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Resisting the duty to die

John Kleinsman |  21 September 2010

The debate about euthanasia, or more accurately 'physician assisted suicide' — let's not dress it up by using soft language like 'death with dignity' — has reared its head again. We are told that there should be a legal right for certain persons (specifically doctors) to be able to kill an individual when that is what the individual wants.

This claim to the right to assisted suicide, which comes out of a deep seated fear of the dying process, will have far reaching effects on the elderly and the sick should it become legalised.

The other evening I was chatting with an older woman, a casual acquaintance, who lives alone: 'You know,' she said, 'I get the distinct feeling that as I am getting older I am becoming more and more invisible.' Just days ago I talked with an elderly man in his 80s, a widower of three years who is struggling to come to terms with his increased level of dependency: 'I feel that I am just a burden on my family,' he said.

Where is this all coming from?

It is interesting that the debate about assisted suicide has arisen only in certain societies, namely affluent western societies. Why is that? It's a question that is rarely explored. I believe the debate is a feature of those societies where certain assumptions prevail; where the dominant notion of personhood is individualistic and the dominant 'virtue' is the individual's right to make his or her own choices.

This emphasis on autonomy and rights shapes us to see the world as belonging to those who are independent, strong and productive. Unfortunately, the price-tag that comes with this is that we struggle to deal with weakness and vulnerability. The sick and dying, the disabled and the elderly have, at best, a tenuous grasp on existence in such a world; they sit uncomfortably and precariously on the margins.

Those in favour of legalising assisted suicide argue that it is simply about recognising freedom of choice — the right of each person to make their own decisions. It is pointed out that those who do not wish to end their lives like this can still exercise their choice without interference. Why, then, should they impose their moral standards and beliefs on others? the argument goes.

It seems a fair enough question, but it's based on a misguided notion. We don't make our choices in isolation — we are affected by the underlying and mostly hidden assumptions of our society. So often we are unaware of the impact of these assumptions, even while they shape us; indeed, they are all the more powerful for being implicit, as there is no reflection involved.

From this it follows that in a society in which the sick, dying, disabled and elderly are undervalued, the 'right' to die will all too quickly become a 'duty' to die. People who feel neglected, undervalued and invisible will understandably think they are a burden and will want to do the 'right' thing.

While there will always be people wanting to exercise the choice to die at the hand of another no matter how much support they have, research suggests their numbers are very small. As Madeleine Bunting notes, this needs to be weighed up against the 'cost' to society of much greater numbers of vulnerable people being exposed to the subtle and not so subtle forms of psychological coercion that flow from the underlying assumptions mentioned above.

Common sense and reflection tell us that the psychological pressures on those who are most vulnerable will only increase given the country's ageing population. Figures quoted in recent reports estimate that while we currently spend about 4 per cent of our GDP on superannuation, that amount is expected to rise to 8 per cent by 2030.At the same time, healthcare spending will also continue to increase at a greater rate than our income growth.

More than ever, we require  strong political leadership willing to address the financial and social challenges associated with ageing populations while ensuring a greater degree of protection for the most vulnerable.

The issue of assisted suicide cannot be debated as if it exists in a moral vacuum. We need to join the dots and make the connections between the debate about assisted suicide and all the interrelated issues. We need to think about assisted suicide within the bigger social, economic and political picture and more in terms of protecting the common good.

Equally, as individuals and as a society, we need to recognise our complicity in fostering the perception held by many who are elderly and ill that they are a burden.

At the same time we need to help them to accept the realities of greater dependence that accompany old age and imminent death. We have the medical knowledge to deal with pain and other aspects of the dying process and the specialist care needed is available through the hospice movement.

In the interests of protecting the vulnerable members of our society, we must not legalise assisted suicide. We should instead deal with our deep seated fear of the dying process — this is where our real struggle for freedom lies rather than in the freedom to choose to demand that someone else end my life.

John KleinsmanJohn Kleinsman is Director The Nathaniel Centre, the New Zealand Catholic Bioethics Centre. This is an edited version of an editorial that appeared in the Centre's journal, The Nathaniel Report.


John Kleinsman


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Submitted comments

John would reduce a claim for a right to euthanasia to a fear of the dying process, i.e. in many cases, loss of meaningful comprehension, physical and mental faculties, and intense unrelieved pain and suffering. Who wouldn't be afraid! I'm sure he is partly right, but it smacks of a simplistic diagnosis of the question. John implies that the moral lynchpin of autonomy favours the strong and healthy at the expense of the weak. I think he may not have grasped why it plays such a central role in the question: I think euthanasia advocates see moral autonomy as a sine qua non of human dignity, and for this reason, rather than prejudice the weak, see its absence or diminishment as the ethical symptom of oppression and injustice and an excuse for keeping the weak in their place. This extends right through many problems involving social, economic and legal disadvantage.

We are all going to die and most of us will suffer pain in doing so. By all means let us continue to improve palliative care, but John has not yet made out a convincing case that euthanasia - the "good death" - may not in any circumstances ever form part of the caring mix of a humane society. More genuine deliberation is needed at least.

Stephen Kellett 21 September 2010

In my mind the argument is less around a person wanting to die because they are all alone, don't want to be a burden or wanting to do the 'right thing' by others. It is more about a person suffering a painful, slow death from a condition which can not be cured or markedly improved, and will lead to their death sooner or later. Who would like to deny them the dignity of a shortened suffering, dying when they are ready.

Gaby 21 September 2010

Mr Kleinsman, how do you justify the comment that "we should deal with the deep seated fear of the dying process"? We, who are in favour of the ending of prolonged suffering, are not afraid of dying. We welcome it. It is the protracted agony, and inability of the medical profession to deal with pain, and the months, sometimes years of suffering for families and individuals, that we are addressing here. Afraid of dying? No. Also, don't forget Mr Kleinsman, that Big Pharma are making an absolute fortune keeping people alive and in extremis! They are laughing all the way to the bank with every prescription the doctor writes to keep a person alive.

Quality of life Mr Kleinsman is the core of this whole discussion. You may have a deep seated fear of death sir, but most of us do not.

lesley archer 21 September 2010

This is article is seriously clouded by projection (fear of death) and a willful ignorance of the fact that any legislation around euthanasia will be extremely tight. Nobody, but nobody is talking about allowing people who've got the blues or who are getting on a bit to go to their doctor and have a green injection! Remember people 'above all do no harm'. Any euthanasia legislation will have to make provision for a measure of individual harm/benefit analysis & exhaustion of other avenues before such medical intervention could be approved. Honestly, the religiously inspired hand waving in this debate is bordering on obfuscation & completely ignoring the fact that when all is said and done we show more compassion to our terminally ill animals than we do to terminally ill people who might wish to choose to end their suffering sooner rather than later, without stigma or legal repercussions for those they leave behind. Such glaring disparity is the height of fearing death as far as I am concerned.

Marnie Simpson 21 September 2010

Get your head out of your books and theories. Read my lips, listen to the 85%+ real people who want this option.

I don't want DEPENDENCE, I don't FEAR DYING I don't give a poo about "the bigger social, economic and political picture and more in terms of protecting the common good" it is not a MORAL ISSUE for me. I don't really want a physician to assist me, I just want the means to have a peaceful, dignified death.

You have it your way and let me have it mine, not a BURDEN, I am not COERCED, I don't feel a DUTY to die, in fact I hope that I have many more years to come before I die at a time and in a manner of my own choosing, not yours.

Steven Mendelson 21 September 2010

Ms Archer - You have failed to identify the difference between a fear of the "dying process" and a fear of "dying".

Rachel Brooks 21 September 2010

This article is spot on. We need to discuss this and we can not do so in a moral vacuum. We must decide as a society, what value we recognise human life as having. Do we ignore the natural law and assume that human life is no different than animal life? Do we only attribute value to those that serve a useful purpose and are no burden to others? Is the value of human life purely arbitrary to be assessed upon what ever the contemporary whim of the day is? Or is does human life have intrinsic value in all its stages. Each life uniquely fashioned with true human dignity as its birth right. Once we start allowing for an erosion of this vision of life then we start to loose our dignity. There are those that insist that there will be laws to prevent things sliding but the same thing happened with abortion when we were all told by the proponents that it was for emergencies or rape victims, only years later to have it on demand for any old reason.

So we must decide do we choose hope by declaring that human life is intrinsically valuable. Or do we choose death by making an arbitrary and changeable definition on the value of human life. I know which world I want my children growing up in.

Ian 21 September 2010

Smear proponents of euthanasia choice as heartless and then wax lyrical about what an evil society it will turn us into. Yawn. Personally, I think it is ordered more or less towards an intrinsic moral evil to prolong the suffering of people who would freely, consciously, and understandably choose otherwise.

Should I myself reach a time of irreversible dependency and infirmity, I do want the choice to depart with a modicum of dignity.

Brendan Lloyd 21 September 2010

What concerns me is that sometimes it seems euthanasia is assumed to include the situation where a person is allowed to die natually i.e. that person is no longer kept alive by abnormnal means. AS I understand it, the Catholic Church and no doubt other Christian Churches do not propose that people must be kept alive by all means available. The debate on the issue of euthanasia must make this distinction.

Patrick Kempton 21 September 2010

The time has certainly come for this issue to be addressed. Let's hope it can be a conversation, rather than a dogmatic and confrontative stoush! Above all, please let's listen to each other - from the responses to the article, it does seem that several people have ignored, or not understood, the main point presented. John Kleinsman makes an excellent point about people's individual decisions not being made in isolation. Once it's possible to choose to end one's life, there is a very strong likelihood that many people will feel a pressure to do it even though they wouldn't have chosen it themselves. Not everyone is strong and confident in their own worth, not everyone can see all the options open to them. I don't personally have any objection to anyone making this choice for her/himself; but legalizing this possibility lessens the choices for many others.

Joan Seymour 22 September 2010

The debate about legalising euthanasia has rarely been conducted in a moral vacuum. The debaters are generally aware that, whenever we legalise any action which had been illegal for traditional moral reasons, the 'pendulum effect' is likely - that is, we will err in the opposite direction for some time until the balance point is found.

This is a particular problem to be guarded against as we move to eliminate extreme suffering in death enforced on some of our terminally ill by our own moral scruples.

As Marnie Simpson commented, we demonstrate more compassion for terminally ill animals than for our human brothers & sisters. How does this show respect for human life? How does this demonstrate the value of human life argued by (the other) Ian in his comments?

There are many records to show that the main impact of torture which eventually breaks a person is the loss of human dignity. Those who manage to retain their dignity despite the torture do not break.

Our society, by its legislation, insists that many of terminally ill have to die horrible deaths in agony, all the time begging for release. And we call this "respecting the value of human life".

Ian Fraser 25 September 2010

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