>Euthanasia: A Right to Death with Dignity or License to Kill with Impunity? (Part 5)

>(Part 4)

So far in this series of posts I have been arguing that legalizing euthanasia will have a negative effect on society by creating a culture of death in which death will become the accepted means for dealing with life’s difficulties, it will lead to abuses that will endanger the weak and elderly, and it will result in other forms of euthanasia (such as nonvoluntary and involuntary) that can endanger everyone; and, therefore, euthanasia should not become an acceptable means for dealing with the difficult end-of-life dilemmas, for rather than promoting death with dignity, it will provide a license for killing with impunity.

In the post yesterday I defended this thesis by arguing that euthanasia proponents have stated in their literature and demonstrated in their practice that promoting euthanasia as a means for mercifully dealing with persons who are terminally ill and suffering with pain is not an end in itself but a means to other ends. Today I want to continue to defend my thesis by arguing that even some euthanasia advocates acknowledge the great potential of abuse by their own stated need for strict limits.

Humphry realizes that the unqualified legalization of euthanasia will lead to serious abuses. In order to attempt to prevent those abuses, he provides a detailed set of criteria that must be met. He states that this practice should never be used on someone to assist them in suicide for mental health or emotional reasons. Rather, it should be restricted to persons who have a physician-verified hopeless diagnosis of an advanced terminal illness that is causing unbearable suffering (combined physical and psychic), including being a burden to others. The person should be experiencing a total loss of quality of life due to protected, incurable medical conditions, or have a grave physical handicap which is so restricting that the individual cannot tolerate such a limited experience (notice here that his sounds more like mental and emotional). the person should be a mature adult and clearly demonstrate that he is making an informed decision himself and not under coercion; euthanasia should be a last resort that is not practiced at the first knowledge of the illness so that time can be spent pursuing treatment. Also, the person’s physician is to be informed to make sure that the individual is not mistaken about his diagnosis.

The reason Humphry provides the criteria is precisely because he knows that if left unqualified, the practice of euthanasia will broaden beyond providing relief to those who are suffering unmanageable pain and on death’s door, to include others who are not. His provision for criteria to prevent abuse is itself an admission that the slippery slope argument is a valid argument, especially given what we saw in the proposals of Quill and Kevorkian yesterday.

In fact, one advocate admits that this is true, but although it is true, she confesses that she is just not convinced that it must become a reality. Marcia Angell who is an advocate for euthanasia claims that the slippery slope argument is unpersuasive, yet admits that, “We cannot avoid the slippery slope; in fact, . . . we are already on it, like it or not.”[1] She suggests, however, that just because the slippery slope is a reality and that we are already sliding down it, we don’t have to go all the way. The way to avoid a headlong slide downhill is to draw a distinction between euthanasia and physician-assisted suicide (henceforth PAS) and to allow the latter but not the former. She believes that PAS should be legalized because it requires the patient to act and allows the patient to retain ultimate control (he can always change his mind). Euthanasia, on the other hand, should not be legalized because the death is not caused by a direct act of the patient, which takes control away from the individual. To support this distinction, Angell also posits that a headlong slide downhill could be resisted by drawing a line between voluntary and involuntary.

Yet, despite Angell’s proposed distinctions as means to avoid a headlong slide down the slippery slope that we are already on even prior to legalized killing, she says, “No system of safeguards for any workable endeavor is absolutely foolproof.”[2] Angell concedes, then, that because of the potential of great abuse, the present reality of abuse and the reality that it is going to get worse, there needs to be limits put in place to try and guard against abuse. This call for limits, then, and her admission that we are already on the slippery slope justify the slippery slope argument. But, as she has admitted, there are no safeguards available to resist the headlong slide down the slippery slope that we are already on. The best we can do is to hold off the abuses for a time, but they will eventually become realities since no safeguards are foolproof.

Isn’t this exactly the concern of the slippery slope argument? If you allow any form of euthanasia at all, it will necessarily lead to abuses and other forms of killing. Angell, then, in stating that there is a slippery slope and that we can hold off a headlong slide down it but only for a time by establishing some safeguards, that will not work completely and will eventually give way demonstrates the validity of the slippery slope argument. She is so convinced of her position to legalize euthanasia, or at least PAS, that she refuses to change her position in spite of her belief that it will lead to abuses. But the fact that she will not heed her own conclusions does not negate what she knows to be true; legalizing euthanasia will lead to abuses that will endanger the weak and elderly, and it will result in other forms of euthanasia (such as nonvoluntary and involuntary) that can endanger everyone. It will provide a license for killing with impunity.

Notes:

[1] Marcia Angell, “Voluntary Euthanasia Shows Compassion for the Dying,” in Euthanasia: Opposing Viewpoints, ed. James D. Torr (San Diego: Greenhaven Press, Inc., 2000), 51.

[2] Ibid.

>Euthanasia: A Right to Death with Dignity or License to Kill with Impunity? (Part 4)

>(Part 3)

In the previous post I introduced the slippery slope argument set forth by euthanasia opponents and noted that euthanasia advocates discount the argument on the grounds that they believe that it is based unnecessarily on fear and on fatalistic assumptions that are mere logical conjecture and not rooted in fact. However, opponents of euthanasia are not just projecting the eventuality of abuses based on logical implications, but on realities that are found in association with actual statements and intentions communicated by certain advocates of euthanasia.

Before I begin to show those present realities that justify the use of the slippery slope argument, let me first address more specifically what I mean by the slippery slope argument. I would note here that there are basically two different types of slippery slope, or wedge argument. The first type is based on moral reasoning and the logic of distinctions between different acts. For example, when one asserts that legalizing euthanasia will result in a lack of trust between a patient and his doctor, it is actually very hard to verify and is certainly not necessarily going to be the case. It might be the case, and it certainly has potential to become the case, but it will not necessarily be the case in every instance. When euthanasia advocates reject the slippery slope argument of euthanasia opponents, this is the type of slippery slope argument they reject, and thus, discount the argument by asserting that the concerns are not necessarily going to become reality and are mere logical conjecture.

Yet, there is a second type of slippery slope, or wedge, argument that is not merely dependent on logical conjecture or possibilities, but is concerned with empirical data that establish and back up the argument. For example, when one argues that the removal of certain restraints against killing will lead to probable moral decline, such as authorizing the killing of a patient for his own “benefit” because he is suffering pain and has a bleak future (no quality of life or dignity) and could open the door to a policy of killing patients for the sake of social benefits, such as reducing financial burdens, the more efficient use of diminishing resources, or the supposition that euthanasia will open the door to involuntary euthanasia. These concerns are not difficult to verify for they are empirical by nature and can be measured and documented. I will use this second type of slippery slope argument to establish that the concerns of euthanasia opponents are not mere speculation or conjecture, but are in fact, rooted in reality, and therefore, warranted.[1]

For many euthanasia advocates, the legalization of euthanasia is not an end in itself, but a means to achieving a further end. Although some say that it should only be used for persons who are suffering and about to die, some advocates desire to broaden the utility of euthanasia. As for who is eligible for assisted death, Quill proposes that it should initially be restricted to the terminally ill; but he also suggests that it should eventually be made available tot hose who are not terminal but have incurable or debilitating conditions associated with severe, unrelenting suffering.[2] In this statement, Quill acknowledges that the practice must start out narrow, but then be broadened. The difficulty in this statement, however, is that Quill is unclear by what he means by “suffering.” He argues that “suffering” can include difficulties like the fear of future suffering (before real suffering actually begins), loss of dignity, and other subjective elements. For instance in his account of his assistance in the death of a patient he calls “Diane” who had a history of alcoholism and depression and who had been cured of vaginal cancer and was diagnosed with leukemia, he says that she asked him to kill her, not because she was suffering with uncontrollable pain, but because she did not want to linger until death in relative comfort. She was convinced she was going to die, so why not get it over with now.[3] As her doctor, Quill did as she requested and killed her.

Kevorkian has also indicated his desire to extend “suicide rights” beyond rare terminal cases or cases dealing with so called unmanageable pain. In an address to the National Press Club in Washington, D.C. on October 27, 1992, he asserted that “every disease that shortens life no matter how much is terminal.” For Kevorkian, terminal cancer patients with less than six months to live are a very small minority of patients for whom euthanasia is needed. Those whom he would include in the larger majority of cases include quadriplegics, people with multiple sclerosis, and sufferers from severe arthritis. But once again, not only is his criteria a problem, but the reasoning behind it. Kevorkian has a disdain for disabled persons. He once called quadriplegics and paraplegics who were not suicidal “pathological,” and exposed his sympathy for eugenics in a court document asserting, “The voluntary self-elimination of individual mortally diseased and crippled lives taken collectively can only enhance the preservation of public health and welfare.” Once again, the criteria for beginning the use of euthanasia is narrow to begin with, but with the purpose of becoming ever more broad.

Yet, with Kevorkian, he admits to even more heinous plans for euthanasia. Instead of wanting to help the suffering and the dying, he candidly acknowledges that euthanasia is a means toward pursuing his own obsession. For him, euthanasia is a distraction to get the public to accept it as a morally viable option for end of life issues, but as the first step that would eventually “open the floodgates” of the equally momentous benefits to humankind of human experimentation and the serious investigation of the phenomenon of death. He calls euthanasia “medicide,” a specialty to be practiced by medical technicians at designated “suicide centers.” His “ultimate aim is the creation of a new specialty and a new institution he calls “obitiatry,” to which assisted suicide is but a means. “Obitiatry” is “the unfettered experimentation on human death” in pursuit of useful knowledge as well as knowledge into what death itself is. But to fulfill this preternatural aim, Kevorkian needs dying patients. His original plan was to use death-row inmates, but since that was shot down, he then sought to accomplish his goal by experimenting on patients who opted for euthanasia.[4]

For Kevorkian, then, getting euthanasia legalized and morally acceptable to the public is a front to his ultimate end of human vivisection. Kevorkian appears to have a three-step plan for achieving his dream. First, popularize assisted suicide and make it seem acceptable for helping the dying and the suffering. Second, give society a utilitarian stake in assisted suicide by using the victims for organ procurement. Why not give the good organs to those who contribute to society rather than leach off it. The third step is to gain permission to conduct his death experiments on the sick and disabled persons he would be allowed to kill. This plan was not just on paper, but was actually being practiced by Kevorkian. For instance, contrary to the media descriptions most of Kevorkian’s known victims were not terminally ill. Of the known 130 or so “suicides” that he facilitated, about 70% of the persons involved were disabled and depressed, and the majority of them were women.

So what does this all mean? There is a slippery slope from assisted suicide to voluntary euthanasia to involuntary euthanasia. As Kevorkian argued, the diseased and crippled who don’t voluntarily seek self-elimination are pathological and society needs to see the benefit of being rid of them and using their good organs for the producers in society, and heck, they make the best test subjects. There is a slippery slope from the terminally ill to those who are incurably ill but not terminal, and to those who are just not happy. And according to two of the biggest proponents of euthanasia, Quill and Kevorkian (both medical doctors), this slippery slope is by design. The way that the argument moves from terminal illness to meaningless life, results in a position that anybody with a suicidal impulse will qualify, with the purpose of acclimating society to death, in order to pursue broader and worse forms of killing with impunity. This slippery slope is no figment of the imagination of euthanasia critics, it is rooted in the very language, practice and goals of euthanasia activists.

(Part 5)

Notes:

[1] For a good discussion on wedge arguments, see Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics (Oxford: Oxford University Prss, 1983), 120-26.

[2] Timothy E. Quill, C.K. Cassel, and D.E. Meier, “Care of the Hopelessly Ill: Proposed Clinical Criteria for Physician-Assisted Suicide,” New England Journal of Medicine 327 (Nov 1992): 1381-385.

[3] Timothy E. Quill, “A Case of Individualized Decision Making,” New England Journal of Medicine 324 (March 1991): 691-94; and idem., Death and Dignity: Making Choices and Taking Charge (New York: Norton, 1993).

[4] Kevorkian, Prescription Medicine, 214-240.

>Euthanasia: A Right to Death with Dignity or License to Kill with Impunity? (Part 3)

>(Part 1)
(Part 2)

There are many different reasons that opponents of euthanasia provide for rejecting it as a viable option for dealing with the difficult end-of-life dilemmas created by modern science and technology. But one of the most prominent arguments is that it does not solve any of the difficulties, and, worse yet, will necessarily create a whole host of new ones. Opponents hold very strongly that euthanasia is a detriment to society rather than a benefit. The legalization of euthanasia will result in a culture of death that will endanger the weak members of society, rather than promote a culture that is genuinely concerned for their welfare. In opposition to the claim that euthanasia is the best means for showing mercy to the weak, opponents argue that it will do the opposite and become a means for justifying cruelty.

The danger of legalizing voluntary euthanasia (killing upon request of individual because of his right of self-determination) is that it will lead to acceptance of other forms of euthanasia that are not voluntary, but are rather done either without the consent of the individual or even against the individual’s consent. Once society is conditioned to accept death as a legitimate means of social engineering, it will become a culturally acceptable way to deal with those in society that no longer contribute to its progress but only “waste” its resources. Human life could become objectified and snuffed out if killing offers an advantage to the national or individual interest. Advocating euthanasia could result in the government, which once derived its ratio essendi (the reason for its existence) from its granting protection to the underprivileged to abandon that goal and reserve all rights to its stronger and fitter members.

Health, efficiency, and beauty are quickly becoming the supreme values in our youth driven culture, which can create a perspective of indifference that presents a threat for the weaker members of society. Those with a lesser “quality of life” could be encouraged to view themselves as insignificant, a burden to their family and society, and not possessing a quality of life worth living. As the physically and mentally handicapped, the elderly, the impoverished, etc., are deemed a burden and undesirable constituents of society, then there could be great pressure placed on them to see themselves as society does, and hence, utilize euthanasia to “self-determine” themselves out of society’s hair and to stop wasting society’s precious resources. Once killing on demand has softened the ban on active homicide, victims are soon likely to be killed without their consent, rather than waiting for them to request it. When society begins to give some individuals the power to end others’ lives, it cannot prevent the principles underlying that permission from being applied to ever more broadening circumstances.

Opponents and proponents alike refer to this argument as the “slippery slope” argument. The slippery slope argument rests on the reality that ideas have consequences, for example, practice A will lead to practice B and then C, etc. Many proponents of euthanasia, however, discount this argument for they believe that it is based unnecessarily on fear and on fatalistic assumptions that are mere logical conjecture and not rooted in fact. However, when one looks at the literature advocating euthanasia, it becomes quite obvious that the advocates of euthanasia embrace the idea embodied in the slippery slope mode of argument themselves. Here are three brief examples:

Example #1: Euthanasia proponents are taking advantage of “slippery slope” logic to move from abortion rights to suicide rights. Derek Humphry, long-time activist for “suicide rights” and author of the bestseller Final Exit has said that the reason there has been a recent increase in momentum for euthanasia is because of the effects of Roe v. Wade. That court case and subsequent right to abortion on demand, which was predicated on the “right to privacy” and the “right to choose” (right to self-determination), has resulted in a view of death and a person’s right to individual autonomy that have led to advocates pushing now for death rights. Jack Kevorkian has also stipulate that “just as birth control and abortion are no longer generally seen as harmful, so, too, should the emotional stigma of taboo be stripped away from the completely moral concept of euthanasia.”[1]

Example #2: Euthanasia proponents also utilize the slippery slope argument with reference to reaching their goal of legalized euthanasia through incremental steps. Humphry suggests that since suicide is no longer a crime, then neither should assisting someone in sucide. He also states that he believes that euthanasia will eventually be legalized because, “with the inevibtability of gradualness, as the idea takes hold amonst rising generations, reform will undoubtedly come.”[2] Kevorkian also argues for the incremental progression to towards legalized euthanasia (A will lead to B, which will lead to C, etc.),

I feel it is only decent and fair to explain my litimate aim. [Euthanasia] is not simply to help suffering or doomed person kill themselves–that is merely the first step, an early distasteful propfessional obligation. . . . What I find most satisfying is the prospect of making possible the performance of invaluable experiments or other beneficial medical acts under conditions that this first unpleasant step can help establish.[3]

In an article supporting euthanasia as the ultimate civil liberty, Barbara Dority utilizes the slippery slope argument in order to argue for euthanasia as protection against the tyranny of doctors. She asserts that there is a rising problem with doctors not fully honoring living wills. Because she champions individual autonomy as a foundational principle for death decisions, she argues that if the medical environment does not change, individual’s rights to self-determination with regards to death will progress to the point of oppressive tyranny. She suggests te best means to keep this potential tyranny from becoming reality is to check the doctor’s authority with the legalization of euthanasia.[4]

Example 3: A final example concerns the desire to see euthanasia become an acceptable practice because of the growing acceptability of what is called “passive” euthanasia. Many ethicists have created a distinction between active and passive, and voluntary and involuntary euthanasia. According to one of the leading advocates of euthanasia, “There is thus a distinct difference between passive–or indirect–euthanasia, where death is induced by suspensions of treatment, and the so-called active or direct euthanasia, wehre death is brought about by a definite act.”[5] John Frame believes that subdividing euthanasia this way is a deceptive and dangerous use of language. He agrees that there is a distinct difference, but it is more than merely a terminological difference, but is inherently a difference in content and action. Active euthanasia is the intentional killing or taking of life that is not otherwise in the prociess of dying, whereas passive euthanasia is allowing one who is already dieing to die. It is inappropriate to label two completely different actions under the same heading. To do so creates an illegitmate moral equation between two distinct issues, and becomes a way to lead persons who are prone to accept passive euthanasia to become willing to accept active euthanasia–not based on the concepts that lie behind the words, but simply because of the similarities of the words.[6]

Frame is correct in his assertion that euthanasia advocates are attempting to sway public opinion to accept the one because of the other. This argument has been used by J. Rachels through what he calls the “equivalence thesis,” which teaches that ther is no “bare difference” between killing and letting die, since both have the same motive and achieve the same end. Since the two are morally equivalent then they are morally indifferent; so since passive euthanasia is seen as an acceptable practice, then so should active euthanasia.”[7]

Euthanasia advocates, then, utilize the slippery sloope argument themselves to get society to embrace euthanasia by emphasizing a proposed progression from abortion rights to death rights, by using it as the initial step in achieving further ends, and by asserting the moral equivalence and indifference between killing and letting die. The purpose of pointing out these examples is to suggest that it is illegitimate, inconsisten, and ultimately hypocritical for advocates of euthanasia to casually brush off the concern that legalizing euthanasia will lead to abuses that will threaten society rather than promote mercy, simply by labeling it a slippery slope argument, since they themselves engage in this mode of argumentation to achieve their own ends.

But the fact that euthanasia advocates use the slippery slope argument does not legitimize the position of euthanasia opponents. Are euthanasia advocates correct in their assertion that the slippery slope argument of euthanasia opponents is based unnecessarily on fear and on fatalistic assumptions that are mere logical conjecture and not rooted in fact? The remaining posts will seek to vindicate the concerns of euthanasia opponents as not being logical flights of fancy, but in fact rooted in reality.

Notes:

[1] Jack Kevorkian, Prescription Medicine: The Goodness of Planned Death (Buffalo: Promethius Books, 1991), 181.

[2] Derek Humphry, “Why I believe in Voluntary Euthanasia and Assisted Suicide.”

[3] Kevorkian, Prescription Medicine, 214.

[4] Barabara Dority, “The Ultimate Civil Liberty,” Humanist 57.4 (1997): 16-20.

[5] Christian Barnard, Good Life/Good Death: A Doctor’s Case for Euthanasia and Suicide (Englewood Cliffs, NJ: Prentice Hall, 1980), 64-65.

[6] John M. Frame, Medical Ethics: Principles, Persons, and Problems (Phillipsburg, NJ: Presbyterian & Reformed Publishing, 1988), 68.

[7] J. Rachels, “Active and Passive Euthanasia,” The New England Journal of Medicine 292 (January 9, 1975): 78-80. For a fuller treatment on euthanasia by Rachels, see The End of Life (Oxford: Oxford University Press, 1986). For a similar perspective see Leslie Burkholder, “Nancy B and Nancy F,” Journal of Applied Philosophy 18.2 (Aug 2000): 193-96.