Is it only involuntary euthanasia which is acceptable?

2008 was a lousy year. 2009 continues in the same way. I haven’t put anything about what happened in 2008 online yet. I’d skip the current problems too were it not for an article in the Times Higher Education this week recently: “It is monstrously wrong that patients cannot ask for euthanasia“. I’m tackling a problem. It’s not the one below, but it’s close.

I am in principle in favour of voluntary euthanasia. I know a lot of people aren’t and believe their beliefs should be imposed on other people. It seems particularly cruel form of bigotry to impose those beliefs on a dying person who may not have the strength to fight back. But there are good reasons to be wary of legalising euthanasia.

The most compelling reason I know is the precautionary principle. There is a concern that if euthanasia is legalised then people will be pressured to take it as a way it against their wishes. While I think I should have the right to end my life at my choosing, I certainly don’t think I should have that right if it means that other people lose theirs. The claim is that if you ban voluntary euthanasia then involuntary euthanasia will not happen.

Events in recent weeks lead me to believe this is a flawed argument.

As a thought experiment consider patient X. X’s mind has detriorated to the state that he no longer knows where or when he is. They don’t know why he is where he is. Additionally he doesn’t want to remain where he is. He wants to go home, which is 30 miles and 60 years away. Frustration at being kept from home has made him grow prone to violence. This makes him a danger to other people as well as himself, so when he takes gets agitated he is sedated. These days he usually gets agitated waking up in what remains a strange place full of people who, he believes, are injecting him with something to keep him there.

The question is: If the hospital continues to sedate X until his heart stops in the interests of keeping him comfortable, is this a form of involuntary euthanasia?

I think this is partly a matter of your own identity. If you see yourself purely as a being of flesh and blood, then clearly it’s nothing like euthanasia. The hospital’s actions are more likely to be prolonging the life of the patient. I don’t know anyone who takes that kind of view though. We store our identities in more than our meat.

If you take the view that you are your mind the situation’s more complex. If X were in a persistant vegetative state then the question doesn’t matter because mind has gone. But in the paragraph above the mind, in a form, is there. If mind is a function of the body, then does prolonging the life of the body really prolong the life of the mind? Possibly in a calendrical sense, but in this case it seems the life of the body is being prolonged by removing the mind. It is the capacity for independent action which is seen as the problem. That’s the sticking point because if we are removing independent action then what exactly are we preserving?

On the Times Higher Education article Carlos Martinez-Thiem argues that Soran Reader should wait for a ‘natural death’. I hope he hasn’t fully considered what a ‘natural death’ is likely to be for someone who has lost most of their cognitive ability. At best it would be wandering out and dying of exposure. It could be walking into traffic, and injuring others. It doesn’t seem a very human response. So instead we corral patients against their will and if necessary sedate them. Possibly until what passes for their conscious life is one continuous round of sedation. I can understand why it’s necessary, you can’t leave someone to harm others, but it’s hardly a good solution. I think what he means is that it would not be his wish to be removed from life support. I can respect that, but I don’t his his own desires for himself are sufficient justification to impose his will on other.

I don’t want to say too much about what is happening at the moment. There are good days and bad days and it’s certainly not as clear cut as the problem above. As always with real life there are complications. Sometimes a thought experiment can help to pinpoint what matters. Another tangentially related link is How do you measure quality of life? at Comment is Free.