Black Triangle

The following is a guest post by Eve Garrard.

In their letter to the Times about the Joffe bill , the Archbishop of Canterbury, the Archbishop of Westminster, and the Chief Rabbi essentially make three points against permitting doctors to help terminally ill people to commit suicide. First, they say that all human life has intrinsic and unconditional value, so it’s wrong to assist in the killing of the innocent. Secondly, there is a worry about consequences – if we allow ourselves out of compassion to assist some people to commit suicide where it might be right to do so, we’ll soon allow ourselves to help to kill them even when their deaths wouldn’t be justified; and furthermore, permitting doctors to assist in the suicide of their patients will damage the relationship of trust between doctor and patient. And thirdly, they say that what is really needed is good palliative care to relieve suffering and preserve dignity in those who are dying.

These points don’t seem to me to be conclusive against permitting assisted suicide. Here’s why I think so.

Firstly, the claim about human lives having intrinsic, unconditional value is certainly one which can be accepted by anyone, religious or secular. It seems very plausible – surely if anything has unconditional value it must be the lives of us humans. What that means is that human life has a positive value in its own right whatever situations or conditions it exists in. But it doesn’t follow that it’s always wrong to assist in the ending of such a life. Because alongside the positive value of the life, there may also be the negative value – the disvalue, so to speak – of the pain and suffering undergone by the person whose life it is, and there is then a question of whether the positive value of the life outweighs the negative value of the suffering. And in some circumstances the answer to that question may be no. It seems reasonable to think, in any case, that the person who is in the best position to decide that answer is the person whose life it is, who has to bear the suffering; and if she decides that overall the negative value is greater than the positive value, it’s hard to see how anyone else can know better than she does. So from the intrinsic unconditional value of human life it doesn’t look as if we can deduce that ending that life is always wrong.

Putting the second point to one side for a moment, I’ll focus now on the letter’s third point, about the need for good palliative care for people who are dying. That seems absolutely right, and I’m sure that everyone who supports the Joffe Bill would prefer to see good palliative care resolve all these end of life problems, so that there were no cases in which people suffer from intractable pain and distress. Palliative care has made tremendous strides in the last few decades, and it can now alleviate a great deal of previously intractable suffering. And if palliative care could remove all such suffering, and if (a big if) it were available to everyone who needed it, then perhaps physician-assisted suicide would never be called for. But palliative care is just not that good; there are some people (particularly those with certain degenerative diseases) whose suffering can’t be adequately relieved by our best techniques, and in those cases it’s just not true that the option of a death with dignity, free from pain, is available. Good palliative care is wonderful, and we should certainly invest in more of it, make it more widely available. But it won’t completely dissolve the problem addressed by the Joffe Bill.

The strongest part of the letter’s argument is its second point, expressing concerns about the possible bad consequences of permitting doctors to assist in the suicide of their patients. The one about destroying trust between the doctor and the patient is not very convincing, since even if this is a worry there is also a worry in the other direction, so to speak – some people are alarmed at the thought that their doctors wouldn’t help them to commit suicide should their circumstances become unbearable to them, and this concern undermines their trust that their doctor will always do what he can to alleviate their suffering. The more convincing concern about bad consequences is the worry that having allowed ourselves to sanction assisting the death of people who do truly want and need it, we may slide down a slippery slope at the bottom of which we will sanction the killing of people who don’t really need it, who have been persuaded against their will, or their better judgement, to ask for death when there are other and better solutions to their distress. And the weakening of our inhibitions about killing the innocent might have broader consequences still, if we came to countenance killing people for reasons that had nothing to do with their needs, and everything to do with the needs or wants of other people altogether. (For further interesting argument on this, see Tom Hamilton at Let’s be Sensible.)

The trouble with this line of thought is that we have no way of telling just how powerful it is. If we decide to sanction the practice of assisted suicide we can surround it with strong safeguards and regulations to prevent abuse of the law; we can put all kinds of blocks on the slippery slope to murder. We can’t tell in advance if these safeguards would be entirely effective – maybe they would, but maybe not. Some people feel that in those circumstances we should err on the safe side, and refuse to countenance taking that first step of permitting assisted suicide. Perhaps they’re right to think this. But if we do decide that way, then we should remember that there’s a price to be paid for it: it’s paid by those terminally ill patients whose suicides it would indeed be morally permissible to help, were it not for the risk of damaging future vulnerable people who might be abused by that permission. Those patients have to continue to live lives that are unbearable to them, in order to protect the rest of us from sliding down an unwelcome slope. We sacrifice their interests for the common good, and we shouldn’t forget that, and nor should the signatories to the letter.

Eve Garrard.

[Also see the response to the letter by Norman Geras, who passes comment about the relationship of the three points Eve deals with in this piece]