In a recent guest post at Catalaxyfiles, David Leyonhjelm (DL) presents an argument for physician-assisted suicide. DL’s argument begins with an attempt to distinguish between euthanasia, which he describes as the infliction of death upon someone or thing that is terminally ill and suffering intolerably, and physician-assisted suicide which is the infliction of death upon the request of a person whose quality of life is severely diminished but not necessarily terminally ill. The key purported difference between euthanasia and physician-assisted suicide, according to this distinction, is that the former turns on the ‘quality of life’ of the person or animal while the latter turns on the will of the person. And yet DL’s argument is cloaked by repeated references to ”suffering’ even though such reference do no intellectual work regarding his argument for physician-assisted suicide. The argumentative weight is purportedly carried by the person consenting to physician-inflicted death, not whether they are terminally ill, nor, contra what DL argues, by whether the person consenting to physician-inflicted death is ‘suffering intolerably’. So it is strange that an argument that wanted to clearly distinguish physician-assisted suicide from euthanasia would muddy the intellectual waters by repeatedly referencing diminished quality of life and suffering.
Well, it is not so strange, because the issue, both philosophically and practically, converges on the question of ‘quality of life’. This does all the rhetorical and intellectual work in philosophical and public policy discussions of euthanasia/physician-assisted suicide which is why DL references ‘unacceptable suffering’, ‘intolerable suffering’, and ‘quality of life’ even though he was purporting to distinguish euthanasia from physician-assisted suicide. In fact, even his chief example involving the late David Goodall emphasizes the idea of ‘quality of life’ which he argues is not exhausted by illness, let alone, terminal illness:
For this centenarian, it was simply about quality of life. He had lived a full and productive existence; but with his physical independence gone, life had simply become “unsatisfactory”.
No one could argue he had anything but full mental capacity. Just hours before his death he made a point of correcting the Swiss clinic’s paperwork that erroneously stated he wished to end his life due to illness.
It was an important point to make. Even when Victoria’s legislation comes into force next year, Professor Goodall would not have qualified for voluntary assisted dying in that state.
What purported establishes diminished ‘quality of life’, in this instance, is ‘loss of physical independence’. However, if ‘physical dependence’ is a sufficient reason to want to die, what morally relevant work is consent achieving? If consent were sufficient, the reasons for wanting death would be morally irrelevant. We have already witnessed a British court rule that hydration and nutrition may be withdrawn from long-term comatose patients with the family’s consent and we have witnessed the same in the United States. In the Netherlands, infants can be ‘euthanased’, according to the Groningen Protocol, so as “to relieve the burden that both the infant and its parents would face in a ‘life of agonizing pain'” at the request of the parent.
So it seems to me that DL is in a little of a pickle. Any support he gives to physician-assisted suicide is effectively support for euthanasia which involves permitting doctors to kill, not only whoever deems themselves to be suffering such a diminished ‘quality of life’ so as to be no longer worth living but allowing the law or public policy to decide such matters where consent is absent. I would also have added but not in instances where the person appears to refuse consent, but a recent instance in the Netherlands where an elderly woman was held down by her family on request of a doctor attempting to administer a fatal dose, suggests otherwise, and for the reasons already mentioned above.
In summary, consent is not morally relevant when considering the reasons a person might have for wanting physician-assisted suicide. What is morally relevant when such requests are made are the actual reasons (loss of physical independence, unacceptable suffering, and the like) given by the person seeking physician-assisted suicide. Which is why physician-assisted suicide, in the end, inevitably dissolves into euthanasia.