Apologia

Note: This is a two-part blog post. The focus in this post of Dr. Hendrik van der Breggen, PhD, primarily addresses the negative arguments for MAID, and the conclusion of both posts.

What about the possible negative consequences of MAID for our neighbors and the larger society that I mentioned? These possible consequences are especially important for thinking about any decision to expand MAID. Here are seven to ponder.

1: Got a problem – get MAID

With the acceptance and expansion of MAID, our society will see suicide more and more as a legitimate way of solving an individual’s problems. Got a problem that makes you suffer? Don’t forget you can get help to kill yourself!

At one of the universities I attended (not too many years ago), I worked as a teaching assistant in an ethics course for a fellow doctoral student who told the class (a) he had advised his roommate that suicide was an option as a solution to the roommate’s problems and (b) subsequently the roommate committed suicide. My fellow doctoral student displayed no qualms about the advice. Nor did most of the students in the ethics course. Some of those students planned to become doctors and lawyers.

2: Life will no longer be seen as society’s default position

This means that our most vulnerable – the elderly, terminally ill, disabled, and whoever else is suffering – must justify the continuation of their lives. Why, after all, should we spend so many healthcare dollars on you – the elderly, terminally ill, disabled, and whoever else is suffering – when you’ve become unproductive? This may not be stated explicitly but will be an unspoken assumption (it is already, I believe) and, as law professor Carter Snead correctly points out, a “subtle coercion.”

In other words, into the darkness of suffering, we add more darkness. But surely this is a nasty burden to place on people when they’re already down. In fact, it’s a kick in their teeth.

3: Adding insult to injury

When we decide not to accept life as our society’s default position, say, by expressing out loud (e.g., via public consultations in Canada) that we want MAID if we were to become handicapped or infirm, we insult the most vulnerable by communicating this message to them: We would rather be dead than be like you! If that isn’t an insult, what is?

4: A big chill

If the choice or autonomy of the sufferer constitutes acceptable personal and legal grounds for the sufferer to end his/her life – a legal right – then will suicide interveners have to add to their script some directions as to where MAID is available? Will National Suicide Prevention Week include some Suicide Promotion Days? Will Bell Let’s Talk encourage referrals to MAID? Will suicide intervention or counseling against suicide become grounds for a lawsuit against the intervener or counselor?

5: Slippery slope

With the acceptance of MAID, a non-fallacious, logical-legal slippery slope looms large – in fact, we’re sliding down the slope already. Reasons for one action sometimes also justify other actions that are unintended to be justified by those reasons.

Here’s a fun fictional illustration that I used in my ethics and logic courses which helped students better understand the slippery slope at hand.

Let’s say that I approach my college president and propose that our school should make a policy of giving philosophy students the right to free tuition if they choose to accept it. My reason: philosophy students are people who must think very hard and aren’t guaranteed jobs after graduation. There would be a slippery slope here, for sure!

Once the rest of the student body heard about this policy, students would appeal to a principle of fairness (and would be motivated by greed perhaps) and would argue that all students should receive free tuition, not just philosophy students. Why? Because all students must think very hard and none are guaranteed jobs.

In other words, if thinking hard and having no guarantee of a job after graduation are sufficient grounds for a student to receive free tuition, then whether a student is taking anthropology, business, history, philosophy, psychology – or whatever – doesn’t make a relevant difference. The principle of fairness is fundamental, and the differences between academic disciplines, though real, are incidental. Fairness demands consistency.

Thus, if my college makes a policy (the legal bit of the legal-logical slippery slope) that gives philosophy students free tuition on the basis of hard thinking and lack of a job guarantee, then, in the name of fairness and consistency (the logical bit of the legal-logical slippery slope), the college should ensure that all students receive free tuition.

If my boss doesn’t want to be unfair or inconsistent (and doesn’t want our university to go broke), then he shouldn’t give philosophy students the proposed deal.

Our lesson: The above non-fallacious, logical-legal slippery slope argument ensues because the reason behind my proposal justifies much more than intended.

Back to MAID: The alleged right to end one’s life because of suffering justifies not only the situation of the terminally ill, but also those situations of the elderly, the disabled, the parent suffering the loss of a child, the person suffering chronic back pain, the depressed teenager, the person suffering existential despair/ meaninglessness/ feelings of being a burden, etc.

Enter: So-called safeguards – and their failure. Significantly, if we have already accepted individual autonomy as a legal justification for MAID, how can we deny anyone MAID? (Think of the experience of Belgium and The Netherlands and, again, The Netherlands.)

Courts will do what courts do: promote consistency. But consistency requires that MAID’s fundamental justifying principle – i.e., that the sufferer has the right to choose MAID to end his/her suffering – will carry more legal weight than the situational differences. The situational differences will (with the help of a good lawyer or activist judge) be seen to be incidental. In other words, legal acceptance of MAID puts gobs of logical-legal grease onto the path that leads to killing as a solution to suffering. The result: eliminating sufferers becomes equated with eliminating suffering, and legality becomes an accomplice to normalization of practice.

What, then, should we do? The best safeguard, it seems to me, is to eliminate the autonomy principle as paramount and instead have our doctors and nurses return to the Hippocratic Oath: “I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.” And we should provide excellent palliative and hospice care (without killing) for all.

6: Caring becomes killing

If we kiss good-bye the above portion of the Hippocratic Oath, then we invite a deep change of character to the practice of medicine. Healers will be asked to be killers. Health care becomes careful killing. And those conscientious persons who refuse to kill will be discouraged from practicing medicine. Sound far-fetched? It isn’t. To those doctors who merely refuse to provide information about MAID as an option, highly-respected University of Manitoba ethicist Arthur Shafer says this: “perhaps you should be practicing in a different branch of medicine or perhaps you shouldn’t be practicing as a doctor.” (CBC News Manitoba, July 16, 2016.) Keep all this in mind when you think about the next possible consequence.

7. Sometimes history repeats itself

Consider these insights from Dr. Leo Alexander, medical consultant for U.S. Chief Counsel for War Crimes at Nuremberg, in his summation of the Nazi German experience:

“Whatever proportions these crimes finally assumed; it became evident to all who investigated them that they had started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as life not worth to be lived. This attitude in its early stages concerned itself merely with the severely and chronically sick. Gradually the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted, and finally all non-Germans. But it is important to realize that the infinitely small wedged-in lever from which this entire trend of mind received its impetus was the attitude toward the non-rehabilitatable sick.” (The New England Journal of Medicine, 14 July 1949.)

By accepting and widening the scope of “medical assistance in dying” (a euphemism if there ever was one!), I don’t think we Canadians will become Nazis, but I do think we significantly increase the risk of becoming a dark, morally-calloused, death-embracing society.

Conclusion

Ideas have consequences – and sometimes the consequences of bad ideas can be disastrous. In view of the pros and cons, I think it would be wise for Canadians not to embrace or expand medical assistance in dying. Instead, we should do a better job of providing excellent palliative care – pain relief and life-enhancing dignity – for all who suffer. We should embrace a culture of life, not a culture of death, for goodness’ sake.