Assisted Suicide and a Life not Worth Living

Writing in theconversation  Lidia Ripamonti asks if assisted dying became legalised who should decide if a life is worth living. She is assuming that assisted dying would become available to those who have a life not worth living. It might be argued because of dangers of pressure being put on disabled people, the aged and those suffering from mental illness that any such decision should not be solely up to the patient. If not the patient who else can say her life isn’t worth living? Her medical team, her priest or a bioethics committee? Others telling a patient she has a life worth living when she has already decided her life is not worth living seems to be unacceptably arrogant. In philosophy how we frame a question is especially important if we want to draw meaningful conclusions. In this posting I will frame the above question slightly differently. I will then argue that in certain situations we should simply accept the patient’s decision.

If we simply accept the framing of Ripamonti’s question then it is possible to conclude that there may be dangers for the disabled, the aged and the mentally ill if assisted suicide became permissible. I now want to suggest that her question might be better framed Perhaps the question might be framed as follows. If assisted dying is legalised, who gets to decide if someone’s life contains unbearable suffering rather than her experiencing a life which isn’t worth living? It might be argued that if the permissibility of assisted dying is based on unbearable suffering that disabled people and those suffering from mental illness would be better protected because they can live enjoyable worthwhile lives. It might be suggested that others, such as a patient’s medical team, might be able to give an objective answer as to whether the patient is suffering unbearably. Unfortunately it seems impossible to give an objective answer as to whether someone’s suffering is unbearable. One person might find some suffering bearable whilst similar suffering would be unbearable to someone else. Whether suffering is unbearable is a subjective question. Others telling a patient that she doesn’t have unbearable suffering when she has already decided her suffering is unbearable seems to be unacceptably arrogant. It might be suggested that this difficultly might be addressed by replacing unbearable suffering in our amended question by unbearable pain. Perhaps we can measure pain objectively. I’m doubtful whether this might be possible but let us assume for the sake of argument that pain can be measured objectively. However even if this was possible it doesn’t help solve our problem. What matters to some is not the degree of pain alone or how long it will persist but someone’s reaction to it. As with suffering someone might find a pain bearable whilst someone else might find the same degree of pain unbearable. It appears to follow if we don’t want to be accused of arrogance that we cannot replace a ‘life not worth living’ with either ‘unbearable suffering’ or ‘unbearable pain’ in an attempt to reframe Ripamonti’s question.

Ripamonti is concerned that letting the patient solely decide if she has an unbearable life endangers the disabled, the aged and the mentally ill if assisted suicide became available. I accept that Ripamonti is correct provided assisted dying became available across a broad domain. I will now argue that in a restricted domain her concern seem much less pressing. No one is suggesting assisted suicide should be available to anyone who finds her life not worth living. Medicine is concerned with illness not social problems. Let us assume that assisted suicide should only be available to terminally ill patients capable of making a competent decision. If we strictly restrict the domain of patients who could avail themselves of assisted suicide in this way the disabled, the aged and the mentally ill would appear to have little to fear from the legalisation of assisted suicide. Unfortunately this restricted domain appears not to be restricted enough, some terminal diseases may kill someone but can take a long time to do so. For instance Stephen Hawking was diagnosed with motor neurone disease MND in 1963 but lived a highly productive life until his death in 2018. Perhaps then the domain of patients who should be limited to those who are autonomous with a terminal illness and who are expected to live less than six months. Accepting such a domain should protect those suffering from Alzheimers, the disabled, the aged and those suffering from mental illnesses.

However accepting this strict domain causes additional problems which are not easy to resolve. If the domain is restricted to autonomous persons then this restriction protects those suffering from Alzheimers. We don’t, or can’t fully understand what it means to suffer from Alzheimers. But does it always protect children? Consider two patients suffering from terminal cancer both of whom suffer identical pain and find their lives not worth living. Let us assume that assisted suicide becomes permissible but is restricted by the above domain. Let us also assume that the first patient is an adult and as a result is able to end her suffering using assisted suicide. Let next assume that the second patient is a child who because of her suffering also wishes to relieve her suffering by ending her life. Children are not usually considered to be fully autonomous and we have restricted the domain of patients who can avail themselves of assisted suicide to those who are fully autonomous. It might be questioned whether we are really protecting the child. We certainly aren’t protecting her from pain and suffering.

I have argued that autonomous adults with a terminal illness with a prognosis that they will live less than six months and who believe that their life isn’t worth living should have a right to assisted suicide. However because I argued that assisted dying should only be available to autonomous patients creates difficulties and doesn’t protect some patients from pain and suffering. What sort of responses might be made to these difficulties? One response might simply be that I am wrong and that the decision as to whether a patient’s life is not worth living should not be solely up to the patient. Accepting this response would mean Ripamonti’s question becomes pertinent again, who should decide. However I would be reluctant to accept this response because of the reason given above. If someone who is expected to live less than six months believes her life isn’t worth living then it might be asked what pertinent reasons could have others advance to say her life is worth living? Of course others might advance other reasons pertinent to the impermissibility of assisted suicide but these reasons are not pertinent as to whether someone’s life is worth living. It would appear that the decision as to whether a patient’s life is not worth should be solely up to the patient. A second response might be to drop the requirement that the terminally ill patient must be autonomous. Of course how a decision is made to request assisted suicide matters. If such a decision needn’t be an autonomous decision should be replaced by a good decision, I have argued elsewhere that autonomous decisions need not always be good decisions wooler.scottus . Let us accept that a good decision is not simply some decisions regarded as a good decision by the decision maker. Others must also be able to regard the decision as a good decision. However if we accept the above the following might occur. The patient might make a decision that her life is not worth living which she believes is a good decision whilst others believe her decision is a bad one and not in her interests. Once again we might question whether the reasons others give for her life being worth living are pertinent. If others cannot give such reasons then there replacing an autonomous decision by a good decision becomes meaningless. I have argued that if assisted suicide became permissible that initially it should only be made available to autonomous adults with a terminal illness and a prognosis that they will live less than six months and who believe that their life isn’t worth living. I have further argued that who decides if a life isn’t worth living is the person living that life.

What can we learn from the above except that applied philosophy is a messy business? Can any practical conclusions be drawn from the above discussion? First I would argue that the discussion shows how a question is framed matters. Secondly a tight restriction on the domain of people who can avail themselves of assisted suicide gives rise to difficult questions. Such a restricted domain would protect the disabled from exploitation whilst enabling those disabled who meet the criteria to avail themselves of assisted suicide. However such a tightly restricted domain would not protect other vulnerable patients from suffering such as children and those suffering from dementia. None the less I would argue that it is better to protect a limited number of people from suffering than none. Perhaps more work might enable us to extend this tightly restricted domain to others but extreme caution would be needed.

Prisoners serving Life Sentences and Voluntary Euthanasia

In previous postings I have suggested that prisoners serving life sentences have a right to be assisted to commit suicide, see Prisoners serving Life Sentences. In this posting I will argue that this right should only apply to assisted suicide and should not extend to euthanasia. Before commencing my argument I will make some definitions I will use clear. Euthanasia means someone deliberately ends another’s life to end his suffering. Involuntary euthanasia means this is done when he does not consent. Non voluntary euthanasia means this is done when he is incapable of giving consent. Voluntary euthanasia means this is done with his consent. Assisted suicide means someone deliberately provides the means for another to end his own life. I will assume without any further argument that involuntary and non voluntary euthanasia are inapplicable to prisoners serving life sentences. In what follows I argue voluntary euthanasia should also be inapplicable to such prisoners.

Let us consider a prisoner serving a life sentence for some gruesome murder of an innocent person. Let us further assume this prisoner decides he wants to die. Why if he fully consents shouldn’t someone end his life? One reason might be that, unless the prisoner was suffering, doing so would not be a case of voluntary euthanasia. Moreover, unless the prisoner was suffering, it is not clear what would be the motive of whoever carried out the act. The motive could not be one of punishment for punishment should not depend on the wishes of the prisoner. However let us now assume our hypothetical prisoner is suffering. Why in these circumstances, provided the prisoner fully consents, shouldn’t someone end his life? One reason might be that the prisoner’s suffering could and should be relieved by other means. If his suffering is caused by poor penal conditions then these should be addressed. Voluntary euthanasia should never be used to tackle poor penal conditions; even if it tackles overcrowding! Let us now further assume that the prisoner’s suffering is not caused by poor penal conditions. Perhaps his suffering is caused by mental health problems. If a prisoner suffers from a physical illness such as diabetes then his suffering should be addressed by medical means. Similarly I would argue if a prisoner suffers from mental problems his suffering should be addressed by mental health experts. Voluntary euthanasia should not be used to address mental health problems. Lastly let us consider a scenario in which the prisoner’s suffering is not caused by penal conditions or any mental health problems. Perhaps he simply does not want to spend the rest of his days in prison or more unlikely perhaps he suffers from remorse because of the terrible crimes he committed. Surely if assisted suicide is permissible in such circumstances then so should voluntary euthanasia? I will now argue that voluntary euthanasia should also remain inapplicable even in these circumstances.

In my previous postings I have argued that a prisoner should retain some limited autonomy. Part of that limited autonomy is the right to commit suicide. As the state deprives a prisoner of the means to commit suicide it should provide him with these means in a controlled environment. The prisoner’s right to be assisted to commit suicide depends on his ability to make an autonomous decision. At this point an objector might point out voluntary euthanasia also involves an autonomous decision. She might proceed to argue, if I use a prisoner’s retention of limited autonomy to justify assisted suicide that, the same justification could apply to voluntary euthanasia.

I have two responses to my objector’s argument. Firstly I would suggest we have no need to kill someone provided he can be assisted to commit suicide. My objector might respond by suggesting that there is no real moral difference between killing and assisting someone to die. This is simply a variation of the acts and omissions problem and I will not deal with his suggestion here. My second response carries more weight. I would suggest we can never be completely certain whether someone’s decision is an autonomous one or not. I will then argue we can be more certain that someone has made an autonomous decision to commit suicide than when he gives informed consent to voluntary euthanasia. I will base my argument on the importance of what we care about when making autonomous decisions, see (1). Frankfurt argues autonomous decisions are decisions the agent cares about. I have suggested that autonomous decisions are decisions which are not discordant with what the agent cares about, see autonomous decisions . However I would agree with Frankfurt by suggesting an agent’s actions are better indicators of his autonomous decisions than the choices he makes or what he decides to do. The choices he makes and what he decides to do are only intentions. Sometimes when we come to act we find we cannot carry out our prior intentions because it was not clear to us what we really care about until we came to act. A prisoner giving informed consent to voluntary euthanasia is making a choice and deciding what would be best for him. His intentions are of course an indicator of an autonomous decision. However in the light of the above a prisoner’s actions in committing assisted suicide are a much better indicator of his autonomous decision.

1. Harry Frankfurt, 1988, The Importance of What We Care About. Cambridge University Press, page 84.

Assisted Suicide and the Verbessem Brothers

Belgian twins, Eddie and Marc Verbessem, were euthanized at Brussels University Hospital last December. The brothers had been deaf since birth and had been recently diagnosed with a genetic form of glaucoma that would leave them blind. William Pearce comments that this case appears to mean the following holds in Belgian,

“Death is a logical and reasonable option if a person will become deaf-blind. By logical extension there are some disabilities that are a fate worse than death. One does not need to be terminally ill to be euthanized”, see Hastings Center Bioethics Forum .

In this posting I will argue even if death is a reasonable option it does not mean some disabilities that are worse than death. I will then examine if death is a reasonable option when, if ever, it is permissible to help someone die.

Pearce seems to believe that all voluntary euthanasia is wrong. In the rest of this posting I will assume voluntary euthanasia is roughly equivalent to assisted suicide and only use the latter term. There are of course some differences between voluntary euthanasia and assisted suicide but don’t I believe these differences significantly affect my arguments. Pearce suggests two reasons for the wrongness of assisted suicide. Firstly he points to research in Oregon where assisted suicide is legal which shows most people who chose to end their lives this way did so because of the loss of autonomy or dignity rather than unbearable pain. The implication of the above is he seems to believe loss of autonomy or dignity is not a good enough reason to justify assisted suicide. I agree loss of autonomy is not a reason that can be used to justify assisted suicide. However it is important to be clear what losing autonomy means. Losing the ability to participate in activities that made someone’s life enjoyable or a loss of her dignity is not the same as losing her autonomy. Losing autonomy means someone losing the ability to make decisions based on what she cares about. Secondly Pearce seems to believe that many of the conditions given as reasons for permitting assisted suicide can be alleviated and hence are not reasons that can be justified. For instance in the Verbessem case he points to the lack of skill centres devoted to the deaf blind. In response I would suggest one cannot say someone ought to do something on the basis of something that ought to be. The Verbessem brothers had to decide what to do on the basis of the circumstances that actually prevailed, not on the circumstances that ought to have prevailed. I of course accept it is possible a reason that is now used to justify assisted suicide may cease to be a reason if and when circumstances change.

It might be suggested that the Verbessem brother’s case implies that living with certain disabilities is worse than dying but this is not so. Clearly some people who are deaf-blind want to continue living and do not see this disability as a fate worse than death. Equally clearly some people would like to live as long as possible regardless of any disability or any disease they may be suffering from. It follows that any condition however bad or painful cannot be the sole reason to justify assisted suicide. What matters is someone’s attitude to her condition. For instance someone suffering from painful terminal cancer might just wish to die whilst someone else suffering from the same cancer might wish to continue living, perhaps for religious reasons. It would appear to follow what matters is someone’s attitude to her condition caused by disease or disability. It further follows assisted suicide is really being justified by someone’s preferences. However because, we do not have a reason simply to satisfy all of someone’s preferences, satisfying her preferences cannot be used to justify assisted suicide. It still further follows that Pearce is correct and neither loss of autonomy nor any condition, however awful someone suffers from, can be used to justify assisted suicide.

It seems to be if we can justify suicide that we should be able to justify assisted suicide. Clearly we have the capacity for rational agency. Joseph Raz argues we also have a duty to respect the exercise of this capacity by others within certain bounds because we value this capacity. Moreover he believes this exercise includes the option to determine when and how to end one’s life and that others may help us implement this option (1). I now want to consider two objections to Raz’s position. Firstly someone might object that euthanasia is not part of a rational person living her life. Raz might reply a rational person might nonetheless value she has the option to end her life, if it became meaningless and full of pain, whilst living her life. He might point out if someone values a right and the exercise of this right does not significantly harm others that we should respect her right. This could be classed as Mill’s position.

I now want to examine what is meant by significant harm in more detail. Firstly the fact that someone is offended, simply by another’s decision to commit assisted suicide, is not a great enough harm for her to fail to respect the other’s decision. The fact that someone is offended by another’s political views should not mean she fails to respect the other’s capacity to express these views. Nonetheless there are certain harms that would sometimes make the exercise of assisted suicide wrong. For instance it would seem wrong for a mother with dependent children to be able to be assisted to commit suicide. Or an aged parent who enjoys life but in spite of this enjoyment chooses to end her life solely to ensure her estate passes to her children rather than being dissipated on her care. However such examples don’t show assisted suicide is always wrong. They merely show, as Raz suggests, there are bounds as to when assisted suicide is permissible.

Should assisted suicide always be impermissible because of the harm it may inflict? In what follows I will argue assisted suicide should only be impermissible in specific cases due to specific harm relevant to the case in question. Let us accept that a complete ban on assisted suicide would prevent harming people such as those in the above examples. However I would suggest a complete ban on assisted suicide would also harm other people. For instance if someone who is terminally ill and in great pain, has no relatives, wishes to commit assisted suicide is prevented from doing so she is harmed. She is harmed not by the failure of society to permit others to help release her from the pain, someone else might well want to continue living even with the same degree of pain. She is harmed in two ways. Firstly she is harmed because society prevents her attaining something she values. Secondly and more importantly in my view she is harmed by the failure of society to recognise her as an agent. In this case she values something, which harms no specific person, but is nonetheless prevented from seeking what she values. It follows a complete ban on assisted suicide would harm some people. It further follows some assisted suicide is permissible.

The above suggests if all assisted suicide is impermissible some people would be harmed and if all assisted suicide is permissible others would be harmed. How is society to decide on which cases are permissible and which are not? I would suggest this decision should firstly be based on harm to others. I would further suggest this harm must be to those who depend on the person who wishes to commit assisted suicide, basically family members. However not all harms to family members make assisted suicide impermissible. Consider an aged woman, suffering from a painful terminal condition, who only has weeks to live. She wants to be assisted to commit suicide. In addition she is also a much loved mother and her adult children do not want her to commit suicide. However her children are not dependent on her any more and even if they will be harmed by her death I would suggest such harm is not so great to make her assisted suicide is impermissible.

Let us assume it is permissible for an autonomous person to commit suicide. If suicide is permissible for an autonomous person why should it be impermissible for someone to aid her to do so in some cases? In order to answer this question I will first consider what means to make an autonomous decision. An autonomous decision is not simply a rational decision. The rationality of a decision depends on how well it achieves the agent’s goals. In this blog I take a position similar to that of Harry Frankfurt. Autonomous decisions are decisions based on what an agent ‘cares about’. Caring about and autonomy are central to being a person.

“Can something to whom its own condition and activities do not matter in the slightest properly be regarded as a person at all. Perhaps nothing that is entirely indifferent to itself is really a person, regardless of how intelligent or emotional or in other respects similar to persons it may be” (2).

However sometimes someone may not be fully aware of what she cares about. She might make a decision based on what she believes she cares about but when she comes to implement her decision finds she cannot. Sometimes what someone cares about is shown more by her actions rather than her decisions. Accepting the above provides a reason as to why even if it is permissible for someone to commit suicide it is sometimes impermissible for others to aid her do so. Someone may make a decision to commit suicide but be unable to implement her decision. Accepting the above suggests if assisted suicide is ever permissible it is only permissible if someone makes an autonomous decision to commit suicide and is unable to implement her decision by herself. It further suggests if voluntary euthanasia is ever permissible it must be so only under the above conditions,

Does the greater certainty that someone’s actions are autonomous compared to her decisions mean we can never justify assisted suicide even for someone who makes, what we believe to be autonomous decision to commit suicide, but lacks the capabilities to implement her decision by herself. I accept that the conditions in which assisted suicide might be permissible are far ideal. Nonetheless even if these conditions are far from ideal I believe assisted suicide is permissible if someone makes a decision to commit suicide and is unable to implement her decision. My belief is based on centrality of autonomy to our lives, of seeing ourselves as capable of determining our own future. I would assume anyone who believes we should not permit assisted suicide does so for beneficent reasons. She believes in acting beneficently has priority over respecting autonomy, at least in this scenario. Some proponents of assisted suicide argue that, because we would not let animal suffer as we do some persons in some cases, we should permit assisted suicide. I have argued above that suffering alone does not provide a basis to justify assisted suicide. Nevertheless in much the same way I would suggest those who place greater emphasis on acting beneficently over respecting autonomy see persons in much the same way as they see animals. They fail to see, or only pay lip service to seeing, others as creatures who can determine their own future, see respecting autonomy and a flourishing society .

Accepting the above has three important practical consequences. Firstly, because our certainty about autonomous decisions is less than our certainty about autonomous actions, we must be extremely careful about assessing autonomous decisions. Unfortunately if autonomy is essentially a matter of someone’s will rather than her rationality this is far from easy to do. I have previously suggested this involves assessing someone’s satisfaction with her decision, see valid consent . Secondly it seems to me Brussels University Hospital can justify offering the Verbessem brothers assisted suicide. Provided the Verbessem brothers had made an autonomous decision to commit suicide which they could not implement. I am assuming in the above that anyone who is both blind and deaf would have difficulty in committing suicide. I do not deny that had there been more skills centres for the death blind might available to the brothers that they might have made a different decision. Unfortunately as I have argued above they had to make their decision in the light of circumstances in their case. Lastly and perhaps even more controversially assisted suicide might be offered to a broader domain of people than just the terminally ill. I have suggested myself that assisted suicide might be permissible for prisoners serving life sentences, see prisoners serving life sentences .

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1. Joseph Raz, 2013, Death in Our Life, Journal of Applied Philosophy, 30(1).
2. Frankfurt, 1999, Necessity, Volition, and Love, Cambridge University Press. Page 90.

Prisoners serving Life Sentences and Assisted Suicide

In his posting on practical ethics 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 Harrosh . 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 appears 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 those 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 in support of capital punishment and that I personally do not believe in such 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. Harry Frankfurt believes 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 (1). Christine Korsgaard believes that by choosing we determine our identity (2).  If we accept that Frankfurt and Korsgaard’s views are correct then were we to deny terminally ill patients the right to choose when to die then 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 suggest 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 most diseases or injuries must of necessity damage someone’s autonomy, diseases of or injuries to the brain might be exceptions. 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 treating 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 damaged moral persons rather than damaged persons. Korsgaard would disagree with my suggestion. However 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 health 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 have committed some terrible crimes they are not damaged as autonomous persons. The recognition of such offenders as undamaged autonomous 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 because 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 loses 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 as such 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 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 (3). In the above circumstances it would be hard to characterise the assisted suicide of an offender as capital punishment. Recently in Belgium Frank Van Den Bleeken who is serving a life sentence for rape and murder has been allowed by a court to undergo euthanasia, see bioedge . However I agree with Frankfurt that someone’s decision only show what he intends to will and in practice his decision may not always truly represent his will. For this reason whilst I believe offenders should have the right to commit suicide I would be doubtful whether this right should extend to euthanasia. 

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.

 

1. Harry Frankfurt, 1999, Necessity, Volition, and Love, Cambridge University Press, page 163.
2. Christine Korsgaard,  2009, Self-Constitution, Oxford University Press.
3. Frankfurt 1988, The Importance of What We Care About, Cambridge University Press, page 84