Wednesday, June 1, 2011

Thoughts on assisted suicide: Why the debate is about human equality

Most people agree that it is wrong for a normal, healthy person to kill himself (commit suicide). Even if the suicidal person is convinced that his life is not worthwhile and will only cause him pain and suffering, suicide is tragic -- because his life does have objective value regardless of how he feels. I will call this Type A suicide.

Advocates of legalized physician-assisted suicide contend that it is not wrong for some sick, disabled, physically suffering, incapacitated and/or terminally ill people to kill themselves. I will call this Type B suicide.

Advocates of assisted suicide (usually) agree that Type A is wrong, but argue that Type B is permissible and perhaps even "humane" and "compassionate." What's the moral difference?

It cannot be the feelings of the one contemplating suicide. Suicide is always the result of certain feelings. And since we reject feelings as an adequate justification for Type A suicide, feelings alone are clearly not sufficient to justify suicide (including Type B suicide).

It cannot be the suffering of the one contemplating suicide. Depression or unhappiness or extreme psychological anguish does not justify Type A suicide. Nor can suffering -- physical, psychological, etc. -- justify Type B suicide. The assisted suicide advocate could respond that suffering for Type A can be treated and alleviated, while that is not necessarily the case with Type B. But, first, the suffering of Type B can today almost always be treated -- whether it is depression (requiring counseling or medication) or physical pain (requiring better pain management). So if the ability to alleviate suffering makes Type A suicide impermissible, then it also makes Type B impermissible. ("If we treat their depression and we treat their pain, I've never had a patient who wanted to die," says William Wood, M.D., clinical director of the Winship Cancer Center.) Second, is the wrongness of Type A suicide really contingent on the availability of solutions to the suffering? We would wholeheartedly recommend against a Type A suicide even if we did not understand the nature of the person's anguish or depression -- even if we were not certain about possible solutions to that anguish. The suicide is wrong regardless -- because that human life is valuable.

Nor can the moral difference be a terminal diagnosis. Each of us will die at some time, but that does not justify intentional killing. Consider a man who is healthy and pain-free (for the sake of argument), but predicted to die painlessly from an obscure disease in 10 years -- the mere fact of his diagnosis clearly does not justify suicide (to repeat, pain does not justify suicide either -- see above). In addition, many assisted suicide advocates reject the idea that legal suicide should be limited to the terminally ill.

So what is the important difference between Type A suicide and Type B suicide? It seems to me that defenders of assisted suicide -- in order to condemn Type A but sanction Type B -- have only one appeal to make. They must argue that the physical and/or mental capacities of the suicidal person are the morally decisive factor. So it is not depression, pain, suffering or a terminal diagnosis, but rather one's physical or mental capacities that make the difference regarding whether one may rightly kill himself.

Here we have arrived, I think, at clarity. The assisted suicide debate isn't about having a "choice" to die, for we all reject the "choice" of death when we know it is wrong (Type A suicide). The debate is about the nature of human dignity -- whether those human beings with diminished capacities and abilities nevertheless maintain the sort of intrinsic moral value that precludes intentional killing.  It is about whether severely disabled or incapacitated people are in some fundamental sense equal to every other member of the human family.

To rationally accept assisted suicide (while condemning Type A suicide), it seems to me, one must reject fundamental human equality and instead base human value on certain characteristics or abilities that some human beings have and others do not (or, perhaps, claim that value is subjectively "bestowed" on a human being by others). The logical consequences of fully embracing this position are morally horrific and unacceptable to anyone but a sociopath.

In short, assisted suicide is wrong because human equality is true.

One additional point: The most extreme advocates of assisted suicide and euthanasia deny that even Type A suicide is wrong. They say that anyone should be able to commit suicide if he or she so chooses. My analysis above does not apply to them (though they are deeply wrong): it is meant only to show that those (more moderate) assisted suicide advocates who reject Type A suicide implicitly acknowledge that the issue is not about choice, autonomy, feelings, suffering, etc., and that their defense of Type B suicide is therefore based entirely on the contention that some human lives are less valuable than others, which is the point they really ought to be defending.

If Type A suicide is wrong (most of us agree it is), and human equality is true, then Type B suicide is wrong also.