Recently a seventeen year old Dutch girl, who had been repeatedly
raped as a child and who suffered from post-traumatic stress disorder, anorexia
and depression, starved herself to death. This was widely reported as an
example of euthanasia, see BioEdge
. Simply starving oneself to death isn’t euthanasia. It was unclear in this
case whether her doctors helped to control her suffering. In this posting I want
to explore whether doctors who relieve the suffering of a patient who starves
himself to death should be regarded as assisting in suicide. In order to make
my argument I will first explore what can be considered as the legitimate use
of medical skills. Let us start with the premise that the decreasing of someone’s
suffering is a legitimate use of medical skills. However accepting this premise
is too simplistic. Surgery might actually increase someone’s suffering in the
short term and surgery is clearly a legitimate use of medical skills. Let us
revise the premise so that decreasing someone’s overall suffering is always
a legitimate use of medical skills when this is possible.
Let us now agree that decreasing someone’s suffering is usually
a legitimate use of medical skills but is it always so? I now want to
examine two arguments suggesting it isn’t. Firstly it might be argued that some
people deserve to suffer and that it would be wrong to alleviate their suffering
due to dessert. Consider a convicted rapist who became infected with HIV when
committing his crime. Let us assume that he is now serving his sentence in relative
isolation due to the hideous nature of this crime and as a result is unable to
infect others. Would treating him for his HIV would be an illegitimate use of medical
skills? What reason could be advanced for illegitimacy of treatment in this
case? It might possibly be argued that in this case the rapist deserves to be
HIV positive and that as a result treating him for this state should be an
illegitimate use of medical skills. This extreme example might concur with many
people’s intuitions but seems to run counter to the caring ethos of medicine. I
would argue linking the legitimacy of the use of medical skills to dessert is
problematic in all circumstances. Accepting that it is illegitimate to treat
some people whilst it is legitimate to treat others because of dessert appears
to imply that it is legitimate to use medical skills to achieve dessert. The
domain in which the employment of legitimate medical skills is extended from simply
treating suffering to treating suffering and ensuring just dessert. We might
link suffering and dessert together but nonetheless they remain independent
conditions. Someone can suffer without deserving to do so and someone may
deserve to suffer without actually doing so. If we accept that the legitimate
use of medical skills is linked to dessert in addition to suffering then
provided a death sentence could be considered as just it would be a legitimate
use of medical skills to carry out this sentence. An interesting account of the
death penalty and the proper ends of medicine is to be found can Silver (1).
Secondly it might be argued that medical professionals have
no duty to alleviate suffering when this is caused by self-harm and the
sufferer is fully aware his behaviour is the cause of his suffering. In
practice accepting this argument might mean that there is less of a duty to treat
conditions when these conditions are caused by alcoholism, obesity and anorexia. Clearly alcoholics, the obese and anorexics suffer even if this suffering is caused by their own
behaviour. What reason could be advanced as to why treating them would be regarded
as an illegitimate use of medicals skills? One reason might be that because their
suffering is self-imposed they can simply stop the suffering by changing their
behaviour and there is no need to employ medical skills. I’m doubtful whether
the eating habits of anorexics or the obese can simply change their behaviour and alcoholism is an addiction. However let us assume that someone’s
suffering is self-imposed and that can change his behaviour and he will cease
to suffer. In this context is the use of medical skills to alleviate his is an
illegitimate use? It might be suggested he deserves to suffer because his
suffering is self-imposed. However if we accept this suggestion it would
re-introduce all the problems of dessert outlined above. Both of the above arguments
as to why medical professionals don’t always have a duty to alleviate suffering
when this is possible appear to be unsound. It follows that we should accept
the premise that the decreasing someone’s overall suffering is always a legitimate use
of medical skills when this is possible.
I now want to consider the relationship between the relief
of suffering and voluntary euthanasia. In particular I want to focus on the
relief of suffering of those people who voluntary stop eating and drinking
(VSED). Most people who adopt VSED do so because they have a terminal illness
but this isn’t true in all cases as the Dutch girl shows. Let us assume that
the relief of someone’s suffering caused by VSED is assisting in voluntary
euthanasia. I have argued above that decreasing someone’s overall
suffering is always a legitimate use of medical skills. It follows relief of
someone’s suffering caused by VSED is a legitimate use of medical skills. It further
follows that assisting in voluntary euthanasia is a legitimate use of medical
skills. Some might be unhappy to accept these conclusions but being unhappy
about these conclusions has nothing to do with the logic of the argument or the
validity of the conclusions.
Lastly let us assume that the relief of someone’s suffering
caused by VSED isn’t assisting in voluntary euthanasia. If this is the case
then there would seem to be no reason to be unhappy about the deployment of
medical skills to alleviate someone’s suffering caused by VSED. However I find
hard to see how alleviating someone’s suffering, when this suffering is caused
by a desire to die, shouldn't be regarded as a case of physician assisted suicide without
using the principle of double effect.
- Silver D, (2003) Lethal Injection, Autonomy and the proper ends of Medicine, Bioethics 17(2), pp. 205-211.
