Friday, July 8, 2011

The Ethics of Euthanasia (Part Four)

(Part One, Part Two, Part Three)

This post is the final part of my brief series looking at the ethics of euthanasia. The series follows the pair of essays from Michael Tooley and Daniel Callahan in the book Contemporary Debates in Applied Ethics . In the most recent post, I looked at the first part of Callahan’s anti-euthanasia argument. In this post, I wrap things up by looking at the rest of what he has to say.

As we saw, Callahan is worried about the social consequences of legalising euthanasia. He thinks proponents of euthanasia mistakenly construe the decision to end one’s life (with assistance) as a private decision, and consequently as something that should be left within the zone of self-determination. This is wrong because euthanasia is necessarily a social act: something that requires the assistance of another individual. What’s more there are reasons to be concerned about the fact that theother individual is likely to be a member of the medical profession. I examined those reasons the last day and found them to be somewhat suspicious.

Today we continue to develop Callahan’s critique by briefly considering three issues. First, the distinction between killing and letting die. Second, the worries arising from the Dutch experience with legalised euthanasia. And third, the personality-type most likely to avail of euthanasia.

1. Killing vs. Letting Die
I won’t talk about this issue too much since I have a podcast planned on the topic. Suffice it to say, there is a tradition within applied ethics that maintains there is an important distinction between actively killing someone and passively letting them die. We talked about this previously when looking at Tooley’s pro-euthanasia essay. The reason this is important when it comes to euthanasia is that some people think it is okay for individuals to refuse life-preserving medical treatment (and thereby let themselves die), but do not think it is okay for the same individuals (with assistance from their doctors or families) to take active steps toward killing themselves.

Euthanasia advocates sometimes try to exploit the openness of people to the passive forms of euthanasia when defending its active forms. They do this by arguing that there is no important moral difference between killing and letting die. James Rachels was perhaps the leading proponent of this argument. Unsurprisingly, Callahan rejects it. He thinks that proponents of the “no difference” argument are confused. They fail to appreciate the nature of a doctor's decision to “let someone die”. Basically, he points out that life is fatal and that, ultimately, doctors can’t prevent death, they can only postpone it. Thus, they aren’t really killing people when they withdraw treatment, they are just making unavoidable decisions about the best use of medical resources.

I find Callahan’s analysis to be a little shallow here. There are complex issues to be addressed in determining what counts as a cause of what, and he fails to discuss those. Also, Tooley’s argument, which opposes Callahan’s, does not rely on this killing-versus-letting-die distinction and so the issue can be sidestepped by the euthanasia advocate. In any event, I think Frances Kamm does a better job of discussing the difference between killing and letting die in some of her work, and I’ll do a podcast on it in the near future. So let’s just move on.

2. The Dutch Experience
As noted last time, one of Callahan’s primary worries about euthanasia is that, if legalised, it will add to the range of permissible killing in society. And if we add to the range of permissible killing, we will find ourselves sliding down a very slippery slope indeed.

He illustrates his point by reference to a study done on the regulation of euthanasia in the Netherlands. Throughout the 1970s and 1980s, Dutch courts allowed for euthanasia provided certain conditions were met. Although the legal situation has changed more recently, it is this period that is covered by the study referenced by Callahan. The study, which dates from 1992, was an anonymous survey of the Dutch physicians who were responsible for ensuring that the conditions mentioned by the courts were being met. Despite repeated assurances over the preceding years, the survey found that 50 percent of euthanasia cases went unreported, and that 1/3 were cases of non-voluntary euthanasia.

Callahan finds this shocking and a dramatic illustration of the slippery slope mentioned above. I’m not too sure. Although I’m unfamiliar with the all empirical data on the Dutch experience with euthanasia, I think it’s worth recalling the observation made by Tooley: what matters here is not whether there are undesirable cases of euthanasia in the Netherlands, but whether there are more such cases than when compared to countries that don’t have legalised euthanasia? After all, just because a practice has not been legalised does not mean it is not taking place. Tooley thinks that when the appropriate comparative exercise is carried out, the results lead us away from Callahan’s pessimistic view.

3. Catering for the Autonomous
Callahan closes his essay with an interesting observation. After examining evidence from Oregon (which also has a form of legalised euthanasia) he notes that very few people actually avail of euthanasia. In practice, those who suffer from painful, debilitating and terminal illnesses tend to make do with palliative care, no matter how unbearable their lives have become. What's more, those who do avail of euthanasia tend to share an unusual personality trait. They are, for want of a better word, control freaks; people who need to exert decision-making power over all aspects of their lives. Given the concerns he has already expressed, Callahan thinks there is no good reason to legalise euthanasia simply to cater to the needs of such people.

I’m not sure what to make of this suggestion. There is, no doubt, a pejorative undertone to what Callahan is saying. He clearly thinks that control freakery is not to be encouraged (this is a general worry, see here for example). Well, when you put it like that, I guess this sounds right. But, still, I don’t think personal autonomy is something to be sneered at. Indeed, I think it is a key moral value in liberal societies, something that should be cherished. However, let’s suppose that I’m wrong about this and that autonomy is simply neutral, it still would not follow that, just because it is a minority interest, it shouldn’t be accommodated by the law. Minority groups are often given special treatment by the law. So I can’t see exactly what Callahan is getting at here.

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