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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: |
198 |
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 |
199 |
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 |
200 |
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. |
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