Assisted Suicide, Slippery Slopes and Empathic Caring

This posting is in part a response to a program on BBC 1 on Sunday 25 January 2009. This program is about the death of Dr Anne Turner who ended her life in Switzerland with the help of the Dignitas clinic. I want to use the death of Dr Turner as a starting point to examine slippery slope arguments. I will argue the success or failure of these arguments depends upon the moral background involved. However before proceeding it is important to make some distinctions. Euthanasia usually means helping severely-ill people die. This can be done at their request, voluntary euthanasia, or by taking a decision to withdraw their life support systems. Voluntary euthanasia can occur in two ways. Firstly actively killing the patient or secondly by providing him with the means by which he can end his own life. The latter might be more accurately described as assisted suicide. Clearly Dr Turner’s death was a case of assisted suicide.

There are generally two types of argument employed against the permissibility of assisted suicide. The first type is faith based. These arguments are usually based on beliefs concerning the sanctity of life or that God alone can decide whether someone should die. It might be remarked that many born again Christians, especially in the USA, have such beliefs but bizarrely also believe in capital punishment. It would seem that to some people such faith based arguments are in reality convenient rather than deeply held. I intend to ignore all faith based arguments and treat them as irrelevant. The second type of arguments, commonly used against the permissibility of assisted suicide, are slippery slope arguments. The central concern of this posting is whether slippery slope arguments against the permissibility of assisted suicide are good arguments.

There are basically two types of slippery slope arguments. Firstly some minor action may be wrong. Tolerating such a minor action leads to a slippery slope opening the way to some unwanted consequences. However it seems provided we ignore faith based reasons against the permissibility of Dr Turner’s assisted suicide that her action was not a wrong action when considered in isolation. Indeed I would argue when considered in isolation her action was both good and brave. Secondly some action, though not wrong in itself, causes other unwanted consequences. For instance it might be argued if we permit people like Dr Turner to undergo assisted suicide then old and vulnerable people will be encouraged to seek assisted suicide even if this contradicts their true wishes. It is only this second type of slippery slope argument I wish to consider.

Let us first consider the validity of the slippery slope argument in the context of a consequentialist account of morality. In this context the unwanted consequences of the slippery slope are harm to others. I will assume that if Dr Turner’s assisted suicide was considered in isolation it would be justified in consequentialist terms. Further it seems clear that the manner of her death cannot be said to directly cause vulnerable old people to seek assisted suicide against their true wishes. However let it be assumed Dr Turner’s assisted suicide means it is more probable that vulnerable people might be encouraged to seek assisted suicide against their wishes. The question to be answered is this, if we accept both the above assumption and adopt a consequentialist account of ethics is the slippery slope argument a good argument? Before answering this question I want to qualify the above assumption. It is clearly dangerous to equate someone’s wishes with his so called ‘true wishes’ when we in part define his ‘true wishes’ to be the wishes he would have had provided he thought more rationally about these wishes (1).  Clearly some people have a wish to end their lives peacefully and we disrespect them if we believe this to be a false wish. However I accept that Dr Turner’s assisted suicide means it is possible that some vulnerable people will be encouraged to seek assisted suicide against their wishes. It follows though Dr Turner’s action was not wrong when considered in isolation it might cause harm to others. Accepting the above leads to the following conclusion; provided the benefits of permitting assisted suicide are outweighed by the harms caused to vulnerable elderly people means the slippery slope argument may well be a good argument in a consequentialist context.

I now want to consider Dr Turner’s action in a different moral context. This context assumes that the basis of morality is based on caring. Further this caring is affective being based on either sympathy or empathy. Once again I will assume that Dr Turner’s action was not wrong in isolation. Is the practice of assisted suicide permissible in this moral context? Michael Slote defines an action to be morally wrong and contrary to moral obligation if and only if it reflects, exhibits or expresses an absence of a fully developed empathic concern for (caring about) others on behalf of the agent (2). I believe this definition adequately defines any system of caring morality subject to suitable substitutions, for instance sympathetic concern might be substituted for empathic concern. Prima facie it might be concluded using the above definition that any action, prohibiting a terminally ill patient who genuinely wishes to undergo assisted suicide from doing so expresses an absence of a fully developed empathic concern for the person involved. It follows in this context prohibiting assisted suicide is wrong and that Anne Turners actions were perfectly justified if we ignore any possible slippery slope arguments.

Are slippery slope arguments good arguments if our moral concerns have an affective basis? It is important to note that in an affective context slippery slope arguments take a slightly different form to the one used in a consequentialist context. In a caring context the unwanted consequences of the slippery slope are actions, not the consequences of actions, which fail to exhibit a fully developed empathic concern for others. It might be objected that in a caring context harm to others should be of prime importance. Prima facie it would seem that if caring actions are of prime importance that harm to others will be automatically considered. I will now consider two objections to the above conclusion. The first objection does not involve any slippery slopes. It might be objected empathic caring involves more than simply helping satisfy someone’s desires. For example desires such as Anne Turner’s desire to be assisted when committing suicide. Empathic caring is a deeper concept than it initially appears to be. Accepting this objection might mean it is possible to prevent someone from undergoing assisted suicide whilst still exhibiting empathic concern towards him. Secondly it might be objected, using a slippery slope type of argument, that if we permit assisted suicide due to our empathic concern for some individual we are lead to exhibit a lack of empathic concern for others in particular old and vulnerable people. I will consider the first objection first. There are two points that count against this objection. I have pointed out above it is dangerous to equate someone’s wishes with his so called ‘true wishes’ when we in part define his ‘true wishes’. If we come to equate empathic caring with being concerned with someone’s deeper desires might we not ourselves be partly defining these desires? In these circumstances might we not be accused of exhibiting epistemic arrogance? See my posting of parenting and excessive guidance . My second point is connected to my first and concerns autonomy. I am happy to concede empathic caring involves more than simply helping satisfy someone’s desires. However I am not prepared to concede empathic caring requires that we might give priority to acting beneficently, as defined by us, towards someone over respecting his autonomy. Indeed true beneficence would seem to be impossible without considering an agent’s autonomous desires, see for instance (3) I believe true empathic caring requires that we must give priority to respecting someone’s autonomy over acting beneficently, as defined by us, towards him; see my posting of caring, empathy and love. Once again if we fail to respect someone’s autonomy and instead satisfy his ‘true needs’ we might be accused of epistemic arrogance. It follows that prohibiting a terminally sick person who genuinely wishes to undergo assisted suicide from doing so expresses an absence of a fully developed empathic concern for that person. However the above arguments would fail if our moral concern was based on sympathy rather than empathy. It is possible to act sympathetically towards someone provided we suffer from epistemic ignorance.

It follows that in an emotive moral context whether assisted suicide is justifiable might depend on whether the emotion involved is sympathy or empathy. My remarks concerning epistemic ignorance suggest I prefer a morality based on empathy. I accept that our natural sympathy is the initial basis on which children start to make moral decisions. However as children develop they acquire greater cognitive skills and empathic caring augments their natural sympathy. Moral development is a natural process. Due to this natural moral development I believe empathic caring can form the basis of our moral concern.

I will now consider the second objection to the above conclusion. This objection argues that if empathic caring forms the basis of our moral concern then we might exhibit a lack of empathic concern for the old and vulnerable by permitting assisted suicide. It might be counter argued empathic caring naturally involves giving more weight to immediate concerns rather than theoretical or distant concerns. For instance we naturally have more empathy for someone we actually know rather than people we just know about. This is true but none the less someone might point out our more limited empathic concern about a large number of distant people might still outweigh our immediate concern for some individual we personally know. It appears to follow even if we have great concern for someone who wishes to undergo assisted suicide we might have greater still concern for the large number of vulnerable people who might be encouraged to seek assisted suicide counter to their actual wishes. However it seems to me anyone who employs this counter argument fails to properly understand empathic caring for two reasons. Firstly anyone weighing concerns as suggested above seems to be doing a calculus of empathic caring. Empathic caring employing such a calculus seems to become merely another form of consequentialism. Empathic caring is not a form of consequentialism, indeed it is partly a reaction to consequentialism. Secondly it might be questioned whether prohibiting assisted suicide is indeed a form of empathic caring for old and vulnerable people. I have suggested above that empathic caring might be a deeper concept than it initially appears to be. It seems to me true empathic caring involves actual involvement with old vulnerable people rather than simply banning some action which might or might not harm them. It follows from the above if our moral concerns are based on empathic caring that slippery slope arguments are not good arguments for the impermissibility of assisted suicide.

1. Berlin,1969, Four essays on liberty, The Clarendon Press, page 32.
2. Slote, 2007. The Ethics of Caring and Empathy, Routledge, page 31
3. Welie and Welie, 2001, Medicine Health Care and Philosophy 4(2), page 130