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Abstract
The physical criteria that determine who is and who is not eligible for assisted suicide imply that some lives—such as lives with disability—are less “objectively” worthwhile than others. Besides being degrading and discriminatory, this view is self-deceived. Aging makes both the nondisabled and disabled prone over time to experience increasingly serious disabilities, from impaired mobility to hearing loss. Anthropologies that undermine life with disability therefore undermine our humanity as such, risking self-hatred and misanthropy. As an alternative to this anthropology of despair, the author considers hopeful models affirmed by disability rights activists and by Christian theology.
Notes
1 Though much of what I say also bears upon euthanasia, my focus will be PAS. This is because every UK and U.S. bill seeking a change in law has proposed PAS, meaning that euthanasia is marginal to the Anglo-American debate, at least for the foreseeable future. Most jurisdictions (including the UK: see https://www.legislation.gov.uk/ukpga/Eliz2/9-10/60) still refer to this procedure as “assisted suicide,” though advocates have coined euphemisms such as “assisted dying,” “death with dignity,” or “medical aid in dying.” I think that “assisted suicide” is the most conceptually clear and satisfactory term we have at this point. The topic would take us too far afield, but obvious reasons are that “suicide” is an active verb that preserves the sense of agency and therefore of voluntariness, whereas “dying” is a passive verb that does not normally refer to a chosen act at all, creating a needless muddle which threatens to obscure autonomy.
2 The Dutch, Belgian, and Swiss approaches differ very much from the Anglo-American approach, both in permitting euthanasia and for assisting terminations using far less restrictive criteria (see Keown, Citation2008). The Canadian law, which permits euthanasia, is the one conspicuous exception in the Anglosphere to the Anglo-American model. See: http://www.livinganddyingwell.org.uk/news/interim-report-issued-on-canadas-medical-assistance-in-dying-law.
5 It is false to describe the intention simply as “eliminating pain,” as if that were the specific aim, since there are alternatives to termination: for example, morphine levels can be raised to the point where pain is neutralized, failing which palliative sedation remains a final option. See http://aahpm.org/positions/palliative-sedation.
6 This is not to say that if a patient chooses to stay alive that those individuals who would have validated the patient’s decision to die (had that been his or her decision) must therefore assume that the patient is wrong to want to stay alive. But the fact that only some patients are validated in the belief that they are better off dead (on the basis of their physical debility) while others are not suffices to show the degrading double-standard at work.
7 See, for instance, https://www.sprc.org/organizations/%20national-federal and https://www.gov.uk/government/publications/suicide-prevention-strategy-for-england.
8 See “Assisted Suicide: The Philosophers’ Brief” (Dworkin et al., Citation1997), an influential and representative paper that argued for strict safeguards and against suicide on demand. Dworkin (Citation2011) makes the argument more expansively in, as does Martha Nussbaum’s essay in favor of PAS for the influential President’s Council on Bioethics (see: https://bioethicsarchive.georgetown.edu/pcbe/reports/human_dignity/chapter14.html). Mainstream assisted suicide advocacy groups likewise say they want strict safeguards and deny wanting a widely permissive policy. See, for example, the Death with Dignity statement: https://www.deathwithdignity.org/terminology/#euthanasia.
9 For a full elaboration of this argument, see Elliot (Citation2018).
10 On suicide facilitation, see http://www.bma.org.uk/news-views-analysis/news/2014/july/assisted-dying-loaded-gun-warning. There are increasingly frequent reports of patients being “coached” or even “bullied” into choosing PAS in subtle and not-so-subtle ways (see http://www.huffingtonpost.ca/will-johnston/the-alarming-trend-of-bullying-hospitals-and-hospices-into-assisted-suicide_a_23325941/).
11 Assisted suicide is opposed by every major national disability groups that has any policy on the issue (see http://notdeadyet.org/disability-groups-opposed-to-assisted-suicide-laws).
12 See the UN press release at https://www.un.org/press/en/2001/hrct610.doc.htm.
13 See page 307 of the Commission’s Report at https://www.demos.co.uk/files/476_CoAD_FinalReport_158x240_I_web_single-NEW_.pdf?1328113363.
14 Alarmingly, a patient at Queen Elizabeth the Queen Mother Hospital was given a do-not-resuscitate order precisely because he had Down syndrome. See https://www.theguardian.com/society/2015/dec/08/hospital-says-sorry-for-do-not-resuscitate-order-on-man-with-downs-syndrome. Grey-Thompson is quoted in The Spectator: https://www.spectator.co.uk/2014/07/the-terminal-confusion-of-dignity-in-dying/
15 Though he applies it to a different subject, I owe this hypothetical to Bernard Williams (Williams & Hawthorn, Citation2008).
18 See Oregon Public Health Division, “Oregon’s Death with Dignity Act—2014.” https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf
19 For present purposes, I am focusing on anthropology in the sense of human worth and value rather than in terms of human capacities and operations. In this sense, an anthropology of despair is one that fails to affirm the worth and value of the human condition in its full dimension, and an anthropology of hope is one that succeeds in doing so.
20 Quoted by St. Thomas Aquinas (Citation2000), Summa theologiae II-II 20.4.
21 The Vatican II document Gaudium et Spes states that this not just good news for Christians since it states a truth about human nature as such, since “by His incarnation the Son of God has united Himself in some fashion with every man.” Available at http://www.vatican.va/archive/hist_councils/ii_vatican_council/documents/vat-ii_const_19651207_gaudium-et-spes_en.html.
22 My account of hope draws on the theology of St. Thomas Aquinas while making further detailed proposals (see Elliot, Citation2017).
23 St. Augustine, In Joannis evangelio 72, 3:PL 35, 1823 (Augustine, Citation1988)
24 William Wordsworth insisted that the downtrodden imago dei represented the pons asinorum, or point at which many fail to grasp, this crucial truth. In poems with titles such as The Old Cumberland Beggar, The Pedlar, The Female Vagrant, The Idiot Boy, The Leechgatherer, or The Beggarwoman, we learn to attend to “the heaven-regarding eye and front sublime/ which man is born to.” Doing so is like being “admonished from another world,” making our minds “turn round/As with the might of waters” (see Lindenberger, Citation1964, p. 75).
25 This is not to say that human life must be preserved at all possible costs, a view known as “vitalism” (for the distinctions between extraordinary/ordinary treatment and intended/foreseen consequences, see Elliot, Citation2018, pp. 32–33).
26 Ibid., Dworkin, 214.
27 Jeremy Waldron, The Theoretical Foundations of Liberalism. The Philosophical Quarterly 37, no. 147 (1987): 127–150.
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