Assisted Suicide and the Nationalisation of Morality

The Commission on Assisted Dying published its final report on 05/01/12. This report suggests a framework which would permit people with a terminal illness to be assisted to end their lives whilst protecting those who are vulnerable. I have argued in a previous posting, see Assisted Suicide, Slippery Slopes and Empathic Caring , that if we have true empathic concern those with a terminal illness it should be possible to assist them in this way. I will not repeat my arguments here. Instead I want to concentrate on one of the reasons given as to why this assistance should not be forthcoming. I accept of course that a purely private morality is nonsense but I will argue society as a whole cannot determine our morality, society as a whole can of course influence it. However, even if a purely private morality is nonsense so too is the idea of a national morality, any morality must include personal acceptance. The idea of a national morality is dangerous one.

George Pitcher writing in the Daily Mail concerning the death of Geraldine McCelland at Dignitas clinic in Zurich, see Geraldine-McClellands, asks us to consider two statements.

"You are in pain and feel humiliated. We agree with you that your life is not worth living. It's your life to do with what you wish, so go ahead and kill yourself. We will help you.

Or:

"You are in pain and feel humiliated. But your life is infinitely precious and is of equal value to anyone alive. We will support you and cherish you, but we won't help you to kill yourself. We will help you."

He goes on to state it is the second statement that that our society should offer as its moral choice. And it's the one which should continue to be protected in our law. In the above Pitcher goes seamlessly from offering us two statements to talking about moral choice. All choice moral or otherwise must involve options. If Pitcher really believes society should offer the terminally ill a moral choice then what are the options related to that choice? It seems to me the only choice Pitcher and those who hold similar views to him is between dying alone, probably in great pain, and receiving palliative care. This is not a meaningful choice. Of course society doesn’t always have to give its members choice. We cannot choose to drive at any speed we would like to on a motorway for instance. However ever since Mill it seems to be generally accepted that in a free society individuals have a right to make personal choices provided these choices do no significant harm to others. Indeed I would argue it is a necessary condition for a free society. Any society that does not permit individuals the right to make such choices is not really a free society. It may of course be a caring society. For instance such a society might prohibit the consumption of tobacco. However in such a society the state makes moral decisions rather than individuals. In the case of assisted suicide society is saying to those with a terminal illness we will help you but only as society sees best. I would suggest that such a society has nationalised morality and the result might possibly be a deeply caring society but it certainly is not a truly free society.

Someone like Pitcher might object that such a society is both a free and caring society by allowing people only to make choices that are best for them. The trouble with this argument is that someone is not really free if his choices are restricted to what is good for him. My objector might respond that someone should not be able to choose assisted suicide because it isn’t good for him but rather because such a choice harms others. His objection seems to be based on the premise that if the terminally ill can commit assisted suicide then the weak and the vulnerable are harmed. I will assume the reason they are harmed is because they might feel under pressure to do likewise. It is this reason I wish to question.

I now want to consider why the weak and old might feel under such pressure. I will not use the term ‘the vulnerable’ in this context because to be vulnerable is to be susceptible to pressure and it is this susceptibility to pressure I want to question. The weak and the old might feel vulnerable for two reasons. Firstly someone may feel vulnerable simply because he is weak or old. Secondly someone may feel vulnerable for some reason connected to their age and weakness but that reason is not simply one of age or weakness. For instance someone may feel vulnerable because he needs a catheter inserted up his penis due to old age rather than simply because he is old. I want to consider the second reason first. In its evidence to the above commission The British Geriatrics Society,

“emphasised the negative impact of low quality care, and the feeling they are not valued by society, on older people’s decision-making processes: In the experience of many geriatricians, the feeling of many older people that life is unbearable in its later stages is a direct result of the reaction of others to their frailty and the care and treatment they are afforded. Our concern then is that many older people, because of the care given to them by society in general and the NHS and Social Care system in particular, will perceive themselves as a burden and feel under pressure to end their lives.”

Perhaps then the weak and old might be vulnerable because they aren’t valued, they are simply existing. They have, to borrow a phrase, an unbearable lightness of simply being. According to Pitcher our attitude to the terminally ill should be one that sees their lives infinitely precious and of equal value to anyone alive. We should support and cherish them. Perhaps then this should be our attitude to all the old and weak rather than just the terminally ill. If the old and weak are supported and cherished they should not see themselves as a burden and hence should become less vulnerable. In which case there would be no need to protect them from feeling under pressure to commit assisted suicide provided this option was available.

My objector might respond even in this improved situation an old man with a catheter up his penis may still feel under pressure to take his own life. I agree he might well want to take his own life. But I would deny he is under pressure to do so. Clearly if we see the lives of the old as infinitely precious and cherish them this old man is not subject to outside pressure. If my objector replies he is under pressure from himself then I would suggest my objector doesn’t understand pressure. If my old man wants to take his own life and is under no outside pressure, he simply desires to take his life and the idea of pressure is irrelevant. I would suggest again that if we really think the lives of the terminally ill are precious then we should also think the lives of the weak and old are precious and hence address the causes of their vulnerability rather ban assisted suicide the terminally ill.

Now let us consider the second scenario in which a few of the weak and old might be vulnerable simply because they are weak and old. In this second scenario I am perfectly willing to admit again that someone who is weak or old might want to commit assisted suicide. But his want is once again caused by his desire due weakness and age not by pressure. I would suggest he would have this desire irrespective of whether or not the terminally ill can commit assisted suicide. Of course if the terminally ill can commit assisted suicide some of old and weak might claim it is a matter of justice that they can also do so. I will not enter into this debate here.

To conclude the following seems to hold. Opponents of right of to the terminally ill to commit assisted suicide argue that this practice should be illegal in order to protect the weak and old. They argue we should do this because we are a caring society. I have argued that provided we do care for and cherish the weak and old, in practice rather than simply talk about doing so, then the weak and old would feel under no pressure to commit assisted suicide even if the terminally ill could do so. If we ban assisted suicide for the terminally ill in these circumstances we have restricted freedom in our society because of a false illusion. If however we do not care for and cherish the weak and old, but nonetheless insist on banning assisted suicide because of the harm that might come to them, then we might rightly be accused of hypocrisy.