Friday, February 08, 2019

Euthansia and Assisted Suicide

Hold this thought from the article:

“There’s not an atom in my body that is in sympathy with what you are describing,” he replied. “This isn’t about money … it’s about empathy, ethics, compassion.”

Death on Demand: Has Euthanasia gone too far? was sent to me, and my first thought was "Oh, The Guardian," but it was reasonably good and I changed my thought to "Even The Guardian..."
I will take a few paragraphs to note my own opinions going in, so that you can see where my prejudices lie.

Suffering is a bad thing. I have seen suffering, and understood why people wanted to be relieved of it, or why they wanted loved ones to be relieved of it.  I have thought for myself that because I do not fear death, telling my family to have a very short rope in keeping me alive is sensible.  I have a horror of being a burden. On the other hand, the Christian church, and Judaism before it, has long had a very high tradition of preserving life in the face of difficulty. Theory melts away, either way. The heat turns up to an even higher melting point when I consider my wife.  She is likely, as we currently see things, to hang on to life with greater tenacity than I would.  She has a very high view of preserving life in general, including her own.  I know that about her and that is part of my deciding for her if a time comes when she cannot decide for herself.  On the other hand...watching my wife suffer, not just for a short season, but for a length of time...

Well, we call them principles when we intend to stick by them, and theory when we don't. We don't need to tell big lies to ourselves when small ones get us over the hump. And which is the lie?  We might exalt ourselves by calling something a principle when we are simply being stubborn and not willing to think very hard; or soothe ourselves by calling it a theory when we are unwilling to face up to hard truth. We learned early in a Bible study exercise about planning our own funerals decades before they were likely, that it is one thing to say "Oh, I don't care what you do with my body!  Throw it in a bin and pay no more attention to it," and another to think "How dare you treat the body of my loved one with anything but the highest respect?"

Dementia destroys memory and - who is David Wyman without memory?  Memory comes very close to defining who I am. I very much hurt to even think that others might have to do without because my care is expensive when I am no longer me. Yet I shrug such things off with contempt, as if the person speaking has no understanding what it means to be a human being, when considering the same questions about my wife. Side note: considering the suffering of your children looms large when they are still under your care, but recedes in stages, first when they become adults and second when they marry and you are no longer the main person affected.

The article describes the added complication of psychiatric illness, and I think I understand both sides of that as well.  There is something quite terrible about letting a person who has a treatable illness, or a temporary exacerbation of symptoms, decide quickly that it is all not worth it and bring this life to an end. If we are worried about slippery slopes when contemplating suffering, how quickly will that slope take us away in an avalanche if we regard suffering as the ultimate evil that must be relieved if at all possible?  At what point on that downhill course do we cease to have any commonality with all of our ancestors before us and what they understood to be the meaning of life? On the other hand, what if the illness is not all that treatable, and the last ten years of treatment that is only partly effective suggest decades more of the same? We might encourage others not to despair, but can we pretend not to understand them?

Now to the article:
I also see the desire for autonomy, the repeated horrified statement that “no doctor is going to control when I die.” This is theoretically clear for assisted suicide – the patient is the driver.  Yet not only is it murkier when we are discussing euthanasia and the patient’s previous versus current wishes, it is similarly murkier what we are even discussing in many situations, euthanasia or assisted suicide. Assisted suicide advocates can point to situations they call good outcomes.  They have been much less successful drawing lines to avoid bad ones. It matters. Our imaginings must include both.

If 25% of the deaths in the Netherlands are euthanasia or assisted suicides, then some of them are mistakes, just because neither humans nor their systems are perfect.  One of the strongest arguments against the death penalty is that there have been errors, and there will continue to be errors.

Twenty-five percent.  On a slippery slope.

What is new in all this? Though people may reject the Bible as inspiration, its writers clearly understood suffering as well as we do, and likely a good deal better, not being sheltered from it by hospitals, senior apartments, specialized residences, and nursing homes. Not to mention that we’ve got way better palliative care now, better than even a few years ago. Modern humans are not facing anything that has not long been known. In the places of the world and the era that has reduced suffering the most in all of human history we have the loudest insistence that the remaining suffering is intolerable. This paradox is not surprising, it is exactly what we see humans insisting about wealth, food, justice, education, housing, freedom of action, and all good things.  As Screwtape advised Wormwood “'Whatever men expect they soon come to think they have a right to: the sense of disappointment can, with very little skill on our part, be turned into a sense of injury."  The societies with the most comfortable lives are the surest that the existence of evil disproves the idea of God.  It is the subject of whole books, such as Gregg Easterbrook’s The Progress Paradox: How Life Gets Better While People Feel Worse. The more you give people, the less grateful they…uh, WE - are.

We can effect death with less mess, that is true, and as the article points out, the fact that someone has to discover the old-fashioned suicide’s body is indeed a trauma.  So that’s new. That’s better.  We can also keep people alive longer, sometimes beyond what their lifespans would “naturally” have been, if we had any idea what we meant by that.  We can keep many systems going as we age, but they are not all preserved equally well. Though that argument of artificially-extended life has been advanced for many years, and in individual cases it certainly looks to be so, I am not sure that is actually new. It might seem to our eyes that hunter-gatherers abandon their old very quickly, but within the context of their survival they bring food, warmth, and protection to those who can no longer get it for themselves.  That’s not any different from what we do, or the Dutch. Extending life is not new, it is human.

“Live Free or Die. Death is not the worst of evils,” General Stark said.  But he meant that dishonor and subjugation were worse – he wasn’t talking about suffering.  We might say in the same spirit that suffering is not the worst of evils either. Apparently that is considered much less true now. The idea is growing that suffering makes life not worth living. Whatever else happens, our culture is going to change very quickly, in unpredictable ways, when the number gets up to one-fourth of all deaths being terminated.  Is it a road to The Giver (book, not movie)? "...death will eventually “get a different meaning, be appreciated differently”.Yes, it will, and we know not how. This is precisely the sort of philosophical idea influenced by facts on the ground that seem "just obvious" in retrospect - because we share the assumptions of the New Society so thoroughly that we cannot even imagine how people could think otherwise.  (CS Lewis, as usual, has the definitive commentary on the phenomenon in is introduction to Athanasius's On The Incarnation.) Yet it is telling, brutally telling, that late in the article the Guardian notes: "Rather than drink the poison or open the drip, 95% of applicants for active life termination in the Netherlands ask a doctor to kill them. In a society that vaunts its rejection of established figures of authority, when it comes to death, everyone asks for Mummy."

And also from the essay and brutally telling, because the advocates do not engage the argument It was also carried out without regard to her relatedness to other human beings. In this case, the woman's son. I am reminded of my friend Dale Kuehne's book Sex and the iWorld, about the isolation of the individuals' decisions from their communities (also pertinent in transgender and abortion issues)

And now, back to the quote at the very top of this essay again.  This is what scares me, not only the moral certitude, which is suspicious enough, but the complete confidence the advocates have that they have no ill motives.  Even the best of us at the best of times have some ill motive. I spoke to a patient this morning who asserted it was obvious he has no illness.  I told him I didn’t know him, but from the little I had read and seen, it was certainly not obvious.  He insisted that he was 100% fine.  I cautioned that this was a bad sign – none of us is 100% fine.  I asked if he was using a figure of speech or if he was making an actual declaration.  He insisted, this time angrily, that he is "150% fine." I told him that is an even worse sign.

It is a worse sign. I extracted the most damning quote from the article, but that attitude runs through the statements of the advocates.  Also, it is clear that they do not quite understand the objections raised against them.  They think they do, but they get them wrong. It is always disquieting to me to read the moral arguments of people who have crested over into that iron obliviousness to the goodwill of at least some others.


james said...

On a tangential note: my father died of dementia. His nurses said that even when he didn't know anyone, he was always a gentleman. He was still there. What my mother says no longer bears close relationship with reality, but it is still easy to see her in the conversation. I know that sometimes personalities change

We sometimes define ourselves by our gifts. Some day the gifts will be taken back.

Assistant Village Idiot said...

I am friendly but impatient. That may not wear well.

Sam L. said...

Met a guy some years ago when I worked in a pharmacy, who told me he went home and found his wife had blown her head off. Found out she had a gambling problem.

"Also, it is clear that they do not quite understand the objections raised against them. They think they do, but they get them wrong." They are way too certain that they cannot be wrong.