Saturday, October 11, 2014

Debate on assisted suicide

With the story of Brittany Maynard circling the internet, I recently got in a debate on physician-assisted suicide with my friend, roommate, frequent sparring partner: the free speech champion and (in?)famous Hopkins Voice for Life founder Andrew Guernsey. It spilled over onto Facebook when he posted an article by prominent social conservative blogger Matt Walsh criticizing the public's widespread support for her decision. Several other people commented on the link as well and it eventually turned into a pretty sprawling discussion. In the interests of brevity and focusing the debate I will only post his posts, my own, and those we directly responded to (under pseudonyms, as I always use in courtesy to those who are unaware they're being quoted).

The condensed transcript is below. I will update it as new comments and rebuttals are added.

Andrew Guernsey (AG): "If you are saying that it is dignified and brave for a cancer patient to kill themselves, what are you saying about cancer patients who don’t? What about a woman who fights to the end, survives for as long as she can, and withers away slowly, in agony, until her very last breath escapes her lungs?Is that person not brave?" (quoting the Walsh article)

John: Or just both are brave and take a lot of strength to do.

AG: If everyone is brave, then nobody is. Bravery implies a noble cause as well as strength. The paths of despair and of perseverance cannot both be noble.

John: Not sure how that applies here. Choosing between suicide or suffering til you die is a pretty hard decision. Neither choice is easy and it takes a lot of bravery and strength to go through with both.

AG: If all choices are equally moral and equally brave then why seek to prevent or dissuade people from suicide in the first place--isn't that judgmental? The fact is, we don't get to decide whether human life has value. Our lives are all free, unconditional and unmerited gifts from our Creator, and each of us is created to be loved--and our choices and attitudes can't change this reality---to boot, it's even written into the Declaration as the sort of first principles of our nation's founding. Even John Stuart Mill agreed about suicide that speaking of liberty without life is a nonsensical proposition. The fundamental divide here appears seems to be between those who admit it's a wonderful life (get the reference) and those who think life is an empty void where we have create our own rules/meaning and invent right and wrong/good and evil for ourselves. It all comes down to first principles of moral action. I can't disprove nihilism---I don't need to---it disproves itself.

Elon: Isn't bravery subjective? That would allow for both cases. Not sure where it's written that there is an objective bravery or that suicide is morally right or wrong.

Albert: Why isn't it brave for a clinically depressed person to commit suicide? They're life can be just as unbearable as the life of anyone who has terminal cancer. If we shouldnt try to prevent suicide in terminal cancer patients, we shouldnt try to prevent it in mentally ill patients either - to do so would be a failure to recognize the serious medical nature of mental illness.

Andrew Doris (me): I'm not saying anything about whether Maynard is brave, and Walsh is fighting a straw man by bringing bravery into it. I'm saying it's her choice, and that both you and Matt Walsh should stay the hell out of it.

When crowds come out to protest the euthanization of an ebola infected dog, and then celebrate the killing of a sick cancer patient --- we have gone seriously wrong as society.

Me: Most would agree that the soldier who dives on a live grenade in order to absorb the blast in his body and save his friends is extraordinarily brave. But calling him brave does not insinuate that his comrades are cowardly; we might view the other soldiers, who instinctually ran away from the grenade, as brave also, merely for volunteering to fight on the front lines in the first place. The statements “soldiers are brave” and “soldiers who willingly sacrifice their lives are brave” are not “contradictory narratives,” even though those who dive on grenades are but a small subset of all soldiers. Similarly, terminally ill patients forced to make difficult choices in the midst of great physical and emotional duress may comport themselves bravely no matter which decision they ultimately make.

The soldier who dives on a grenade also, in a technical sense, commits suicide. But it does not follow that by venerating that soldier’s heroism and self-sacrifice, we are endorsing other sorts of suicide in other situations (just as endorsing war itself does not endorse killing in other contexts). It seems obvious to me that whether or not suicide is ever okay, not all suicide should be weighed the same in our moral calculus. Even if Walsh thinks it should, he must know that most of his adversaries do not see it that way. He knowingly conflates the different types of suicide anyway, writing:

“I’ve been sickened to see that suicide is now most commonly described with words like ‘dignity,’ ‘bravery,’ ‘courage,’ and ‘strength…I am terrified to think that my children will grow up in a culture that openly venerates suicide with this much unyielding passion.”

Walsh is too smart not to see the distinction he glosses over. By feigning horror when people condone one unique subset of the larger whole, Walsh is attacking a straw man to raise moral panic, which is intellectual dishonesty plain and simple.

AG (paragraph breaks added by me): In the scenario you described, Andrew, the soldier is trying to save his fellow soldiers (primary effect) and, in the attempt, it will kill him (secondary effect). He isn't trying to commit suicide, he's trying to save his buddies, with the terrible indirect effect of being killed. Physician-assisted suicide, on the other hand, has the primary object and intention of killing a human life. No way to get around that.

If our laws say that the value of human life is up to "individual judgement" then we will have unhinged the foundation of the American project of ordered liberty---the dignity of the human person. And as Albert
(pseudonym) argued, we will no longer be able to stop our mentally ill friends and family members from harming themselves because it infringes on "their right to self-autonomy." 

To say there is a right to be killed by a doctor is no different from saying that there is a right to be enslaved voluntarily. To walk around in a master's chains violates human dignity, even if desired by both master and slave. Consent cannot make sex trafficking okay either, even if mutually consented to by both the pimp and the prostitute for whatever reason. Both of these things are wrong, regardless of consent, and should be outlawed. Similarly, a doctor killing a suffering patient, even if desired by both parties, violates the fundamentally violates dignity of that patient and ought to remain prohibited.

Euthanasia hurts all of us. What a sick person needs, besides medical care, is love and support of friends, not killing. The problem in the world, as Mother Teresa said, is not too much suffering, but too much wasted suffering! We need to learn how to accompany and care for the suffering---to see it as an opportunity--even if it's difficult, for us to come together and support one another in our times of need.

Me: I'll respond in order, to keep it organized.

1. Couldn't you argue that the "primary object and intention" of physician assisted suicide is decreased suffering, with the unfortunate truth being that the only way to do that is through the "terrible indirect effect of being killed"? Injecting yourself with a chemical you know will kill you seems no more direct than jumping atop a grenade you know will kill you.

2. You say, "If our law says that the question of the value of human life is up to individual judgment, then we will have unhinged the foundation of the American project of ordered liberty." I don't see how. In fact I think the American project of liberty is based entirely on the ability of each individual to make judgments about what to do with their own life, liberty and property. Prohibitting certain judgments restricts that liberty.

3. (edited due to a misunderstanding, disregard the old #3)

Albert's argument about the mentally ill makes a big leap between two things I think are very different: things we should try to prevent, and things we should outlaw. He writes: "If we shouldnt try to prevent suicide in terminal cancer patients, we shouldnt try to prevent it in mentally ill patients either." But I'm not arguing against trying to dissuade Brittany Maynard's choice. I'm arguing against making it illegal, and throwing doctors in jail if they agree to help her execute that choice. If you think euthanasia violates the dignity of the patient, it is your right to advise the patient not to choose it, or the doctor not to provide it. It is not your right to wield force upon either of them, nor to enlist other people to do it for you.

4. There is no such thing as voluntary enslavement. By definition, slavery must be involuntary. Voluntary servitude can be discontinued at any time by either party without repercussion, quite unlike slavery. And quite unlike slavery, volunteering to serve another - whether for charity or food or any wage - should be totally legal.

5. I think prostitution should be legal too, so that analogy won't convince me either!

I have lived with chronic depression my entire life. Thoughts of death are symptomatic of this illness. However, it is a slap in the face to suggest that suicide is an ever an act of heroism--choosing life despite unimaginable suffering is the ONLY heroic choice!

What if the symptom of depression could only be relieved if we kill someone else? Should we do that? Is that heroic? If it relieves my suffering would it be logical that I have the right to kill someone else because of my interior suffering and my only relief is if I get to kill someone?

Disordered or false compassion is not true compassion for someone who is suffering. True compassion acknowledges and appreciates that someone is suffering and is choosing to live as fully and joyfully as one can, despite his or her suffering. THAT is what it means to die with dignity--to accept that suffering until natural death occurs.

Me: Maureen, I'm sorry you suffer from depression and appreciate the insight that gives you on the issue. I'm also sorry if anything I said offended you or seemed to belittle the resolve and inner-strength required to fight such a disease. The crux of my argument is not that this woman is heroic, but that words like words like heroic, brave, and dignified mean different things to different people, and that the law should allow each of us to act on our own conceptions of righteousness so long as we do not impede other people's ability to do the same.

I think the example of a soldier diving on a grenade to save his friends shows that on rare occasions, suicide CAN be heroic. At the very least, it demonstrates that not all suicide is the same. Likewise, not all killing is the same. For example, we distinguish killing in self defense from other sorts of killing, which is why we do not consider most soldiers to be murderers. We also distinguish based on consent; your comparison to killing someone else is invalid because unlike Brittney Maynard, that person presumably does not want to be killed.

The heart of the matter is that many people - myself included - see a another distinction between killing yourself when imminent death is inevitable and killing yourself when it is not. Perhaps you think both are immoral, but even if so, don't they at least seem different? Might one be worse than the other? As with killing in general, suicide can be called wrong in the abstract even as we carve out exceptions to the general rule. I do not believe God's moral code is so simplistic and unwieldy as to be unable to discern the complex nuances that inform our moral intuitions.

Me (in a separate comment): Guernsey writes: "The fundamental divide here appears seems to be between those who admit it's a wonderful life (get the reference) and those who think life is an empty void where we have [to] create our own rules/meaning and invent right and wrong/good and evil for ourselves."

False choice. I think it's a wonderful life (not an empty void) where God helps us discover (not where we have to create) right and wrong/good and evil for ourselves. The Bible is an awesome starting point for that endeavor, which informs, guides and refines our moral intuitions. But it does not tell us all we need to know about moral philosophy in explicit terms, and it does not free us of the responsibility to think for ourselves about what's right and wrong in the same way we seek truth in every other category of human knowledge.


AG: Apologies for the delayed and lengthy response:

1. In the grenade example, if the person survives the grenade blast, he will have still fulfilled the object of his action, namely saving his fellow soldiers by using his body as a shield. The soldier’s
death is not a means to an end but a side effect. Swerving off the road to avoid hitting a child also has a high risk of death for the driver, as does running into a burning building, saving a drowning person, etc. Naturally, in a society that presumably values human life, we call these acts noble and brave, whilst murder and suicide ignoble. The suicide dies because he views his life as meaningless, and the martyr dies precisely because he so values his principles and the lives of others that he forgets himself---to paraphrase Chesterton. In the case of euthanasia, surviving the attempt would constitute a failure to achieve the desired end. The killing of the sick person is the means to the end of suffering—and hence is immoral and a violation of their dignity. There is also a difference between “killing” through withholding basic medical treatment/food or administering lethal drugs, and “letting die” by removing the presence of extraordinary medical care such as scarce and expensive machinery when there is no hope of recovery. The former, I argue, is immoral but the latter permissible. (This line of moral argument is called “double effect” and applies in numerous cases if you are curious)

2. In Planned Parenthood v. Casey, Justice Kennedy famously upheld Roe, writing: “At the heart of liberty is the right to define one's own concept of existence, of meaning, of the universe, and of the mystery of human life.” Kennedy suggests here the alleged conflict between freedom and law which underlies much of modern conception of liberty, which can be seen from Mill to Nietzche to Rawls in varying degrees….the age old tension between “Freedom from” of negative liberty vs the “freedom for” of positive liberty. In this view, to “legislate morality” is to do violence to individual (“autonomy” meaning literally “self-law” in Greek) ---who decides for himself what is right and what is wrong. The way I with much of the Christian and classical Western tradition of natural law, reaching back to Aristotle and Plato, see it, however, statecraft is soulcraft, that there is an objective moral law that governs human affairs and flourishing, and that codifying some of these rationally discernible moral precepts in law (like do not deliberately kill an innocent human life, or do not steal, etc) help to form the souls and consciences of the community to direct them to their proper end. Far from doing violence against the individual, such legislations of morality serve as signposts in the right direction for individuals who threaten to do violence to themselves and their communities by their actions.

In the marketplace of consumer goods, a laissez fairre approach often can be a good thing--- to have minimal regulation precisely because there is not always a right answer for everyone. There is not a clear answer about what is best shoe to buy or the best trumpet to use, and in what quantity, depending on people’s preferences and circumstances. But a laissez faire approach to morality is a bad idea in those areas that touch upon the foundational moral principles of human action and a just society—for which there is a right answer for everyone by virtue of our shared humanity---and some of these rational precepts indeed overlap with the faith-based beliefs of Christians, Jews, Muslims, Hindus, etc. A moral collectivism in these matters is necessary in order to safeguard individual liberty, because human liberty and diversity must be bounded by the constraints of our common humanity. (e pluribus unum---out of the many one) can only make sense as long as there is a “one” of some sort we can identify.

You write::“Many people - myself included - see another distinction between killing yourself when imminent death is inevitable and killing yourself when it is not.” Why must it be imminent? Some of the proposed euthanasia cases are people with chronic illness or disability, who could live on for decades, albeit disabled or with pain, but who have lost the will to live any longer. The fact that you have to go to such lengths find acceptable circumstances for legal physician assisted suicide is one the one hand understandable, since it is extremely difficult to see and hear someone in such pain who wants to end their life---but on the other hand it is premised upon an assumption that from the standpoint of the law, this life is all there is, with the moral implication that such suffering has no meaning---that suffering is meaningless before the abyss of nothingness that follows, such that there can be no more “utility” narrowly understood in further existence that could justify opposing the desires of another. But physician assisted suicide cannot provide what the desire to end one’s life actually suggests—which is a search and a desire to find meaning and purpose. Law can serve the end of showing that life has a purpose--as laws against murder do, but removing laws that prevent doctors from becoming killers --- suggests by its intolerable tolerance, a lack of meaning and a lack of caring for the lives of the terminally ill. We cannot say it is wrong to give suicidal pills to a young adult with a deformed face who has been struggling with depression his whole life, and then turn around and say it is okay to give suicide pills to that same person if your doctor has said you have less than six months to live.

Suffering and death are guaranteed in life. There is simply no way to avoid either of these things. How we deal with suffering and the dying says everything about what we say the dignity of life truly is as a society. If we are endowed by our Creator with rights to life, liberty and property, what gives us the right to kill ourselves, let alone to pass a law allowing a doctor to take away someone else’s life who has lost the will to live do it? You can’t play both sides by saying, get the government out of it, because the government has a legitimate role in affirming the fundamental value of human beings, even of those who may not believe it for themselves.

Me: 1. You make some good analogies here with the swerving driver and the fireman, but I still think ending your life is not the primary purpose of euthanasia: if there were a way to end her suffering without dying, she would take it. You write "In the case of euthanasia, surviving the attempt would constitute a failure to attain the desired end." But that's only true if the sickness remained. The chance that Brittany wakes up from her euthanasia not only alive but cured of cancer seem scientifically impossible...but as someone who's seen grenades explode, I doubt they're much lower than the chance the soldier survives lying on top of one.

Imagine doctors wanted to give Brittany Maynard a highly experimental treatment that had never before been tried on human subjects. Imagine that the experts thought this treatment had a 5% chance of saving her life, and a 95% chance of killing her. Would it be immoral to administer this treatment? If you say no, then what if it were a 0.5% chance? In this situation, it seems likely Maynard would still prepare herself for death before the treatment were administered, calling her friends and family into her room and saying her goodbyes in much the same fashion. She may pray for a miracle, but deep down she knows she is deciding to do something which will almost assuredly kill her. So how small does the likelihood of success need to be before it ceases to be something attempting to cure her and becomes suicide?

AG: Even if you knew for certain he would not survive the blast, the soldier would still not be committing suicide-- his death is not the means to the end of saving others, but an unintended side effect. When someone catches a bullet for someone, we all know that the act was one of defense of human life, not an offensive attack against his own. The martyr did not deliberately initiate the act of violence, or the tragic circumstances thereof. Common sense tells us the acts are different. Administering a risky new treatment that could likely kill Brittany, would not be suicide, but an attempt to save and preserve her life--or those of others after her should the treatment succeed. It is a qualitatively different act of administering a drug aimed at healing her (although things could go very wrong unintentionally), and administering a drug aimed at killing her. The history of medicine is a long list of procedures that have gone wrong in trying to heal human life (not destroy it deliberately). The euthanasia case involves deliberately ending one's life--even though the end goal is to end suffering, the means to the end involves killing, not saving human life. The evil of killing and death is not an intended side effect, but precisely how one goes about doing the good thing of reducing human suffering. And as the old saying goes, the path to hell is paved with good intentions. It's not a probability calculation, but a question of means and ends. Doctors used to take the classical version of the Hippocratic oath for this reason, which reads: "I will use those dietary regimens which will benefit my patients according to my greatest ability and judgement, and I will do no harm or injustice to them. I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion."

You do a good job of explaining the origins of our different conceptions of liberty, clearly through lots of practice in similar discussions haha. Obviously I think all of it is very very wrong, but perhaps we're going in circles by rehashing it. I will cherry pick a few snippets, though. I apologize preemptively for the length. Also, I propose that if you want to continue the discussion from here on out, we move it over to my blog to stop giving all these nice people who liked your status an onslaught of notifications.

  • You think "statecraft is soulcraft," and I think that's amazingly naive. Perhaps you mean statecraft should be soulcraft in an ideal, perfect world, which is fine - but that it is soulcraft? Look at our current state: a tangled mess of gridlocked parties, powerful interest groups, ignorant voters and bloated bureaucracies. Statecraft is a game of corrupt, power-hungry and deceitful rich people doing whatever necessary to remain in office. Now look at all the states that have ever existed in the course of history, including especially those states which claimed to govern according to the eternal, rationally discernible Catholic truths you advocate. Were they better? Did their actions and decisions accurately reflect the moral guidance of our souls? The state has been an instrument of destruction and pain for the majority of its history, before and after Aristotle and Plato. It's one thing for them to hypothesize about Republics led by philosopher kings, and quite another to put it in practice.

    When the state seeks to impose complex new regulatory schemes, build new bureaucratic agencies or launch tax-and-spend initiatives, you are wisely skeptical that it's an efficient or effective tool for implementing those plans. Why is it more efficient at legislating our personal morality? You express great doubt that the government can effectively manage schools or healthcare, but when it comes to regulating drugs or sex or war, you trust it to not only discern but effectively enforce this allegedly objective morality. Why?
  • You think "codifying some of these rationally discernible moral precepts in[s] to form the souls and consciences of the community to direct them to their proper end." I have two doubts about this.

    First, I think the list of objective truths which are rationally discernible is far smaller than you do, such that even rational, informed and well intentioned people can and do disagree on moral issues. Our opinion on these issues has far more to do with our unique upbringings, experiences and values than it does how rational we are. But we've already discussed this in person so maybe we're going in circles again.

    Second, even if there are as many rationally discernible objective moral truths as you say, and even if you're right about what they are, and even if you are able to get the government to codify them into law, what is your evidence that codifying helps convince the community at large of their veracity? It seems to me world history suggests just the opposite; the longer these conservative Christian moral precepts remain in effect, the more and more backlash they incite, and the more minds are pushed towards liberal conceptions of progress and tolerance. Do you deny that the past several centuries, and certainly the 20th century, have featured steady progress away from religious conservatism, both inside the government and outside of it? That doesn't mean religious conservatism is wrong, but it does cast doubt on the idea that codifying it "helps form the souls and consciences of the community."
  • You write "Far from doing violence against the individual, such legislations of morality serve as signposts in the right direction for individuals who threaten to do violence to themselves and their communities by their actions." I'm all for using the state to prevent individuals from doing violence to their communities, but even that definitely involves "doing violence against the individual." To advocate state enforced morality is to advocate doing violence against those who breach that morality. That's what enforcement consists of. Everything the state does is inherently violent, because the use or threat of force is the only thing that separates it from the private sector. That may be okay in certain situations, but you have to at least own up to it.
  • You insist "there is a right answer for everyone by virtue of our shared humanity...human liberty and diversity must be bounded by the constraints of our common humanity" - You're gonna have to be more specific than that if you want your ideas to catch on. To people who don't already agree with you, references to "shared" or "common humanity" seems like a bunch of flowery hand waving. What values underlie our humanity is a matter of great debate, so to me, this translates to "there is a right answer for everyone by virtue of what I think." By contrast, all I'm saying is "there is a right answer for ME by virtue of what I think." You needn't agree that's any different, but can you at least understand the moral intuitions about individuality and diversity that cause most people to find your assertion more troubling than mine?
You lapse back into abstract ruminations later on in your post as well. You opine that declining to imprison physicians who assist in suicide implies: 
  • "that suffering has no meaning"
  • "that suffering is meaningless before the abyss of nothingness that follows"
  • "that there can be no more "utility" further existence"
But imprisoning them implies:
  • "a search and a desire to find meaning and purpose,"
  • that "law can serve the end of showing that life has a purpose."
  • and it "says everything about what we say the dignity of life truly is as a society"
Say wha??? This is not an argument as presently formulated. You use the word meaning three times, and purpose twice, but never specify how suicide calls either into question. I too think life has meaning and purpose, and yet I disagree with you. Why does the fact that something has meaning signify that we cannot reduce its longevity? Is it suffering which has meaning, or life? If it's life, why must we speak in absolutes? Might some life be more meaningful than others? If it's suffering, does that include cases in which lessening it does not involve death? If so, isn't that the same logic that leads some religious fanatics to oppose medicine in general? Sure, Vicadin or surgery might help you fight your illness, but who are we to lessen the suffering which God hath ordained? Should we just pray instead? Perhaps that's not what you meant to suggest, but if not, you've yet to specify which suffering it is okay to lessen and which is it not.

Lastly, you accuse me of "going to such great lengths to find acceptable circumstances for physician assisted suicide." I go to exactly zero lengths: it should be legal in all circumstances. It should be legal for perfectly healthy people in the prime of their lives in no mental or physical pain at all - not because it is advisable or noble or brave or in any way good under those conditions, and not because the law should actively encourage it in any situation, but because banning it makes no sense. Even if it were my business, it is no deterrent! It is no "moral signpost" - just as criminals are not deterred from gun ownership by laws banning guns, suicidal people are not deterred from killing themselves by pious political finger-wagging. If banning suicide does not prevent or even decrease suicide (as you privately admitted to me in our conversation), why do you feel so compelled to write "suicide is bad" on a piece of paper and have the president sign it? Doing that neither bolsters the conviction of those who already think it wrong nor changes the mind of those who do not. It's just moral imperialism.

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