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Bill Muehlenberg's commentary on issues of the day...

Euthanasia, Choice and Autonomy

Sep 26, 2010

A leading argument for euthanasia is the argument from human autonomy and self-determination. “It’s my life and I can do what I want with it. It’s my choice!” is the oft-heard cry. Today this idea of independence and autonomy is seen as the ultimate trump card to beat off all other considerations.

The emphasis on personal freedom and autonomy is relatively new. It has been growing strongly since the Enlightenment, although most Enlightenment thinkers still condemned suicide. Today autonomy is a main consideration in bio-medical ethics.

But this was not always the case. The pre-Christian Hippocratic Oath made it clear that there were limits to human autonomy: “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.” Even if the patient asks for this, the doctor is to realize that this request is wrong and cannot be obeyed.

This plea for personal choice and autonomy is really saying that in this case we all have the right to commit suicide. Whether a doctor assists in this suicide, or we carry it out ourselves, this is what is really at work here. But civilised societies have long had good reason to view suicide as immoral and therefore make it illegal.

Killing another innocent person is murder, and killing oneself is self-murder. Thus for millennia it was regarded morally wrong and was to be deterred by the laws of the land. Suicide has seldom been looked highly upon, and of course is to be distinguished from martyrdom, which is quite different.

And in medicine the whole purpose of the physician is to heal the patient. The wholeness, wellbeing and health of the patient is the aim of the doctor, and killing the patient can hardly be said to line up with those goals. A dead patient receives no benefits. Healing does not take place by extinguishing the patient.

Moreover, personal choices must always be weighed up and balanced against the greater community good. Just as murder is wrong, and a selfish act, so too is suicide. Moreover, the creation of new rights and freedoms often takes away from existing rights and freedoms.

As bioethicist Mark Blocher puts it, “Expanding one freedom often limits another. It does more than simply provide options. . . . Expanding personal freedom to include assisted suicide undermines another right – to remain alive without having to justify one’s existence.”

There is already such a huge problem with suicide amongst young people in the Western world, that any laws giving the OK to physician-assisted suicide will simply compound matters and make things much worse. Indeed, the argument from autonomy, if consistently applied, would mean everyone should have the right to be killed.

As already mentioned above, it will not just be the terminally ill who will demand their ‘rights’ in this regard. As Mark Foreman points out, “if the argument from autonomy is valid and can really stand on its own, then one would have to argue that any anonymous individual at any time has the right to die, and … has the right to ask others to help.”

Joni Eareckson Tada is a quadriplegic who has spent her entire adult life in a wheelchair. If anyone has a right to consider suicide, or physician-assisted suicide (PAS), it is her. But she sees what a selfish and anti-social act this would be: “Society is you. Your actions, your decisions matter. What you do or don’t do has a rippling effect on everyone around you.”

She continues, “Your self-determination to die has strings attached if it adversely affects the rights of others. That’s why more than half the states in our country have laws against aiding a person in suicide. . . . You may want to exercise a right to die, but you cannot ask a physician, whose duty is to heal, to comply with your wishes or even to make a referral. No person, in the name of self-determination, can oblige a doctor to inject him with orphenadrine when it goes against the physician’s oath to heal.”

And euthanasia or PAS are never really “truly autonomous acts, since each involves at least one other individual – an individual who remains behind to struggle with issues of responsibility, morality, guilt, and remorse,” as some leading ethicists put it.

Also, the mantra of choice is quite misleading. Choice in and of itself is not what is important, but the object of one’s choice. Quite often the supposed freedom of choice is really the stuff of coercion. As John Keown puts it, many requests for PAS “are not truly autonomous but result from depression or inadequate palliative care.” And “the value of autonomy lies not in making just any choice but choices which are consistent with a framework of sound moral values.”

Indeed, coercion will come from many quarters once euthanasia is legalised. As Nigel Cameron rightly argues, “Many people can stand to gain when someone dies – financially, emotionally or simply in terms of domestic convenience. The pressures can be subtle and much stronger than those involved realise. They are by no means limited to the narrow area of inheritance. There are several different parties whose suffering a patient’s death may relieve.”

And the argument for a right to suicide is a very strange argument indeed. A person seeks to use his autonomy to end his autonomy! Suicide thus means the end of personal autonomy. It seems to be the ultimate oxymoron to speak about the choice to rob oneself of choice. As Leon Kass points out, “In the name of choice, people claim the right to choose to cease to be choosing beings.”

Or as Arthur Dyck asks, “how can suicide be considered a right, when the freedom to undertake it puts an end to all possibilities to act, to freedom and life, and hence is an act that abolishes these basic rights?” So much for choice and autonomy.

And as J.P. Moreland says, “Suicide is also a self-refuting act, for it is an act of freedom that destroys future acts of freedom; it is an affirmation of being that negates being; it serves a human good (e.g., a painless state) but, as a means to that end, violates other, more basic human goods (e.g., life itself).”

No wonder ethicist Daniel Callahan could speak of “When self-determination runs amok”.

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15 Responses to Euthanasia, Choice and Autonomy

  • It seems to me a great contradiction that it is wrong for a person in mental and emotional anguish to end their suffering but the those is physical pain should be allowed even assisted to end their lives. Surely in both cases the answer is to relieve the suffering of the person not end their lives.
    Kylie Anderson

  • The difference between autonomy as they conceive it and dignity as is commonly understood is an ocean of blood. They’re betting on there existing enough dupes to push their wacky metaphysical principle into law.

    It should be clear by now that radical conceptions of autonomy require concommitant radical increases in the size and power of the state to maintain protect these radical ‘freedoms’. This is another self contradiction. These secularist only believe in the existence of power and so bang on about power relations in every aspect of life – don’t they see a problem with a Leviathan going up against a little fragmented autonomous citizen unit? stripped of its special metaphysical status of intrinsic dignity and left naked before such a beast?

    “But you’re not autonomous enough; autonomy is the fundamental metaphysical principle of our social order, its what unites us all; I’m sorry what you say has no force vulnerable person – you’re not as autonomous and human as the rest of us; in everyone’s interest we’ll just push you off quietly – you won’t feel a thing.”

    Martin Snigg

  • Thanks Bill
    As I understand it doctors do not have to make the Hippocratic Oath anymore. Even so a doctor’s whole purpose is to heal the patient if possible, or to make pain bearable. If this is not done in that order, their vocation is not Hippocratic, but hypocritical.
    Freedom is a great thing if it is rooted in truth. Apart from truth there can be no authentic freedom. It is true that we are free to choose, for God has given everyone a free will.
    However he never gave us the right to choose evil. Today one of the most common errors of all time is to confuse freedom and license. Today, frequently under the pretext of freedom, as you mentioned, “It is my life and I can do with it what I want,” mankind acts in a manner that is really license. No one has the moral right to do evil. “It is my body and I have the right to choose.” I think this is the only sentence in human history which was never finished! Choose what? Choose the “right” to murder my baby should be at the end of that sentence.
    The inevitable consequence of abusing freedom is losing freedom. Loss of personal freedoms, one at the time, is already well underway. One day we shall awake from our moral slumber and find that we have become slaves.
    For as Jesus says, “The man who sins is the slave of sin ” (John 8:34.)
    Anne Van Tilburg

  • Thanks again, Bill.

    Euthanasia is the grand culmination of a self-centred existence. The desire of the sinful human heart is for greater and greater autonomy, in life and in death. I want everything to happen on my terms, and when it comes time to pull the plug and leave this world, I want to be the one who does it.

    As a doctor, I appreciate your remarks about the Hippocratic oath and the physician’s committment to heal. What stands out in the modern debate around euthanasia is the fact that the medical profession (represented by bodies such as the AMA) has by and large opposed PAS. It simply goes against everything we do. I suspect that even if euthanasia-legalisation laws are finally passed, it will be quite difficult to find a doctor who will actually practice PAS, and those that do practice it will probably spend little time doing anything else.

    Personally, I believe that if a euthanasia industry starts up, services should be provided by non-medical executioners (just like with lethal injections in the US) rather than medical practitioners.

    I just want to stress yet again, as someone within the medical profession with palliative care experience, that there is no grey area between euthanasia on the one hand, and palliation or withdrawal of futile life support on the other. The latter are well within the bounds of medical practice, the former is well outside. The myth of a grey area is only perpetuated by people who are ignorant of the role of doctors and medicine during the dying process.

    Jereth Kok

  • The slippery slope really does appear to apply in the euthanasia case. Read this article by Wesley Smith on the descent of Dutch euthanasia into killing disabled infants:

    http://www.weeklystandard.com/Content/Public/Articles/000/000/012/003dncoj.asp?pg=1

    Damien Spillane

  • You may be interested in my articles discussing the “choice” issue, that it is a “carrot” to get people to think that they want something that is, in fact, counter to preserving their own individual choices, especially when they are older and have money that others want or have some type of health condition. This is due to the potential for abuse, etc. See e.g. Margaret K. Dore, “Aid in Dying: Not Legal in Idaho; Not About Choice,” The Advocate, official publication of the Idaho State Bar, Vol. 52, No. 9, pages 18-20, September 2010. http://www.margaretdore.com/pdf/Not_Legal_in_Idaho.pdf
    Margaret Dore, Seattle, USA

  • Well, I guess it`s ok if Jesus does it, right? God did sacrifice himself to himself, making it a suicide. It is most unequivocally NOT a case of self-sacrifice for the greater good, for if you accept the claims in the bible, he set the whole thing up to fail, and could have required an ice cream cone in exchange for redeeming the whole world.
    Winston Jen

  • Thanks Winston

    I of course normally do not waste my time replying to atheists who simply come back time and time again with their smart alec remarks, seemingly without the slightest interest in pursuing truth. Yet as an educational tool, I will deal with this for the sake of others who are interested in truth and really do care about learning.

    Jesus of course did not commit suicide. He was a martyr which is quite different. He died for a cause, and allowed himself to be killed. The Romans of course actually put Jesus to death, with the insistence and consent of the Jewish leaders.

    And Jesus certainly did not want to die – unlike those who commit suicide. He in fact prayed that the cup of this death would pass from him. Nonetheless he took upon himself the death which we deserved, so that everyone – including atheists who think they are being so clever – can become restored in their relationship with God, if they are willing to swallow their pride and arrogance, and recognise that the deserve death, but can forego it if they make use of the mercy extended by God in Christ.

    Bill Muehlenberg, CultureWatch

  • Hi Jereth
    I did not realize that you were a doctor. It must be very difficult today to practice according to your beliefs. On the one hand, and it might come to that, do I keep my job and practice according to law, or, if not, I could very well be prohibited from practicing. I will keep you and all doctors in my prayers. it is very hard to proclaim the truth in and out of season.
    Anne Van Tilburg

  • It adds another dimension to becoming an organ donor doesn’t it?
    Tony Morreau

  • Many thanks for your prayers, Anne.

    The biggest challenge right now is the Victorian law which requires us to refer people for abortions. I hope that I am never sued over this… but if it ever does happen, I’ll be looking for a wealthy donor to help me out! (else, I’ll see you on the dole queue!).

    Jereth Kok

  • Thanks Damien I read the article as you suggested. What a horrifying situation our descendants will face if we don’t resist now in every way that we can. When God’s law is abandoned nothing is surer than that society will descend to the depths of depravity and inhumanity. We had better all find ways to make a difference without delay.
    Anna Cook

  • Bill,
    Thanks for taking the “educational approach” to Winston’s e-mail. It is good to see the truth simply and clearly put.
    Winston, ice-cream cones weren’t around two thousand years ago, and if you think God could have redeemed the world with an ice-cream cone, am I to believe that’s all you think you and everyone else is worth?
    Next question. How are you feeling, now that Bill has capably parried your central thrust…and disarmed you. Third question. Do you really want to spend the rest of your life throwing out those kind of remarks, that display an incredible ignorance of Christ and His work, and apparent little respect for those who love Him?
    In response to Bill’s reply, and perhaps mine, I see that you now only have two choices; hatred or humility. Indulgence in hatred will extinguish the best of you, and even your life, but if you stop and humbly inquire concerning Christ, you will reach a manliness and nobility that you so far have not displayed.
    C’mon Winston, stop running with the mockers, (and perhaps enjoying their praise) but between you and Jesus, make your own decision; and if you don’t understand something, ask!
    Yours for encouragement,
    Robert Greggery

  • Two men wander in the woods. One has a compass, one does not. Both make choices. Yet one is free and one is lost. There’s a difference.
    Anthony McGregor

  • Thanks Bill for another thoughtful and pursuasive contribution to the debate on euthanasia. Readers of your blog may be interested in attending a public meeting on opposing euthanasia and assisted suicide at which Alex Schadenberg, Executive Director of the Euthanasia Prevention Coalition, will speak on “Caring, not Killing”. It is being held at 7.30pm on Wednesday, 13 October, 2010 at the O’Hanlon Centre, Mitchell Street, Mentone. He is also speaking in Perth, Adelaide, Sydney, Tasmania and the ACT.
    Terri M. Kelleher

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