The Death Treatment (2015)
newyorker.com
newyorker.com
One of the stories that made me reconsider my position was about a young man who was severely burned in an accident which also killed his father. He spent a long time in the burn ward, and was completely disfigured and disabled. He was in constant agony and felt he had nothing to live for.
He made a video about himself called "Let Me Die", and submitted it to his state's legislature, begging them to allow him to legally end his own life. His appeal was denied, his injuries eventually healed (to the extent that he was no longer in the burn ward, not completely), he was glad that he lived, and went on to a career of educating others about these issues.
Another story that affected me was about some island where the population discovered a readily available fruit that grew on trees on the island was deadly. So they had a rash of suicides, with teenagers killing themselves because they were told by their parents to clean their rooms or some such.
I may be confusing bits of that last story with some others that I've read. But I have read multiple stories of teenagers killing themselves over things that most mature adults consider trivial and blown out of proportion by teenage angst that the kids would most likely would have been able to put behind them as they got older, if only they hadn't killed themselves.
There are legitimate concerns about autonomy, self-determination, and paternalism. I'm the first to admit those are serious concerns, and in some extreme cases the decision to allow or even help someone take their own life is clearly ethical. But there are also a lot of cases where the ethics of the situation are not so clear-cut, and I find it disturbing that some people are so dogmatic about their position that they can't see any dillema, are unwilling to seek other ways of helping or alleviating these people's suffering, and seem to view suicide as the default answer to difficult situations.
I'm also disturbed to hear that Etienne Vermeersch, a philosopher of ethics and "the most influential intellectual in Flanders", can confidently proclaim that Belgium "stands, ethically, at the top of the world." This smacks of hubris, and is unworthy of a man or nation so distinguished.
http://www.ethical-perspectives.be/viewpic.php?LAN=E&TABLE=EP&ID=59
We could quibble over the ethics and morality of euthanasia in the absence of terminal illness. I can't say I have strong feelings one way or another. (Mostly because, IME, when you strip away the context from these sorts of questions there's little of substance remaining to discuss. If I wanted to debate questions of little consequence I'd prefer to write an essay on why smart tabs are the only way to code.)
But if the concern is mental health and people being pressured to kill themselves, it seems to me the law is reasonable. Given that I'm a product of the Western enlightenment and that my preference is to see the law err toward the benefit of individual autonomy, people criticizing constraints in a law permitting euthanasia should be required to proffer data showing that the opposite (status quo) situation--outright ban on euthanasia--in fact results in fewer pressured suicides, assuming the effect exists one way or another. I.e.
If we permit euthanasia, people will be pressured into suicide.
If we disallow euthanasia, people will not be pressured into suicide.
And don't use a strawman. I know of no euthanasia law that doesn't constrain how and when a physician (or other person) can legally provide assistance. No reasonable person (lawmaker or otherwise) needs instruction on dilemmas that mental health and social pressure pose. They're immediately self-evident, and so-called ethicists are wasting ink on the matter as they're no better at resolving the nuances than most other people. The real question is who should get to resolve the situation in thorny cases--people intimately involved in the specific situation, or the state by passing a blanket rule?
These two implications are not logically equivalent.
We all have a psychological predisposition to prefer the status quo. And we tend to assume the latter type of statement is true (e.g. believe it intuitive that without legal euthanasia people aren't systematically pressured into suicide) even when we don't explicitly think about it. But if we state the latter explicitly and burden ourselves with it, then it becomes easier to reason about the whole issue. We can examine our biases. Whereas by focusing only on the first statement we're predisposed to believe the status quo better.
That's also why I dislike abstract questions and contrived situations (e.g. the Trolley Problem). When we frame social issues too abstractly we lose sight, IMHO, of our inherent biases and implied assumptions, and tend to equivocate outcomes. Stick to real facts as much as possible and it's easier to identify and come to grips with our biases and assumptions.
In some ways my opinion is counterintuitive. Isn't it supposed to be the case that by distilling an issue into a simple dilemma that we make it easier to make moral decisions? I don't think so. I think it was Wittgenstein who pointed out, more-or-less, that it's the fine, concrete details of a situation wherein most of the substance lies. By stripping the facts and talking in abstractions or relying on contrived scenarios we've changed the context to an entirely different, fictional reality such that any logical analysis and decision is largely irrelevant to the real-life situation.
I feel like you're arguing from the exception though. This one person suffered and made it, but i think many others suffer and do not make it. There are also others who suffer, but want to continue.
I think there's room for the state to have a limited override. It's clear this person is miserable, but the doctors are sure the misery is temporary, ok. Give doctors the power to override the patients wish for some limited time.
My personal experience is the opposite extreme. There was nothing doctors could do. My relative was stuck in a hospital for about 3 weeks before she let go. Doing that to a dog would be considered torture. I think this case is much much more common than the complete recovery you described.
IMHO, people who want to live, regardless of how hopeless the situation is, should be cared for as well as possible. People who do not want to live, who's chances are very slim, should be given the option.
Twenty-five years after his accident, Dax is adamant that he would still want the same thing under identical circumstances, that he would still want the freedom to refuse treatment and die: "Another individual may well make a different decision. That’s the beauty of freedom; that’s his or her choice to do so."
I'm not going to say this issue is black and white. But I think "it might make him/her happy later" is a tricky argument to make why we should deprive someone of freedom.
I guess I believe that people ultimately do have a responsibility to others. Her son did not ask to be born and Tom's quote "You’ve just taken away the suffering of one person and transposed it to another!" convinces me that euthanasia is not as clean as we might believe. What if Tom having suffered this triggering event and having a genetic predisposition to depression applies for euthanasia? It seems euthanasia for the whole family is ethically above board in Belgium, but I still feel that outcome is unacceptable.
The only thing that really bothers me is that so many ethicists in Belgium (as far as this article describes) believe this is clear cut. I generally don't have too many disagreements with most concepts of western philosophy, but if this is the end result of the application of self-determination, I definitely have plenty of reservations.
Finding out that your parent committed suicide after the fact is just unacceptable to me, especially because the parent in this article did honestly express to the doctor that she cares for them.
I do agree with your sentiment about the ethicists. The article paints a picture like the review boards and experts are closing ranks against the "outside world". It's somewhat understandable given that these are considered hard-won "victories" by the humanist camp and still under constant pressure, but it reduces transparency in an area that absolutely requires both transparency and accountability. It's almost like regulatory capture: it encourages practitioners to play it fast and loose knowing they will be backed, and that should not be allowed.
However, in this particularly case: I understand it can be very hard for next-of-kin to learn that someone close has chosen to die, and that they were not involved in the process. I've watched it happen twice from somewhat nearby, and I certainly hope never to experience it any closer. The anger, hurt and guilt from not being included in such a life-altering decision can be enormous.
At the same time, I don't see how drawing more people into the situation should be up to the physician; that choice too should be squarely in the patient's hands. For me it is enough that the doctor suggested she should contact her children.
For me, the bigger question is why these doctors felt qualified to assess her wish: it does not sound like any of the doctors that approved her request had more than a cursory involvement in her (long-term) treatment.
Big problem. Doctor shopping is a big issue in euthanasia.
It covers the Dignitas[1] facility in Switzerland, which specializes in euthanasia (eu = good & thanatos = death), mostly for the wealthy ... if I remember correctly. It's one heck of a subject and the above documentary really hit me quite hard. For those interested in the subject (hopefully not the action), you might also find Exit International[2] pretty intriguing.
1. https://en.wikipedia.org/wiki/Dignitas_%28Swiss_non-profit_o... 2. https://en.wikipedia.org/wiki/Exit_International
If children are allowed legal euthanasia, should they be able to decide independent of their parents or guardians? Could their parents or guardians so decide without the child's consent? Should there be any age limit at all?
So, yes, all the questions you ask are really good ones. And, exactly mentally ill people and children are two categories ripe for abuse and where there needs to be tight regulations. It's extremely complex.
That's confounding the issue with an orthogonal question. We already have the means to measure and control mental capacity before the law: it's called legal guardianship.
If children are allowed legal euthanasia, should they be able to decide independent of their parents or guardians?
"Decide" is a bit ambiguous for me. Yes, they should reach their own decision independently; and no, their decision alone is not reason enough to go through with it.
Could their parents or guardians so decide without the child's consent?
"Without" is a bit ambiguous for me. Yes, if consent cannot be ascertained from the child (e.g. coma, paralysis), that should be possible; and no, "against the child's wishes" should never be allowed.
Should there be any age limit at all?
I simply don't believe in universal hard limits. There will always be corner cases where what's "right" falls on the wrong side of them.
Especially in the case of voluntary termination, I believe that every case is a tragedy in itself, and every case should stand on its own arguments and merits. To do any less would be a disservice to the suffering.
Conversely, to put an age limit on voluntary termination to me feels like mandating by law that young people can't suffer (i.e. I think it amounts to using the law to create the illusion of a perfect world).
It made me think a lot. I knew my pain would go away, there were drugs for it, etc. But and those who are suffering a great pain, with no drug making effect to reduce it, and knowing that the time is coming?
It's not humane not to provide an end for those who want it, those who are suffering and the end is near.
It was not my case. But I'm sure it's the case of someone else.
I firmly believe in the right of anybody, for any reason, to self-terminate. But that's not euthanasia. When we start getting society involved in the business of terminating people who request it? It's another level of moral and utilitarian complexity.
I think a lot of folks are mixing it all together and demanding that my right to self-terminate should force the doctor down the street to help out. These two things do not have to be related. People have been offing themselves for eons. They will continue doing so without the medical establishment.
I don't have any easy answers for what society should do for the mentally ill. It seems obvious to me, however, that we should certainly be able to provide food, housing, and medical treatment to them before we'd consider setting up a system to euthanize them.
So if your child was about to jump out a window or run in to a busy street you wouldn't try to stop them?
Even if I did, I might still stop them (or an adult) if I believed their actions were unintentionally putting themselves in harms-way or if they were endangering others (pedestrians below or roadway users).
Even if I were to agree with GP, I'd probably still stop my friend high on ketamine from walking in front of a bus (if he actually exists, that is).
I was going to correct or reply, but I felt it would be more useful to the forum to have folks push the edges and discuss them.
I don't claim to have an in-depth analysis of those edge cases. As a suggested place to start, if the state feels that you are able to live on your own -- provide yourself food and clothing, make choices about your location and lifestyle -- you should probably be able to make the decision to self terminate. Or rather, you are able to do that whether we like it or not, the question is really whether or not we feel we should use force to stop you. I don't think we should.
How do we determine this? What's a sound mind? One may argue that if one wants to die they, by definition, aren't in a sound mind and need mental health services instead.
Once I couldn't get released from a hospital for a physical problem - and they used the same argument. Because they could. (I ended up calling my lawyer who came and reassured them that I was indeed crazy to want to leave, but that their liability ended when I signed the acknowledgement that I might die at any moment.)
I'd assume that if it were to become legal, there would be some sort of evaluation process - the state does like its checklist of criteria met.
https://dredf.org/public-policy/assisted-suicide/some-oregon...
So yes, I would stop her from running in front of a car.
The driver who strikes the person in this hypothetical, for example, would likely be traumatized, feeling all kinds of strong emotions for being involved in another's death. The would-be suicide has no right to impose that on the random driver whose vehicle they want to use to commit suicide.
This was a bit of a hit-piece on euthanasia, but also a lesson to spend time with your family before the inevitable happens (whether intentional or not).
Sometime you don't realize what you have until it's gone, as the old saying goes.
Besides, whatever emotional or psychological issues existed between this person and his mother, they don't discredit the central points of this article, which were to bring attention to the complexities surrounding the question of euthanasia, to question whether euthanasia is being performed in cases which aren't hopeless after all, and to ask at what point should euthanasia be legally permitted.
An alternative reading of the situation might be that the mother was emotionally needy and manipulative, using her death to get the last word. It's extraordinarily common in teenage suicides, and this woman seemed similarly immature. Anybody with any experience of a dysfunctional relationship could identify the telltale signs of attention-seeking and conditional love.
Tom seems very much the victim, here. As does his mother, frankly. It takes a very narrow, cynical view of psychology to claim that her mental state was irreversible, hinting at a serious, systemic lack of oversight and possibly even abuse. The ex post facto notification of the Tom's mother's death is particularly cruel.
One wonders who he is to convince them that they may end their suffering.
I think that there's something very cold about a society which says, 'on net, the world is better without you in it' not to someone who is a murderer, rapist or traitor but to someone who is depressed or afflicted with cancer.
> Last year, De Standaard, a prominent Flemish newspaper, published a long tribute to a depressed mother who was euthanized after being abandoned by her boyfriend and becoming disillusioned by her psychiatric care. “I am forever grateful to her that she handled this so well,” her twenty-four-year-old son told the paper. “I am so glad we were able to say goodbye in a beautiful way.”
One wonders if the son attempted to support his mother in life, rather than tell her goodbye.
> On the morning on which the euthanasia was scheduled, Boeykens’s daughter, Kerstin, said that she called De Deyn, crying, and begged him to move her mother’s 9 A.M. appointment a few hours later, so that she would have time to drop her children off at school and then drive to the clinic. But De Deyn said that he was booked for the rest of the day. (De Deyn denies that this happened.) Records show that Boeykens died at 9:20 A.M., at which point De Deyn removed her brain and performed an autopsy.
I don't really know if there's anything more to add to this vignette. It's like something out of Brave New World (a book which, incidentally, I've always found far more prophetic than 1984).
One wonders if the son attempted to support his mother in life, rather than tell her goodbye.
Also: when my mother was diagnosed with (terminal) cancer, she tried the treatments at first. Chemo, radiation, everything. Doctors told her at best it might buy her a few more months.
After learning what those treatments would do to her, she made the decision that a few months of that wasn't worth it, and stopped treatment. Do you think it was my job as a son to try to force her to continue, out of "support" for her?
No; there's a major difference between refusing further treatment and pursuing suicide.
It's worth noting here that explaining that a patient can end their suffering is very different from convincing a patient to end their suffering.
Yes, I realise you wrote "convince them that they may end their suffering," but makes little sense. Convincing someone that they may end their suffering would go like this:
"You can end your suffering." "Can I?" "Yes." "Oh."
Remember when you were a kid and your mother explained to you the difference between 'may' and 'can'? Yes, it is possible to end one's suffering (in this world, anyway — no guarantees about the next), but it is not licit.