Rethinking the Legitimacy of Assisted Suicide

                              Edmund Daleford

                     Issue XV--  June 27, 2003

Over nine months ago, within the pages of this very publication, I had argued for granting  the moral and legal sanction to the process of voluntary, consensual assisted suicide in "Daleford v. Stolyarov: A Euthanasia Debate." My chief arguments were deeply theoretical and fundamental. Man holds a property over his own life, and it is his, not the state's, to dispose of. Moreover, there exist conditions, of "negative value," in which the state of zero value that is death is preferable. Examples of such cases may include a patient whose terminal paralysis has deprived him of prodigious value-producing capacities earlier possessed.

On an extremely basic level, especially under a government which adheres to the premise of man's full control over his existence (which no government today does to any admirable degree), these arguments are comprehensible. But today, given the nature of statist health care, are they implementable? This was what had given rise to a question whose resolution had brought me closer to Mr. Stolyarov's viewpoint on assisted suicide than I had expected. Namely, I have become convinced that, in today's abusive, inhibitive milieu of  bureaucratic imposition, legalizing assisted suicide would thwart the very principle under which Objectivists and Libertarians advocate this course of action.

In the majority of situations to which assisted suicide is applicable, the patient is not a man in the prime of his life, nor as physically and mentally competent as he had once been, due to either the complications of his disease or the psychological damages resulting from it. Such illnesses often exhibit a terminal and irreversible nature (among them are cancer and paralysis) and occur without extensive warning. It is infrequent that one would state, in writing, during a time of health, "In the event that such and such circumstances come about, I would like to be euthanized." In the full exercise of volitional consciousness, this consent is conceivable. But, in a state of severe illness and injury, the patient may be physically or mentally crippled from either voicing his request or deprived of the very ability to decide on this matter.

This is a position that statists are lunging lustily to exploit by means of the notion of "substituted consent." John Walker, author of "On Assisted Suicide," explains.

"Under this doctrine, we establish a legal fiction whereby others (whether family, physicians, special committees, or the courts or other agencies of government) are deemed to make the judgment 'as if' the individual had made it. Some of these proposals at least make some deference to individual rights by calling for preceding mechanisms such as living wills and durable powers of attorney. Some proponents of assisted suicide, however, are clearly willing to have decisions take place on the basis of what they think people 'ought' to want. The decisions of 'professionals' are frequently advanced as the preferred mechanism for deciding who is killed (by passive or active means) and who isn't. In an age of government-funded and government-controlled healthcare, the threat to the individual is obvious."

To advocate the idea that an individual holds a property in himself implies, automatically, that no one else does. "No one else" includes parents, spouses, children, siblings, and physicians. Even those assuming legal guardianship over an individual without full capacity to exercise his volitional consciousness (such as a child who is suffering severe physical/cognitive deformities) cannot negate the fact that they do not own the individuals they steward. Philosopher John Locke, in examining the nature of parental oversight, for example, observed that, while parents can legitimately restrict children from those undertakings for which their minds are not yet adequately developed, they cannot deprive them of property already held. The food, shelter, and physical safety that parents have granted their children are property of the children, as are the children's lives and bodily integrity. While a father can forbid a child to attend a decadent party, he cannot beat him or kill him. He must discipline to prevent the commission of harm, not to inflict it, for whatever considerations.

Hence, any notion of "substituted consent" is immoral. To assume that any individual's life is not worth living on the part of anyone but that individual himself is to propose the primacy of the collective over the individual, is to expound the bloodied-altar doctrine that it is permissible to sacrifice one for the stability or "general welfare" of someone or something else.

As Mr. Stolyarov most eloquently points out, this applies in relation to even so small a group as a family. "The calculus that one would wish to die in order to "not burden his loved ones" is but another example of the sacrificial altruism/collectivism of the death premise. A rational man will prioritize his values in the following manner: his own life, then that of the people from whom he derives friendship, comfort, assistance, and pleasure. Therefore, all of the financial resources that are legitimately his should rationally be devoted to prolonging his own life and pursuit of values. To love one's family is a virtue; both parties receive material and emotional commodities from the relationship. To sacrifice to one's family is a vice; one surrenders one's own existence, prosperity, and integrity to receive nothing in return from those one supposedly 'loves.'"

And there exists no greater sacrifice than that of one's own life. For a family member to presume that this is what the individual would have desired in a competent state is to commit the most atrocious moral and legal abuse, not merely a violation of rights, but a thorough effacement of any shred of the targeted individual's dignity. Man, recall, is a rational being, and to be held as possessing rational pursuits unless demonstrated otherwise. The presumption that one would "wish to die" under any circumstance is tantamount to assuming that the nature of one's relative is essentially irrational, and is the most repugnant betrayal of a family member's trust and confidence that could ever occur.

Can someone in such a paralyzed state truly give consent to terminate his very being? All indications of his behavior are to the contrary. The diseased man or the cripple demonstrate a willingness to live by the very fact that they are not dead! All of their bodily processes (many of which, in any condition, still function properly) are directed toward the functions of life, eating, breathing, thinking (to the extent the patient can think), toward holding on to the thread of hope and the morsel of volition still present. Death is what ultimately curtails volition and movement. While those exist, and while the man, with body and mind, shows no indication to pursue them (or resists automatic movement in that direction), then it cannot be said that he has given consent to be euthanized.

While "substituted consent" is both an abhorrent evil and a metaphysical misnomer, the government of today, more so than any family, no matter how inconsiderate, leaps for joy at its existence. The state of the practice in the Netherlands is a forewarning to what will occur if the United States at large legalizes euthanasia. According to Walker, "The situation in Holland is already well known. Even when patients have explicitly insisted that they be kept alive, and even when their own physicians have supported that decision, people have been put to death because others knew 'better' — or wanted to open up bed space more quickly." Any time "substituted consent" enters the picture, the considerations of the individual are inevitably subordinated to those of them who give the consent. In the very act of substituting consent is implicit the premise that the individual's life is not the prime value, that something else can take precedence. Involuntary euthanasia is merely the taking of this premise to its logical conclusion.

Just how large this phenomenon has become was presented to me by Mr. Stolyarov in our discourse. According to Terence Monmaney, Medical Writer for the Los Angeles Times, "Chris Rutenfrans, a criminologist in the Department of Justice in The Hague, said that their analysis shows that nearly half of all doctor-assisted deaths in the Netherlands in 1995 (2844 out of 6368) were not voluntary. 'In too many cases,' he said, 'it is the physician who decides.'"

And what would motivate the physician to decide so, especially considering that a continued relationship with the patient would bring him greater profit than just a one-time installment for administering the euthanasia? This is where the horde of government "incentives" comes into the picture, the bonuses for "not spending too much" on any given patient, which are stimuli to killing him outright rather than continuing to administer treatment, the fear of frivolous "malpractice suits" from living patients (who are now guaranteed by law hefty millions in winnings if they win the jury's emotional appraisal), the rationing of essential medical supplies by the government which prevents the patient from being treated as the physician sees fit and leaves only the option of immediate death by euthanasia or slow, grueling death from the intensification of a curable disease, the vast waiting lists caused by the state's suppression of competition in medicine and the compulsion inflicted upon physicians to respond to these lists in a cursory, not-too-thorough manner. As government further creeps into the field of medicine, the profit motive begins to lose relevance. It is replaced by another-- fear.

The entirety of the medical profession today is dominated by this fear of bureaucratic retribution against doctors who do not mercilessly and drudgingly adhere to the state's impositions. Should assisted suicide become legalized today, it would be naive to presume that it would not be affected by the same circumstances. This is already occurring in Oregon, the only state which has legalized assisted suicide. John Walker explains.

"In Oregon, the Health Services Commission decided in 1998 that lethal doses of prescription drugs should be provided as a welfare benefit for the poor. Government, which outlaws easy access to pain killers, does not want to be 'uncompassionate' by denying tax money to end the lives of those in pain. Libertarians object both to the principle of welfare and to its still-increasing cost. Let us hope few libertarians believe in capital punishment for welfare recipients. Government is not apt to be so compassionate when it wishes to cut costs."

Implicit in the philosophies of welfare and Medicare is that "the needy" can obtain medical treatment at taxpayers' expense. Extended to euthanasia, this doctrine preaches that "the needy" can be killed at taxpayers' expense, and that it is a society's duty to cleanse itself of "undesirables." But, just as Medicare patients today receive not what they truly desire or objectively need, but rather what is least costly for the state to provide (especially if the newest adjustment to the program will be passed, which effectively bars seniors from selecting their drugs and type of care), so will they continue to fall prey to the "need-balancing" calculus of bureaucracy in the event assisted suicide is legalized. Only here, the bureaucrats will decide whether to balance a patient's life against the next year's budget surplus. And they will have a clean, expedient, permanent means toward securing the latter. Such is the inevitable consequence of government meddling in men's pursuit of their own lives.

Any given policy is desirable only in the proper context. One who opposes gun controls in the United States, for example, would not conceivably argue for the same liberalization in Iraq, which Saddam Hussein, several months ago, would have employed to organize efficient channels of training for local terror militias in every community. Someday, perhaps in thirty to fifty years, welfare and Medicare are abolished, "substituted consent" is declared the criminal equivalent of murder, and an Objectivist sits in the Oval Office, it may be safe to permit consensual assisted suicide without bringing about the "slippery slope," the decline into a situation too eerily reminiscent of the dystopia in Lois Lowry's The Giver, a novel where a futuristic society's senior citizens are "released" from life due to the general public's "inconvenience" experienced in administering care to them.

But for the time being, assisted suicide must remain illegal. This may result in gruesome scenarios of personal suicide on the part of those who relentlessly pursue it, such as the bloody death of Dr. Percy Bridgman in 1961. Nevertheless, the majority of assisted suicides in Oregon, our perhaps most reliable source for a case study, occur, according to anti-euthanasia activist Wesley Smith, out of a desire "not to burden one's family," which, as shown above, is an immoral, sacrificial mindset. Would this motivation play out to its grim conclusion absent a legal sanction? Mr. Stolyarov's response to this question yields some profound food for thought. In regard to Dr. Bridgman's gruesome self-inflicted shot in the head, "it is precisely because such a choice is most repulsive that it is preferable in the realm of suicide choices to a clean and tidy euthanasia. Do you understand the deterrent effect it would create for men inclined toward self-destruction? How many people would have the courage to blow their brains out who, when offered it, would have willingly gone along with a needle in their vein? The ultimate effect of a prohibition of euthanasia would, therefore, be a dramatic reduction of suicides due to the psychological inability of most to pull the trigger on themselves."

While I do not fully accept Mr. Stolyarov's premise of the immorality of suicide under any conditions, I concur with him that the prohibition of assisted suicide would result in only those individuals taking their lives who have shown a firm resolution to do so. If they had been able to surmount the tremendous psychological barrier of pulling the trigger, then their case is not one of transient whim-induced rashness, nor even remotely one of "substituted consent" (as both family and bureaucrats would be immensely repulsed at the consequences of such a means of death). This state of affairs would also deprive the government and others who think they know better of prompting an individual's death in the fabricated interest of collective expediency. "Cleaning up the mess" is costly, but explaining one's advocacy for need-calculus-based trigger-pulling is even so. Any official found promoting such means of clearing out "undesirables" against their consent will be immediately exposed for what he is, a moral monster, whom nothing would separate from Hitler himself.
 

Edmund Daleford is a freelance writer whose works have been published on Enter Stage Right and Objective Medicine. He is also the Vice Editor-in-Chief of The Rational Argumentator. He can be contacted at rationalargumentator@yahoo.com.

This TRA feature has been edited in accordance with TRA's Statement of Policy.

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Learn about Mr. Stolyarov's novel, Eden against the Colossus, here.

Read Mr. Stolyarov's comprehensive treatise, A Rational Cosmology, explicating such terms as the universe, matter, space, time, sound, light, life, consciousness, and volition, here.

Read Mr. Stolyarov's four-act play, Implied Consent, a futuristic intellectual drama on the sanctity of human life, here.

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