Wednesday, 21 July 2010

Prisoners serving Life Sentences and Assisted Suicide

In his posting on practical ethics of 23/06/10 Shlomit Harrosh connects the rights of death row inmates in certain states of the USA to choose the method of their execution and those of terminally ill patients choosing when to die, see http://www.practicalethicsnews.com/practicalethics/2010/06/choosing-how-to-live-death-row-inmates-and-terminally-ill-patients.html#more . Harrosh believes some personal autonomy is important even in the difficult circumstances of death row and that by choosing how to die a prisoner is to some limited degree choosing how to live as an expression of who he is and what he values as an autonomous agent.
“Like the choice of a last meal, the choice of method of execution is a final exercise in personal autonomy. Within limits, it gives prisoners the opportunity to choose the final experiences of their lives and express their values and preferences.”
Harrosh goes on to suggest that by choosing when to die terminally ill patients are making a similar choice.
“Terminally ill patients who choose voluntary euthanasia are similarly choosing how to live. The choice to hasten death is simply a means to an end: ensuring that their remaining time is lived according to their standards of a worthwhile life, expressing their values and preferences.”
Harrosh believes both of these rights have the same basis. He concludes if the right of death row inmates to choose between methods of their execution is permissible it follows that terminally ill patients have the right to choose when to die. I agree with Harrosh’s conclusion even though some might argue choosing when to die is not the same as choosing how to die.

The public at large seem to believe if some murderer, paedophile, terrorist or mass rapist attempts to commit suicide whilst in prison that no attempt should be made to prevent him doing so. In this posting I want to subject this common belief to some philosophical scrutiny. I will initially restrict my consideration to offenders who have committed terrible crimes which mean they will never be released from custody. In what follows offenders will specifically refer to offenders who never be released from custody unless I specify otherwise. Harrosh makes a connection between the right of prisoners on death row to choose the method of their execution and the right of the terminally ill to choose when to die. I want to connect the right of terminally ill patients to choose when to die and a right of offenders to choose when to die. In what follows I will propose if terminally ill patients possess a right to choose when to die then so should these offenders. At the outset I must make it clear this is not an argument for capital punishment and that I personally do not believe in capital punishment.

Do terminally ill patients have the right to choose when to die? Most people working in applied philosophy would accept this right and as a consequence I will only present a brief argument to support the right. Harrosh believes terminally ill patients have this right because they have the right to choose how to live their lives. I agree with Harrosh and would further argue these patients have the latter right because we should see such patients as the same sort of creatures as ourselves. Both Dworkin (1988, The Theory and Practice of Autonomy, Cambridge University Press, page 112) and Frankfurt (1999, Necessity, Volition, and Love, Cambridge University Press, page 163) believe the intrinsic value of our autonomy is connected to the recognition of us by others as the kind of creature capable of determining its own destiny. If we accept Dworkin and Frankfurt’s view is correct then were we to deny terminally ill patients the right to choose when to die we appear to be failing to accept these patients as the same sort of persons as ourselves. Someone might object this appearance is false and that we do see these patients as the same sort of persons as ourselves even if we deny them the right to choose when to die. He might argue we see ourselves as the sort of persons who can normally choose how to live our own lives but whom, if we became terminally ill, would have this choice restricted. I would counter argue due to our identity being so closely tied to our ability to choose if someone becomes terminally ill and his health is damaged and as a result his choices are restricted then even though he remains a person he is treated as a damaged person. I would further argue damaged health should not automatically mean a damaged person. My objector might now argue my argument carries little weight because I have failed to adequately specify what I mean by a damaged person. I accept his argument. I suggested above our identity as persons is closely tied to our ability to choose. I would now suggest this ability to choose is not just the ability to make any choice but an ability to make an autonomous choice. The above means a damaged person might be defined as one whose capacity to make autonomous decisions has been damaged. I see no reason why disease or injury must of necessity damage someone’s autonomy. It follows even if disease or injury damages someone’s health that it does automatically damage him as a person and that we should continue to treat him as such. Let it be accepted without any further argument that terminally ill patients do have the right to choose when to die because they have the right to choose how to live their lives. However it is certainly not true that offenders have the same rights as the rest of us. My objector might now argue even if not all terminally ill patients are damaged persons all offenders are. I would reject such an argument as I have defined damaged persons as people whose capacity to make autonomous decisions has been damaged. I would suggest for the most part these offenders are bad persons rather than damaged persons. None the less I must accept some offenders are damaged persons unable to make autonomous decisions due to physiological or psychological conditions. I believe such offenders should be in secure mental institutions such as Broadmoor rather than normal prisons. In the light of the above I will limit my discussion further to offenders in a normal prison who will never be released. I believe we should see such offenders as basically the same sort of people as ourselves, autonomous persons. Indeed history teaches us that evil is not usually perpetrated by people who are vastly different from ourselves. The Milligram Experiment further supports this point, see my previous posting. It follows even though these offenders they have committed some terrible crimes they are not damaged persons. The recognition of such offenders as undamaged persons means we should accept that they retain some choice about how to live their lives provided these choices will not harm others. For instance they may have the choice of attending religious services, which library books they choose or attending literacy classes. Should these limited choices include the right to choose to die?

The answer to the above question depends on why we send offenders to prison. We send offenders to prison for three reasons; firstly to protect ourselves, secondly to punish the offender and lastly to rehabilitate him before he is released. We can disregard the last reason in this discussion. Prima facie if we should treat offenders as persons like ourselves then these offenders should retain all choices about how to live their lives provided these choices don’t endanger the public at large or detract from any punishment involved. Clearly giving offenders, who will never be released from prison, the right to choose when to die will not endanger us. The only question that remains to be answered is whether giving such offenders the right to choose to die detracts from their punishment? The answer to this question is not clear cut. Let it be accepted our sense of common humanity, our sense of seeing others as persons rather than monsters, does not permit us the option of cruel punishments such as simply putting an offender in a cell and metaphorically throwing away the key. It follows we must give offenders some quality of life including limited choices about how to live their lives. Provided prisoners must have some quality of life and enjoy certain limited choices it seems to me giving offenders the right to choose to die does not detract from their punishment. In the light of the above it might be concluded if the terminally ill have a right to choose when to die then so do offenders who will never be released from prison.

I will now consider four objections to the above conclusion. This Blog is concerned with applied philosophy and someone might object it is pointless to give rights to people who will never use them. In particular it might be argued even if such offenders are the given the right to end their lives that in practice they will never avail themselves of this right. However there is some empirical evidence to show that at least some such offenders desire to die. Consider for instance consider the cases of Fred West the Gloucestershire builder who murdered 12 people and Harold Shipman who had 215 murders ascribed to him who both committed suicide in prison. Further evidence is provided by the need to place some prisoners on suicide watch.

Our objector might advance a second objection. He might point out there are a lot of mentally unstable people in prison and invariably among these people there will be some offenders who will never be released. Some of this mental instability may be due to depression. He then might argue if we give these offenders the right to choose to die rather than face life long imprisonment that some of those who exercise this option will not have made an autonomous choice due to depression. Indeed he might still further argue that if this option is made available some of offenders might feel they are being pressurised into taking it. If offenders are simply offered this choice then I believe this is a perfectly good argument. However I believe the argument looses its validity provided some safeguards are introduced. These safeguards must ensure that only offenders capable of making an autonomous decision are offered this choice. Our objector might now introduce a counter argument. He might argue these safeguards would involve counselling the offenders to ensure they can make an autonomous decision and that counselling is expensive. He might then proceed by arguing such offenders do not merit such expense and hence conclude these safeguards should not be introduced. In reply to this counter argument I would make two points. Firstly I would point out keeping people in prison for a lifetime is very expensive. If an offender who will never be released chooses to die his choice saves the taxpayer a great deal of money even if this choice includes expensive counselling. Secondly and I believe more importantly I would question whether these safeguards really need to include expensive counselling. For I would suggest all that is needed for a decision to be autonomous is that it is wholehearted and un-ambivalent. I would suggest if an offender expresses a constant un-ambivalent desire to die over a period of a few months, then his decision is an autonomous one and ought to be respected. Our objector might respond that my suggestion means a severally depressed offender might choose to die. In reply I would simply point out being depressed may well be the natural state of affairs for such an offender and suggest his depression does not preclude him from making an autonomous decision to die.

I have argued the reason why we should allow such offenders the right to die is based on their autonomy. I further argued that the basis of autonomy is seeing others as basically the same sort of persons as ourselves. However our objector might mount a third objection. He might argue if we allow these offenders the right to die then we are sending them a message that even at this basic level they are not the same sort of persons as ourselves. He might point out if we saw someone about to jump from a high building we would try and talk him down rather than simply pass by or tell him it’s his choice whether to jump or not. Indeed our objector might accuse us of double standards. The same objection might also be made if we allow terminally ill patients to choose when to die. I would reject his objection by arguing the difference in our attitudes is due to a difference in circumstances rather than a supposed difference in persons. An offender may be depressed and as I have suggested this depression may be both natural and normal considering his circumstances. His depression may be natural because his ongoing circumstances will not significantly change. Someone about to jump from a building may also be depressed but his depression may not be natural and certainly need not be ongoing as his circumstances might change. These different circumstances mean the offender’s decision, subject to certain safeguards, is an autonomous one whilst the decision of the man about to jump from a high building may not be. An autonomous decision is a constant un-ambivalent decision. If we permit an offender to die we can be fairly certain his decision is an autonomous one because the prison authorities would require that he had expressed an un-ambivalent desire to die over a period of some months. The same requirement cannot be applied to someone about to commit suicide by jumping from a high building.

Our objector might now point out, offenders do not have a handy means of suicide readily available, and that if my conclusion is accepted the means of suicide would have to be approved of and brought into prison by the relevant authorities under strictly controlled conditions. I accept the objectors point. He might then use this point to raise a fourth objection to my conclusion. He might argue accepting my conclusion reintroduces capital punishment by the back door and once again accuse me of double standards due to my stated opposition to capital punishment. In reply I would reject his argument by firstly pointing out capital punishment is imposed and not simply optional. Secondly I am not proposing that the prison authorities kill these offenders even with the offender’s approval. I am proposing that the prison authorities make the means of suicide available to such offenders in controlled circumstances. These circumstances might be the much the same as those in the Dignitas clinic in Geneva. The person committing suicide in this clinic takes an anti sickness drug followed half an hour later by the overdose that kills him. In similar circumstances the offender would not have the drugs administered to him but would have them provided for him to take them himself. The fact that these drugs would be self administered would be an important additional safeguard of the offender’ autonomy, for often someone may believe he should take some course of action but when he tries to implement this action finds he cannot. For as Frankfurt (1988, The Importance of What We Care About, Cambridge University Press, page 84) points out someone’s decision only show what he intends to will and that when he attempts implement his decision he might be surprised to find out his decision does not in practice represent his will. In the above circumstances it would be hard to characterise the assisted suicide of an offender as capital punishment.

In conclusion it appears all my imagined objector’s objections remain unconvincing. Finally I wish to consider an additional reason to that of the offender’s limited autonomy to support my position. Harrosh suggests if a prisoner on death row chooses a method of execution involving greater suffering that his choice can be a form of atonement. I would extend Harrosh’s suggestion further by suggesting if an offender chooses to die this might also be a form of atonement. In practice I don’t believe the need for atonement would be a major factor in decision making of most these offenders’ decisions to die. Rather it would be a desire to escape from life long imprisonment. None the less I believe it might be a factor in some such cases. Such atonement should be accepted not only because it is an expression of an offender’s limited autonomy but also because the acceptance of responsibility by the offender for his offences is something which may benefit the victim or victim’s relatives.

No comments: