Memorandum by the Centre of Medical Law
and Ethics, King's College London
The issues raised by the Bill divide into those
concerning fundamental moral principles and those about possible
risks and dangers if the Bill is passed and how they compare to
the possible risks and dangers of the status quo.
1. FUNDAMENTAL
MORAL PRINCIPLES
Supporters and opponents of the Bill tend to appeal
to different basic moral principles. Those who support the Bill
usually give great emphasis to Autonomy and to Preventing
Avoidable Suffering. Those who oppose the Bill usually give
great emphasis to the Sanctity of Life. People on both
sides appeal to Respect for Dignity. There are questions
to ask about the principles invoked.
(a) Autonomy
This part of the case for the Bill is that it
respects the autonomy of the terminally ill person. (This line
of thought was encapsulated in the title of the play and film
Whose Life is it Anyway?) This was part of the case for
removing the legal prohibition against suicide, and the present
Bill can be seen as an extension of this. People able to commit
suicide are legally allowed to do so, and the Bill would extend
the same control over their life and death to those not able to
commit suicide without assistance.
Critics of the appeal to autonomy make the point
that respecting someone's autonomy is most often a matter of not
preventing them from doing something. For society to respect autonomy
in matters of religion is to allow people to build churches, synagogues
and mosques as they please and to allow them to practice their
religion unimpeded. It does not require society or anyone else
to assist them in worship or to provide them with facilities.
On the other hand, providing facilities such as wheelchair access
is often seen as required by respect for the autonomy of people
with disabilities. There is controversy over the line to be drawn
between what kinds of positive assistance are or are not required
if someone's autonomy is to be respected.
(b) Preventing Avoidable Suffering
This part of the case for the Bill appeals to
the humanitarian thought that, if someone is suffering, it is
desirable to stop their suffering if it is possible to do so.
Here "suffering" can mean physical pain or other, psychological,
distress. Few would dissent from the principle as stated, but
critics say that sometimes there are other, less drastic, ways
of avoiding suffering. (How often this is so is a disputed issue
of fact.) Critics also point out that the humanitarian thought
has a suppressed "other things equal" clause. A lot
depends on what means are needed to eliminate suffering, and what
are the costs (not in any limited financial sense) of those means.
The central disagreement is whether it is acceptable to end someone's
suffering by ending their life. The humanitarian principle may
come into direct conflict with the principle of the sanctity of
life.
(c) The Sanctity of Life
The sanctity of life is not normally interpreted
to mean that any life ought to be preserved at all costs. It is
normally restricted to human life (though supporters of animal
rights query this). And it is normally interpreted to prohibit
absolutely the intentional killing of innocent human beings. ("Innocent"
allows the possibility of killing, for instance, in a just war.
Someone who is part of an army committing an unjustified act of
aggression is not in this sense "innocent".) The phrase
"intentional killing" allows for two other possibilities.
Allowing someone to die is distinguished from killing. And some
doses of pain relieving drugs have the foreseen consequence of
accelerating death, but if the intention is only to relieve pain,
this is not intentional killing.
Critics of the sanctity of life say that "sanctity"
suggests a religious prohibition and that in a society with a
plurality of religious and non-religious views, particular religious
prohibitions have no place in the law.
Others question whether the distinction between killing
and letting die is a clear one and whether it is a distinction
that really has moral importance. Critics also claim that the
contrast between consequences that are intended and those that
are foreseen but unintended is a distinction without a difference.
(d) Respect for Dignity
Some of those who request assisted suicide do
so less because they wish to avoid suffering than because they
wish to avoid the indignities of incontinence and of other forms
of loss of control.
Opponents of assisted suicide sometimes say
that respect for human dignity requires absolute respect for innocent
human life.
It is clear that different conceptions of what
human dignity is are in play in the debate.
2. RISKS AND
DANGERS
Supporters and opponents of assisted suicide
also disagree about the relative risks and dangers of enacting
the Bill as against the status quo.
Supporters cite the danger of the law being
made to look an ass, or at least out of touch, when there is a
wave of public sympathy for someone in a distressing state and
yet the law does not allow their request to be helped to die.
This may lead to doctors furtively doing things to get round the
law, which may not enhance the standing either of the law or of
the medical profession. It may lead people to go to other countries
to obtain the assistance that is illegal here.
Opponents cite the danger of a slippery slope.
Will legalizing assisted suicide or voluntary euthanasia lead
on to legalizing euthanasia without the request of the person
whose life it is? There is the memory that the Nazis murdered
70,000 psychiatric patients in the name of "euthanasia".
On the other hand, there is a question of how we tell which slopes
really are slippery. (There are factual disputes about whether
the experience of the Netherlands tells for or against the slippery
slope argument.)
Opponents also cite the danger of medical professionals
feeling obliged to act against their own religious and/or moral
convictions. And they cite the dangers of people being pressured
by family members to request assisted suicide. It is clear that
family members could have motives for this: either financial motives
or the desire to be rid of a burdensome relation. We will make
some brief comments on whether the Bill contains adequate safeguards
to meet these concerns and make some comments on the experience
in other jurisdictions.
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