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I thought this request made perfect sense .... In our discussion
it became clear that preoccupation with her fear of a lingering
death would interfere with Diane's getting the most out of the
time she had left until she found a safe way to ensure her death.
Not all dying patients who wish to die are fortunate enough
to have a doctor like Timothy Quill. Betty Rollin has described,
in her moving book Last Wish, how her mother developed ovarian
cancer that spread to other parts of her body. One morning
her mother said to her:
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Taking Life: Humans
I've had a wonderful life, but now it's over, or it should be. I'm
not afraid to die, but I am afraid of this illness, what it's doing
to me .... There's never any relief from it now. Nothing but
nausea and this pain .... There won't be any more chemotherapy.
There's no treatment anymore. So what happens to me
now? I know what happens. I'll die slowly .... I don't want
that. ... Who does it benefit if I die slowly? If it benefits my
children I'd be willing. But it's not going to do you any
good .... There's no point in a slow death, none. I've never liked
doing things with no point. I've got to end this.
Betty Rollin found it very difficult to help her mother to carry
out her desire: 'Physician after physician turned down our pleas
for help (How many pills? What kind?).' After her book about
her mother'S death was published, she received hundreds of
letters, many from people, or close relatives of people, who had
tried to die, failed, and suffered even more. Many of these people
were denied help from doctors, because although suicide is legal
in most jurisdictions, assisted suicide is not.
Perhaps one day it will be possible to treat all terminally ill
and incurable patients in such a way that no one requests euthanasia
and the subject becomes a non-issue; but this is now
just a utopian ideal, and no reason at all to deny euthanasia to
those who must live and die in far less comfortable conditions.
It is, in any case, highly paternalistic to tell dying patients that
they are now so well looked after that they need not be offered
the option of euthanasia. It would be more in keeping with
respect for individual freedom and autonomy to legalise euthanasia
and let patients decide whether their situation is
bearable.
Do these arguments for voluntary euthanasia perhaps give
too much weight to individual freedom and autonomy? After
all, we do not allow people free choices on matters like, for
instance, the taking of heroin. This is a restriction of freedom
but, in the view of many, one that can be justified on paternalistic
grounds. If preventing people from becoming heroin
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Pradical Ethics
addicts is justifiable paternalism, why isn't preventing people
from having themselves killed?
The question is a reasonable one, because respect for individual
freedom can be carried too far. John Stuart Mill thought
that the state should never interfere with the individual except
to prevent harm to others. The individual's own good, Mill
thought, is not a proper reason for state intervention. But Mill
may have had too high an opinion of the rationality of a human
being. It may occasionally be right to prevent people from making
choices that are obviously not rationally based and that we
can be sure they will later regret. The prohibition of voluntary
euthanasia cannot be justified on paternalistic grounds, however,
for voluntary euthanasia is an act for which good reasons
exist. Voluntary euthanasia occurs only when, to the best of
medical knowledge, a person is suffering from an incurable and
painful or extremely distressing condition. In these circumstances
one cannot say that to choose to die quickly is obviously
irrational. The strength of the case for voluntary euthanasia lies
in this combination of respect for the preferences, or autonomy,
of those who decide for euthanasia; and the clear rational basis
of the decision itself.
NOT JUSTIFYING INVOLUNTARY EUTHANASIA
Involuntary euthanasia resembles voluntary euthanasia in that
it involves the killing of those capable of consenting to their
own death. It differs in that they do not consent. This difference
is crucial, as the argument of the preceding section shows. All
the four reasons against killing self-conscious beings apply when
the person killed does not choose to die.
Would it ever be possible to justify involuntary euthanasia
on paternalistic grounds, to save someone extreme agony? It
might be possible to imagine a case in which the agony was so
great, and so certain, that the weight of utilitarian considerations
favouring euthanasia override all four reasons against killing
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Taking Life: Humans
self-conscious beings. Yet to make this decision one would have
to be confident that one can judge when a person's life is so
bad as to be not worth living, better than that person can judge
herself. It is not clear that we are ever justified in having much
confidence in our judgments about whether the life of another
person is, to that person, worth living. That the other person
wishes to go on living is good evidence that her life is worth
living. What better evidence could there be?
The only kind of case in which the paternalistic argument
is at all plausible is one in which the person to be killed
does not realise what agony she will suffer in future, and if
she is not killed now she will have to live through to the
very end. On these grounds one might kill a person who has
- though she does not yet realise it - fallen into the hands
of homicidal sadists who will torture her to death. These cases
are, fortunately, more commonly encountered in fiction than
reality.