assisting suicide’. The Daily Mail claims this has taken Debbie Purdy ‘a step closer to dying on her own terms’.

Critics of the latest development seem to fall into two camps. They may deplore suicide on moral grounds. For example, Ruth Dudley Edwards writes about a friend, a successful lawyer, who ‘decided when he was diagnosed with terminal cancer that he would try to make his dying life-enhancing for others’. Her comments seem to imply that other should follow his example, whether they want to or not.

Curiously, one does not hear the same people condemning the common practice by doctors of hastening the death of terminally ill persons by administering excessive doses of painkillers, or suggesting those people could have been induced to make their dying ‘life-enhancing’ for others. Perhaps it is presumed that a doctor’s judgement on this issue can never be wrong.

The other type of critic regards the latest development as a move down the slippery slope towards legalising murder. Part of the problem here lies in the definition of ‘assistance’. Accompanying someone to the place where they plan to commit suicide seems innocuous. Giving an elderly person a lethal injection and claiming afterwards that they asked you to do it may seem less so.

As is usual in such discussions, however, the context – that medical goods and services are immorally controlled by a monopolised profession which transfers the right of decision from the patient to the doctor – is ignored. If the law on medicine reflected the basic moral principle (respect for individual volition, unless others are harmed) a number of consequences would follow.

First, medicine delivered by doctors would become more accessible to many people who currently find it obnoxious to submit to arrogant authority figures who can choose to refuse them what they urgently need. Second, the goods and services necessary for treatment would also become available without the involvement of doctors. For both these reasons there are likely to be people currently contemplating suicide who would be able to recover their health sufficiently to want to go on living.

Third, the issue of ‘assistance’ would become far less relevant. In a free market for all medicines, including those which can be used to produce a painless death, ways would be found for individuals to administer the means of suicide themselves, even if they were incapacitated, without an active role being played by outsiders. Family members could be present at the suicide without having to become involved. People would not have to travel to far-off locations to achieve their objective.

Fourth, and most importantly, the issue of assistance by medical professionals would also cease to have the same level of relevance. This – not assistance by laymen, and certainly not ‘assistance’ in the sense of accompanying on a journey – is the most worrying possibility among those being contemplated. In the institutional setting of a hospital, where respect for autonomy is absent, and where ‘best interests’ arguments have been used to perform euthanasia without consent*, legalising suicide-with-assistance in general seems certain to lead to even more surreptitious medical-killing-with-presumed-consent than is already going on.

* as for example in the case of Hillsborough victim Tony Bland