BARBELITH underground
 

Subcultural engagement for the 21st Century...
Barbelith is a new kind of community (find out more)...
You can login or register.


Professor calls for non-consensual euthanasia

 
 
Hydra vs Leviathan
20:09 / 08.06.06
Front page of today's Guardian:

One of the country's leading experts on medical ethics today calls for doctors to be able to end the lives of some terminally ill patients "swiftly, humanely and without guilt" - even if they have not given consent.

I have extremely strong views on the whole euthanasia/assisted suicide (incidentally, i consider these to be 2 very different things, both practically and ethically) debate, but unfortunately they don't coincide exactly with those of *any* of the major/vocal pressure groups, legislators or other high-profile individuals concerned with the issue... they're complex, and i will probably attempt to articulate them more fully in subsequent posts, but suffice to say both as a disabled person and as a(n anarchist-feminist-) libertarian this horrifies and disgusts me, and i really can't think of anything to describe what he advocates as except murder (which doesn't make me a "pro-lifer", just to make that clear).

I think this whole thing is a complex issue, with loads of different debates to be had about it (disability/eugenics/"suffering" as something to be eliminated from life, autonomy over one's body vs medical authority, consciousness and presumption of desire in the absence of consciousness, utilitarian/resource-based medical ethics, etc) - it could as easily be in the Laboratory or the Head Shop as the Switchboard, but i put it here because it's a current parliamentary-political issue, and has been in the news quite a bit recently...

What do people here think about the whole issue? Does anyone think this sort of thing can be justified?

[was going to post some other recent-ish euthanasia-related links, but was unable to find them, so they'll have to go in another post...]

more later (or tomorrow, most probably)...
 
 
diz
21:54 / 08.06.06
He's basically talking about euthanizing terminally ill people who are already incapable of anything but feeling pain and who are surviving entirely by feeding tube, and doing it after the decision to remove the feeding tube has already been made anyway.

I'm sorry, but I don't see how anyone could have a problem with that. I think it's barbaric to starve people to death (sorry...technically I suppose we're just "allowing" them to starve to death "naturally") when you could just give them an injection.

This is already common practice in the Netherlands, as I understand it, and it doesn't seem to cause any problems there.
 
 
STOATIE LIEKS CHOCOLATE MILK
22:22 / 08.06.06
If we had sensible euthanasia laws this wouldn't even be an issue- you could tick, or not tick, a box while healthy that would give your wishes and consent before you became ill.

However, we don't...
 
 
SMS
04:11 / 09.06.06
I'm trying to work out how much of my thought I should post, here. I, at least, would consider it murder if a doctor were to actively euthanize me. Going through my reasons have to do with the way we experience pain, what death really means, and what I think is the proper interpretation of what it means to live. I started to write a post just covering the part about pain and got several paragraphs down before realizing I still hadn't really addressed even a 1/4 of the relavant critiques 'lithers would be likely to have about it.

Let me see if I can say three things.

I don't want to deny the pain of my death by killing myself faster. Depending on the circumstances, I might want painkillers, but not with a primary intent to be killed.

I don't believe my life is of value only because of the pleasure I get from it or from the contributions I make to others. I don't believe any amount of pain or suffering can remove the inherent value of my life.

Even though others disagree with me about the inherent value of life, I don't want to be a part of their killing by being the one whom they kill. In other words, I don't want you to become a murderer for my sake, and I hope that the law will at least defend me from well-meaning doctors who think differently. If, on the other hand, I am no longer present in my body (because my brain damage is so severe that it is only a shell), then I don't think that passive euthanasia can be worse than active euthanasia because it wouldn't be causing pain to an actual person. In other words, removing the medical support from my body could not possibly be worse than actively destroying my body, because neither could effect me.
 
 
elene
13:37 / 09.06.06
I can't see the difference between letting someone starve when I could prevent it, or my refusing medication that could save them, and killing them in any other way. He's quite definitely correct in that regard, and the question is rather should withholding treatment ever be permitted.

Unfortunately it must be because resources are finite. Ultimately someone who's received treatment but has no hope of recovery must stop being treated, or someone new will not get treated in the first place.

It's very difficult to stop living when modern medical technology is used to keep one alive. What would take hours or days without this bulwark can take years with it. That is not something one bargains with, unless of course one has already seen others, one's loved ones or one's patients, go through it. In that case this is something one might wish to spare oneself and others, but equally one might not. Almost no one dies gladly.

So I don't know.
 
 
diz
02:08 / 10.06.06
If we had sensible euthanasia laws this wouldn't even be an issue- you could tick, or not tick, a box while healthy that would give your wishes and consent before you became ill.

However, we don't...


That would be a nice start, yes. It's absurd that we regularly run into debatable cases like this. How do we let things get to the point where someone's incapable of communication before we start to wonder how they would like to handle the situation?

This should be systematized. Everyone should be expected to fill out a living will.

I don't want to deny the pain of my death by killing myself faster. Depending on the circumstances, I might want painkillers, but not with a primary intent to be killed.

I would. There's a point where the cost/benefit ratio of living tips too heavily to the "cost" side, and I would so much rather

I don't believe my life is of value only because of the pleasure I get from it or from the contributions I make to others. I don't believe any amount of pain or suffering can remove the inherent value of my life.

I do. Not only do I believe that about my life, but I believe it about your life, too.

There is no inherent absolute value to human life, or any other life. It's all conditional and contextual.

Even though others disagree with me about the inherent value of life, I don't want to be a part of their killing by being the one whom they kill.

I appreciate your concern, but it's misplaced. Euthanizing someone who's clearly suffering and whose actual life is over wouldn't keep me up at night.

If, on the other hand, I am no longer present in my body (because my brain damage is so severe that it is only a shell), then I don't think that passive euthanasia can be worse than active euthanasia because it wouldn't be causing pain to an actual person. In other words, removing the medical support from my body could not possibly be worse than actively destroying my body, because neither could effect me.

Which, incidentally, is exactly the case at issue here.
 
 
Tryphena Absent
02:29 / 10.06.06
I don't want to deny the pain of my death by killing myself faster

I think you're limiting yourself to a specific type of death here. If you die of advanced alzheimers combined with a stroke and pneumonia you won't be able to conceive of that pain in the way that you're suggesting.

I support euthanasia for very specific reasons. Witholding food is as much murder as active euthanasia and I thoroughly disagree with the slippery slope argument, which I feel is akin to suggesting that doctor's should not carry potentially lethal drugs because they could be inclined to kill patients with them. You legislate and consistently monitor these things, you don't deny them to people. There is a strong and significant difference between a person who is in control up to the point of their death and someone who does not recognise a single thing around them. It's about time that was noted and basic dignity was recognised as a valuable thing. To be a person when you die is so important, I can't even express it in writing.
 
 
STOATIE LIEKS CHOCOLATE MILK
11:50 / 10.06.06
Apart from anything else, euthanasia is going on all the time anyway, unlegislated. And that's not going to change. Relatives who have been put by fate or whatever into an intolerable position are being turned into murderers, as are doctors.

It's about time we actually had some sort of framework for dealing with the whole thing, because it's not going away any time soon.
 
 
SMS
21:11 / 10.06.06
Which, incidentally, is exactly the case at issue here.
Just to clarify, because I may not have said this well, my point was that, if the person is absent from the body, then there can't really be a moral case that we have to make the death as quick and painless as possible. Hence, the claim that it is barbaric to let someone die slowly only holds water if it is acknowledged that it's someone dying slowly.

But on to this:
I appreciate your concern, but it's misplaced. Euthanizing someone who's clearly suffering and whose actual life is over wouldn't keep me up at night.
What if that person is me? I've expressed here, in what is not anything like a legally binding document, but what is nevertheless my actual wish, that I don't want to have poison injected into me in order to make my death quicker. Given that what is called the right to die is being extended in certain cases to people like me, who haven't signed requests specifiying that I don't want to be killed, I probably will fill out a form soon.

However, the case that gives people trouble really is the case in which we have to have a default policy. And in some hospitals, an ethics team is making the decision on behalf of the patient. Instead of having a default policy of not killing, they have a default policy in which a team of experts decides the value of the patient's life.
 
 
SMS
21:36 / 10.06.06
Sorry about the quick second post, but …

I do. Not only do I believe that about my life, but I believe it about your life, too.

There is no inherent absolute value to human life, or any other life. It's all conditional and contextual.


I distinguish between an absolute (or infinite) value and an inherent value. An inherent value is one that we are morally obligated to acknowledge independently of its use for other goods. My individual happiness is inherently valuable whether or not it positively contributes to a just social ordering. An absolute value is one that we are morally obligated to acknowledge as maximally valuable. So if my happiness is only possible if I rule the world with an iron fist, then, inherently valuable as it may be, it is not worth worldwide tyrrany, and therefore has less than absolute value. (If two conflicting goods both have maximal value, then we have a tragic situation.) I also think that my own life has a certain kind of inherent value when it comes to the question of suicide, partly because it provides the context in which all my decisions are made. But I also think it has a normal inherent value because it is by nature human, and this value I acknowledge in all people.

What I might concede is that often the means by which the law might try to stop a person from killing herself in the case of illness are often morally unacceptable. A doctor who doesn't share my philosophy and who knows full well that this is dizz and dizz wants to be killed doesn't really deserve to be charged with first degree murder.
 
 
Hydra vs Leviathan
00:06 / 11.06.06
Right, i'm going to try to articulate my position now.

I believe euthanasia is utterly different from assisted suicide (often wrongly conflated with it), and that the difference is basically that the latter is suicide and the former is basically murder.

I believe the only consistent libertarian position that can be taken on life-and-death issues is that the individual, and only the individual, has an absolute right over hir own body and hir own life (and, to make this possible, the only limit to that is that ze absolutely and categorically has not got a right over any other individual's body or life).

This means that i do believe every person, regardless of disability, illness or lack thereof, has the right to suicide, as the right to life, IMO, is rendered utterly meaningless if it is not accompanied by its converse, the right not to choose life. In the case of a person too severely physically disabled to commit suicide without help, therefore i believe that, just as ze has a human right (IMO) to free assistance with every other task ze wants to but is physically unable to do (as far as is possible), ze has a right to be assisted to commit suicide (although i do recognise the potential ethical difficulties in requiring someone employed as a personal asistant to effectively end their own employment, and to do something they may have major moral problems with... so i'm not sure that anyone should be required to assist in an individual's suicide).

Where i think assisted suicide as a right does get into extremely dodgy ground is the issue of doctors or family members putting pressure on a person to commit suicide (to free up hospital beds, say, or relieve the burden of caring responsibilities), or of people's choice to die being motivated primarily be society not accommodating their needs or impressing on them that their life is not worth living or that they don't deserve to live (part of my response to that is, of course, a call for change in social attitudes towards illness and disability; another part is the assertion that assisted suicide should be carried out by someone who the disabled person has authority over, such as a personal assistant, rather than by someone who has authority over them, such as a doctor).

However, assisted suicide is not euthanasia - euthanasia is the killing of one person by another, not by hirself. Euthanasia, to me, is totally morally unacceptable because it is a total violation of the principle of autonomy over one's own body/self - it is not carried out at the request of the patient (or if it is, it should be categorised as assisted suicide), buit at the decision of a doctor based on criteria of whether there is any chance of recovery or whether "suffering" is unbearable - criteria which to me are irrelevant, because to me the only possible judge of whether the suffering of life is unbearable is the "sufferer" hirself.

If the person in question has no capacity to consent or no ability to communicate, as in the case of a small child (such as Charlotte Wyatt) or a person who is unconscious or in a vegetative state (such as Terri Schiavo), then IMO the presumption has to be in favour of life - because, if the person's desire, were they conscious or able to consent/communicate, was to die, then they would be being kept alive against their will, but they would not be in a state to know or express that will, whereas if their desire, were they conscious or able to consent/communicate, was to live, and they were "allowed to die", then they would be being killed against their will - and the only word for that is murder.

IMO it makes absolutely no difference if the motive is "ending the person's suffering" as opposed to "hating or wanting to exterminate the person" - in fact, if anything, IMO, the former is worse - paternalism on such a level that the state/doctors/whoever actually gets to overrule your own (actual or speculative) wishes on whether you want to live or not (reminscent of when Hell is taken over by the angels in Gaiman's Sandman: Season of Mists...) Only the person suffering can decide if hir suffering is great enough to render their life unlivable or not, and if there is no way of finding out their feelings on the matter, or they are not sufficiently capable of rational thought to make such a decision, then IMO the only morally acceptable thing is to keep them alive - just as, if you believe the death penalty is appropriate for a particular crime (rape, say), then it's still not acceptable to execute unless there is proof beyond reasonable doubt that the accused actually did it...

Also IMO there isn't a fundamental difference between killing someone by withdrawal of nutrition, etc (as has been quite correctly pointed out is already routinely done, just not talked about) or by "actively" killing - except that the former could, at an extreme stretch, be sortr-of-semi-justified by "lack of resources" arguments, whereas the latter never could...

The "lack of resources" argument is, to me, a bit of a red herring anyway - you could equally well say that, say, gender reassignment operations were not "life-saving" as such, and thus resources should not be spent on them but on more "urgent" operations (which argument is actually used to force transsexuals in the UK to pay (in part) for their own operations even on the NHS, which i'm sure no one here would regard as defensible)... likewise abortion on demand, or anything else...

And i'm not sure why you can dismiss "slippery slope" arguments - if doctors (as opposed to the individual living it) are given the power to decide whether a life is worth saving or not, then what if they decide, say, that a life paralysed isn't worth saving, and don't bother trying to save the lives of people who have had spinal cord injuries? Or, say, that a life with under a certain IQ (itself a highly dodgy concept) isn't worth living, and don't bother giving essential medical treatment to mentally disabled people (which category could include myself)? Many hospitals already deny heart surgery to children because they have Down's syndrome. I personally know people who have recovered from prognoses considered "terminal". These are very real concerns for many disabled people - who do see a slippery slope, and themselves (ourselves) in very real danger of ending up at the bottom of it...

responses to same topic on BBC disability message board
 
 
elene
07:48 / 11.06.06
The argument that resources are finite is not a moral argument, Natty Ra Jah, it's a physical boundary. There is a difference between keeping a long-term comatose stroke victim with no significant chance of recovery artificially alive, constantly monitored and tended, and providing an active but highly endangered heart patient with medication, or even more so with providing a once-off operation to improve the patient's condition. More and more of us are becoming older and older, more and more of us are falling victim of conditions that while they are no longer fatal, are totally and permanently incapacitating. This trend will continue as long as modern civilisation does not collapse and ultimately delaying the inevitable deaths of people who will never again be able to contribute positively to society will consume every possible health budget. At that point, when the health budget can no longer grow, we will have to decide who will be treated. We will then decide to stop keeping some people alive.
 
 
Hydra vs Leviathan
20:02 / 11.06.06
OK, i accept that, but what that really boils down to is the fairly universal truth that, if rights require resources to uphold them, and resources are finite, then the extent to which rights can be upheld is also finite. I am, however, very wary of using criteria like "how likely someone is to recover from their current condition" to decide whose rights are to be sacrificed, since mistakes can be and are made about that, and "miracle" (or rather, supposedly impossible or very unlikely) recoveries do happen. I was born very prematurely, one of my best friends more prematurely still - at that time, at a stage when it was considered pretty much impossible for a baby to survive - but she did survive, and is disabled as a result, but if there wasn't a presumption of "always try to save life" (to which I, as a libertarian, would add "unless the patient has capacity to consent and communicates otherwise", but that's not a necessary addition here), then they might not have bothered to try to save her (or me, for that matter). TBH I'm not sure what other criteria could possibly be used to choose - random hardly seems fair either - and i'm very willing to accept that this is a situation of an impossible choice, ie one which has no possible fully-ethically-acceptable solutions. But as i said, i think this applies to all finite-resource situations...

However, i *do* think that resource issues would enter into the decisions of many people to choose to die or to make "living wills" requesting treatment not to be given in certain circumstances. While this *is* arguably problematic in itself (since you could argue that the resource issues shouldn't be there to influence such a decision in the first place... tho i think that's a bit utopian), i think such a autonomous decision is much better than doctors or "ethics teams" (who, however well informed, are still fallible humans) making such a decision on another person's behalf...

Letters in response to the Guardian article

Demonstrations by disability groups against Assisted Dying Bill
 
 
elene
06:28 / 12.06.06
There already is a status quo, Natty Ra Jah. Different lives are valued differently. If you disallow the choice of one life over another there will not be a random choice. You're actually asserting that celebrities, the rich and the powerful, their families and those they need or care for are more valuable than the rest. Americans will almost always be chosen over Iraqis, Europeans over Africans, the rich over the poor, no matter how great the burden of sustaining the one we save or how great the loss of the other. Perhaps this is a good survival strategy, perhaps it is fair in some sense, but I doubt it.

No one is worried about putting resources into a child who might turn out too weak to live and die six weeks or even six years later. We will however eventually be forced to consider whether it is correct to keep a deeply brain damaged, comatose stroke victim with practically no prospect of recovery alive indefinitely. I think you'd do better to help lay down ethical guidelines that protect the disabled rather than going with a default system that protects the rich. Your choice.
 
 
Hydra vs Leviathan
15:47 / 12.06.06
I don't believe there was anything in either of my posts to indicate that i support the status quo...
 
 
elene
17:25 / 12.06.06
No, you didn't. You don't have to support it. You just have to leave it be and it'll work just fine.
 
 
Hydra vs Leviathan
19:45 / 12.06.06
Well, i don't think being opposed to a change in one direction means wanting to leave things be... i thought i'd made reasonably clear that what i would actually like is change in a completely different direction...

Sorry for possibly snarky-looking briefness of replies, i don't currently have massive amounts of internet time...
 
 
elene
20:16 / 12.06.06
Yes, I'm sorry, you did suggest alternatives, i.e. allowing one to choose to die or limit the form or extent of treatment. Personally I imagine very few people will do this, but I may well be wrong.
 
 
diz
23:17 / 12.06.06
I appreciate your concern, but it's misplaced. Euthanizing someone who's clearly suffering and whose actual life is over wouldn't keep me up at night.
What if that person is me?


To put it simply, if "you" are incapble of something resembling cognition and communication, and there's no hope of recovery, that "person" isn't "you" anymore in any way that I recognize, and so I don't feel that your wishes are really a consideration, because you're already gone. I don't have to worry about what you'd want for dinner if you're not there, I don't have to ask you how to deal with any other problem. I don't see why your wishes come into play when the rest of us are trying to figure out how best to dispose of the twitching mass of nerves and organs that used to house your personality after your personality is gone.

I distinguish between an absolute (or infinite) value and an inherent value.

I don't tend to distinguish between absolute and inherent value, though I don't equate absolute with infinite in this context. An absolute value is a value that is fixed and independent of social context and other considerations, in other words, inherent to the object, being, or state and not dependent on the degree to which someone actually values it.

An inherent value is one that we are morally obligated to acknowledge independently of its use for other goods.

I don't think such a thing exists. ultimately, the value of anything is entirely dependent on its utilitarian value in achieving some goal, and there is no moral obligation to consider any goal universal or absolute, though generally societies that don't share a few basic goals (whatever they may be) tend to fall apart, and so in practical terms it behooves each of us to find a community with whom we share common goals so as to be able to share in all the benefits of cooperation and so on.

My individual happiness is inherently valuable whether or not it positively contributes to a just social ordering.

I disagree. You may feel that your individual happiness is important to you, but no one else is obligated to acknowledge any value to it at all. It only becomes valuable if other people value it, and to that end you may find it helpful to convince others to essentially enter into a reciprocal contract with you whereby they agree to value your happiness in exchange for you choosing to value theirs, in which case, welcome to society and the social contract, with all the benefits and restrictions inherent in that.

I believe the only consistent libertarian position that can be taken on life-and-death issues is that the individual, and only the individual, has an absolute right over hir own body and hir own life (and, to make this possible, the only limit to that is that ze absolutely and categorically has not got a right over any other individual's body or life).

Two points:

1) You seem to be presuming that it's a given that we're interested in finding a consistent libertarian position on life-and-death issues. Why?
2) More importantly, at what point does the individual cease to exist? Is it a hard-and-fast point, or is it more nebulous?

I think both end of life and beginning of life issues are frought with problems of definition. Whether or not a fetus, or, say, Terri Schiavo, is a person really depends on what your definition of a person is, which criteria are crucial and which are incidental. Unfortunately, like every other definition, it's entirely subjective, ultimately arbitrary, and dependent on both general consensus and the willingness and ability of the community to act according to that consensus.

My argument is that we have no moral obligation to define life in any way that is not useful to us, because the whole reason we agree to play along with the fiction of "natural rights" in the first place is that we get useful outcomes in so doing.

And, regardless of my argument, that's how it actually works in practice. People can bitch all they want about rights and morality and whatever, but they require the cooperation of other people in order to enforce their visions, and people as a collective ultimately act in their own perceived self-interest. The whole Enlightenment concept of natural rights and individual liberties was a byproduct of the emergence of new economic systems and new technologies which favored individual liberty. We ultimately began to believe we had inherent rights because it became economically advantageous to live in a society which acts as if we did.

If the person in question has no capacity to consent or no ability to communicate, as in the case of a small child (such as Charlotte Wyatt) or a person who is unconscious or in a vegetative state (such as Terri Schiavo), then IMO the presumption has to be in favour of life - because, if the person's desire, were they conscious or able to consent/communicate, was to die, then they would be being kept alive against their will, but they would not be in a state to know or express that will, whereas if their desire, were they conscious or able to consent/communicate, was to live, and they were "allowed to die", then they would be being killed against their will - and the only word for that is murder.

This is what the question comes down to. You look at Terri Schiavo, and decide whether or not to pull the plug.

In these cases, I think there's no compelling reason to argue in favor of life support and the presumption has to be to terminate. It is useful to support the basic autonomy of individual persons, but it is not useful to anyone to define Terri Schiavo as a person.

OK, i accept that, but what that really boils down to is the fairly universal truth that, if rights require resources to uphold them, and resources are finite, then the extent to which rights can be upheld is also finite. I am, however, very wary of using criteria like "how likely someone is to recover from their current condition" to decide whose rights are to be sacrificed, since mistakes can be and are made about that, and "miracle" (or rather, supposedly impossible or very unlikely) recoveries do happen.

It's always possible to make mistakes, or rather, it's always impossible not to make mistakes. People die who could probably have been saved, people are kept alive when it would probably make more sense just to let them die. That's life. You don't judge a system by the types of mistakes it makes on a case by case basis, you judge it on a larger scale. Getting emotional about individual cases tends to just blur the issue.

It's not about finding the most "just," "fair" resolution to every individual case, but rather about finding a strategy that works well enough for society most of the time. Some people are going to get screwed by that, but some people always get screwed.

I was born very prematurely, one of my best friends more prematurely still - at that time, at a stage when it was considered pretty much impossible for a baby to survive - but she did survive, and is disabled as a result, but if there wasn't a presumption of "always try to save life" (to which I, as a libertarian, would add "unless the patient has capacity to consent and communicates otherwise", but that's not a necessary addition here), then they might not have bothered to try to save her (or me, for that matter).

OK, but not to be a jerk or anything, but why does that matter to me, or to society in general? There's no single life we can't afford to lose.

So as not to think I'm picking on you, let's put it this way. My mom was pregnant with me in 1975, after Roe v. Wade in the US. She was single and working at a job that really couldn't support her and a baby, and so she was forced to be dependent on her parents, moving in with them, etc. I have no problem advising any other young women in similar situations to abort, even though I would not exist had my mom done so. Though I love my life, when I take my own self-interested emotionalism out of the picture, I think she made the wrong call, frankly, and I think we as a society should argue that we should always default to abortion.
 
 
SMS
03:00 / 13.06.06
And, regardless of my argument, that's how it actually works in practice. People can bitch all they want about rights and morality and whatever, but they require the cooperation of other people in order to enforce their visions, and people as a collective ultimately act in their own perceived self-interest. The whole Enlightenment concept of natural rights and individual liberties is a byproduct of the emergence of new economic systems and new technologies which favored individual liberty. We ultimately began to believe we had inherent rights because it became economically advantageous to live in a society which acts as if we did.

I don't thinnk people ultimately act in a collective, but, if they do, it isn't in their collectively perceived anything. We perceive individually always with qualitative experience. If a collective has something like a qualitative experience, we have no access to that experience.

Individually, however, perceived self-interest can refer to a concept that includes living in accordance with a moral obligation. I point this out because it can be a deceptive step in the argument. I know your basic point is that there is no moral obligation, but, for the sake of your argument, you are assuming it does ("regardless of my argument"). To say that there is only self-interest leaves the boundaries for all kinds of causes open for the perceived effects (political and econimic influence, peer pressure, clever poets trying to deceive, and the mysterious collective perception) except for the possibility of legitimate belief in morality. It's quite unfair to morals to insist that they in no-wise play a causal rôle.

But it is actually impossible to have any self-interest whatever without having some concept of good by which it can be measured. I believe (and many others do as well) that always following that which is good (in desire, thought, deed, etc) is necessarily a fulfillment of moral obligation, and that, what's more, moral obligation can be adequately described in terms of a full concept of the Good.

It has been shown that the Enlightenment was made possible by various economic and political conditions, but this does not mean that legitimate and persuasive arguments were not also necessary to make the Enlightenment possible. Philosophers of that era get a bad rap for thinking they had finally made progress on the search for wisdom. It is charged against them that they thought they could stand on the rocky crags of the world and peer at all creation with the eye of God, finding the transcendental truths and firing them into the commonest of men, to bring about a utopian age of peace and prosperity. This charge is simply false. Those philosophers paid less attention to form and context than perhaps they should have, but they were nevertheless aware of serious human limitations, even if they had hope in the future. Even the transcendental idealism of Immanual Kant presupposed a human context — philosophy was done from a perspective of minds like ours. And this is precisely the context in which I propose that people have moral obligations, and the context in which I propose that we recognize some good as good. An attempt at suicide is the denial of this context, or the refusal to continue in it, which is the opting out of one's moral obligation as such. But here's the most serious point of disagreement I have with you. It is also a failure to recognize humanity as it really is, for it is the false (by my reckoning) assertion that all persons are only valuable as they exist in reference to me, and that, therefore, I am only valuable as I exist in reference to myself, and not in reference to some greater or ideal or divine or anything Good. But to say this places all value within two spheres: the sphere of my will and that of the powers that surround me. Everything reduces to power. But once this is known, then it is known that most of my value beliefs are illigitimate — they are things that deceive me and control me, and who could value this? And we are left with the conclusion that the wisest among us will value the least. And that is completely incredible.
 
 
Hydra vs Leviathan
16:06 / 13.06.06
An attempt at suicide is the denial of this context, or the refusal to continue in it, which is the opting out of one's moral obligation as such.

This is rotting my own thread, but i'd argue that it isn't always, since i'd argue that in some circumstances it's possible to believe you have a moral obligation to commit suicide (stereotypical silly extreme case, if you're one of 3 people a lifeboat with only enough water for 2, and you're the only one who can't row)...

Would be happy to argue that in another thread if so desired...

Dissanetizing the Eschaton - your argument's basically a utilitarian one, right (not dissimilar to Peter Singer's)? Will try to respond properly to that in a bit...
 
 
elene
08:06 / 14.06.06
I believe that people only have value in their relation to each other. These are the only values, and I believe all moral obligations are rooted in preserving these values. Above all I believe it is our moral duty to preserve ourselves and our world, for the obvious reasons. I believe that when choices must be made, as they will be in a world of finite resources, the continuity of humanity ought to be our overriding aim. This might change were we to encounter some entity we also value and value above ourselves, but it has not as yet happened and probably won't.

This means that I do see a moral responsibility to free up resources reserved for a terminal patient in order to assist one who is not as yet terminal if those resources are not otherwise available, but I see no moral responsibility to shorten the dying patients suffering. To do that I must look beyond the primary purpose.

This involves the wishes of the individual, now divorced from any conflict with the needs of humanity, so I would resolve the problem like this. If a sufficiently large group of people consider this the right thing to do - they would wish it done to themselves - then we should do it, unless the dying person has requested in some way that this not be done. Otherwise, if a sufficiently large group of people consider this the wrong thing to do - they would not wish it done to themselves - then we should not do it, unless the dying person has requested that it be done.
 
 
Hydra vs Leviathan
10:20 / 05.11.06
Now it's fucking newborn babies.

This makes me feel so sick with horror and rage that i can hardly speak coherently about it. All i can say is... this is genocide. In its most literal sense.

Hopefully more reasoned thoughts a bit later...
 
 
Ganesh
10:33 / 05.11.06
If we're to view it as genocide/murder, what motives are being attributed to the medical profession here? Are doctors insisting upon the right to "murder" in a societal vacuum? Why do we think these issues are arising within UK medicine at this point?
 
 
redtara
23:56 / 06.11.06
SMS; Just to clarify, because I may not have said this well, my point was that, if the person is absent from the body, then there can't really be a moral case that we have to make the death as quick and painless as possible. Hence, the claim that it is barbaric to let someone die slowly only holds water if it is acknowledged that it's someone dying slowly.

Frankly, and apologies if I have misunderstood you, this gives me chills. Define absent from the body. Is this the absence of a personality recognisable to family and friends of long standing? Is this persistant vegitative state you're on about? (Check out the 'Controversy, Recoveries, Possible Contributing Factors' in the Wiki link).

Neither human existance nor medical science(despite what ER and Holby City might have you believe) is made up of absolutes. The unique manifestation of spirit that is each and everyone of us means that doctors get it wrong, alot!

All this talk of finite resources forcing tough choices is making me feel sick. The hypotheticals presented to prop up this, frankly fascist view, are utter nonsense when so much of the resources of my country and the US are being ploughed into blowing people up. Why don't we talk about how many intensive care beds trident could fund?


Eugenics anyone?




English Translation:

60000 RM this is what this person suffering from hereditary defects costs the Community of Germans during his lifetime.

Fellow Member of the German People, that is your money, too.

Read 'New People'The monthly magazine of the Office of Race Politics of the NSDAP
(Nationalsocialist German Workers Party).

I do not want legislative mediation between me and those who are entrusted to care for me when I become vulnerable. The current murder legislation is perfectly adaquate. As has already been stated assisted death is common place and very rarely becomes a matter for the courts because the value judgements that are made are about juggling harmful treatments to provide a dying patient with dignity rather than affording an NHS trust with more financial wiggle room.

A very common scenario is the pain management of cancer patients in the last hours of their lives. (Apologies to those with personal experience of cancer, I am not making this point lightly and hope this comment is seen as evidence of the humanity and compassion of cancer specialists when helping a patient and their family with shit decisions.) Morphine is a problematic drug. It can give great pain relief but has it's own set of unpleasant side effects. Use of morphine to manage chronic long term pain will cause constipation that can, in a patient that is not eating, lead to an impacted colon making it impossible to eat and creating another site of pain. As a patients condition deteriorates the dose is usually increased to keep pace with the pain. In the last hours of a patients life a pain specialist might have to weigh up the fact that the morphine dose that will kill the pain has also reached a level where it will hasten the death of the patient, an overdose. A great many treatments provide medical practitiors with these kinds of dilemmas. The lack of legal nonconsensual euthanasia legislation keeps everyone pretty circumspect, I suspect.

And as for the neonatal

Life is extraordinary. Science is without imagination. The potential in each person to endure and survive is astounding. Doctors prognosis are based on historical observation of similar cases. Doctors do not have crystal balls.

My son was less than a kilogram when he was born three months premature. It took over three minuits to resusitate him. He was the third triplet and I was told there was a good chance he would suffer from cerebral palsy. On his 13th day he suffered a pulmonary hemorage that created a domino effect throughout his tiny system, the worst effects of which were bleeding into his lungs and brain. I was told there was a significant (wetf that means) risk of permanent brain damage - if he survived. What happened next was three months of one step forward and three steps back, until finally their, not quite done, bodies began to get the hang of life.

No one has cerebral palsy, no one has brain damage and you know if they did it still wouldn't mean the huge cost we put the local NHS Trust to wasn't worth every penny. I fucking double dare anyone to come at me with any cost analysis arguments for not giving any baby a go at life.

I think that to try and euthanise a baby against the wishes of their mother can not be part of any society that would like to call itself developed, civilised or moral. Natty lets go burn out some cars. I am incandescent with rage at the cheapness of human life, here in this thread, in our sodding Blairised society and in our fucked up fearful world.
 
 
ONLY NICE THINGS
06:58 / 07.11.06
I didn't expect to see pictures of aborted foetuses used in the Head Shop to argue against abortion rights, and I'd rather not see Nazi propaganda used in the Switchboard to argue against euthanasia. Could we try for an argument without the props, thanks?
 
 
diz
07:01 / 07.11.06
Natty Ra Jah

All i can say is... this is genocide. In its most literal sense.


Only if your definition of the word bears little resemblance to the one in the dictionary:

"The systematic and planned extermination of an entire national, racial, political, or ethnic group."

That's the American Heritage Dictionary version, but all the others I'm looking at appear to be similar.

First of all, national, racial, political, and ethnic identity is not even remotely a factor here, only health status.

Second, we're not talking about a systematic and planned extermination of anyone here. There's no discussion of mandatory euthanasia, as far as I can tell, and I suspect that that proposal would be a non-starter. We're talking, as far as I can tell, about putting the option on the table for parents who, once advised of the treatment options (or lack thereof) want to opt to end their child's suffering quickly and humanely, and possibly allowing physicians to suggest it as the best alternative. That's it.

However, i *do* think that resource issues would enter into the decisions of many people to choose to die or to make "living wills" requesting treatment not to be given in certain circumstances.

You might think that, and statistically, you'd be right, but in the exact opposite of the way you'd expect. Apparently, there is a strong correlation between wealth and things like DNR orders and the like - it's just that the wealthier you are, the more likely you are to refuse treatment, and the poorer you are the more likely you are to take every medical avenue available regardless of the low odds of success. It appears that the more money you have, the more likely you are to value your autonomy, your dignity, and your quality of life over the possibility of living just a little longer.

redtara

A very common scenario is the pain management of cancer patients in the last hours of their lives.


Or the last few months of their lives. I can't tell you what I would have given to have had the option to spare my late grandfather and my family those months in a way that would have been quick and painless for him.

The unique manifestation of spirit that is each and everyone of us

That may be your belief about human nature. It is not mine, and I don't welcome the idea of you legislating on the basis of such a belief in such a way that it imposes on my right to appropriate medical treatment.

Life is extraordinary.

Is it? It seems to pop up everywhere, even in volcanic vents deep underwater where sunlight has never shone. There are a lot of reasons to look at the world with the presumption of the abundant and fecund ubiquity of life, rather than it's scarcity.

Science is without imagination.

And the unbelievably intricate computer you're using to impart this wisdom onto us represents a failure of that imagination, then? Spare me this Luddite "science is cold and remorseless and has no soul and ultimately leads to Cylons" nonsense.

I think that to try and euthanise a baby against the wishes of their mother can not be part of any society that would like to call itself developed, civilised or moral.

I agree with you, but what about with the permission of the mother? That, I think, changes the equation significantly.

I absolutely respect and admire your decision with your infant, and I am thankful that it worked out for you. However, and I don't mean this to question your decision AT ALL, in the slightest, but my partner and I have talked about your situation in the hypothetical many, many times, and I know us both very well, and I don't think we would have made the same call in your case, and I think it would be indefensible to force us to do so against our wills, given the probable outcome.

I think that in cases where there's an infant with extremely low chances of survival without severe birth defects, society has an obligation to respect the wishes of the parents. Whichever way they want to handle it, whether that means taking their chances with treatment or opting for euthanasia, I find it hard to find any compelling and compassionate argument for doing anything other than backing their decision, no questions asked.
 
 
ONLY NICE THINGS
07:51 / 07.11.06
That said, I'd like to go back to Ganesh's question:

If we're to view it as genocide/murder, what motives are being attributed to the medical profession here? Are doctors insisting upon the right to "murder" in a societal vacuum? Why do we think these issues are arising within UK medicine at this point?

Ganesh, I'm aware that you are not a doctor working with the sort of patients usually found at either extremity of life, but your understanding of medical practice is more informed than mine, based as it is on ER and Holby City. What do you think the doctors are arguing for, here? In a way, the emotional and financial hardship of raising the child is not, ultimately, the concern of the ob-gyn who delivered it, so either this proposal is to some extent at least disinterested, and the welfare of the parents is being considered, or it has a specific motivation, about resources, possibly, or time allocation, or some other desire - unless we assume that obstetricians, on the balance of probabilities, just like killing babies.

So, there's that. There is also thhis quote, from the article NRJ linked to:

Edna Kennedy of Newcastle upon Tyne, whose son suffered epidermolysis bullosa, said: “In extremely controlled circumstances, where the baby is really suffering, it should be an option for the mother.”

It strikes me that, coercion or persuasion aside, there _is_ a difference between euthanasia being compulsorily administered to severely disable babies, and euthanasia being an option for the mothers of newborn, and profoundly disabled, babies. As far as I can tell, for example, cerebral palsy isn't really in this - we're talking about the voluntary killing, with the parents' consent, of babies born with conditions that will radically shorten their lives and make those lives extremely painful. The two examples given in the article are extreme spina bifida and epidermolysis bullosa - although both conditions do allow people to reach adulthood. Jonny Kennedy, Edna's son and the most famous sufferer of EB in this country, at least, argued passionately for the right of parents to abort babies with EB. If a birth-then-euthanasia was less traumatic physically and psychologically than a late-term-abortion, would that be a better option?

Which is another awkward question here. Any boundary on when human life can be said to begin is ultimately going to be somewhat arbitrary. Is a baby - a life able to survive outside the human body - a human life? If so, does that mean that the boundary of when human life begins will be pushed further and further back as medicine advances? Yoking different issues is always horrendously awkward, but there's a question about a woman's right to choose - is the right to choose to terminate a pregnancy equatable to the right to choose to end the life of child that they might otherwise watch living its life in agony before an early death? Or are we saying that, in the trauma of a birth, and the discovery that the child just born is profoundly disabled, a mother cannot be seen as emotionally competent to make such decisions, and the doctor will always have the advantage of being comparatively distanced from the process? Again, then, when do we decide that a woman is emotionally competent or not competent to make decisions about their unborn child? And, speaking practically, if a mother of a child who is constantly in pain, for example, and will continue to be constantly in pain throughout its short life decides that she cannot stand witnessing that pain, is it better to end that small life clinically, or to end up with the mother in court, pleading diminished responsibility to infanticide?

These are huge and horrible decisions, and I feel nothing but sympathy and respect for anyone called upon to make them. However.

Incidentally, Diz:

It appears that the more money you have, the more likely you are to value your autonomy, your dignity, and your quality of life over the possibility of living just a little longer.

I haven't seen the statistics on that, but I think that's a reach. It may be the case, but there may be any number of other reasons - not the least of them being, for example, that the wealthy might already feel that they have made provision for the care of their loved ones - by having moeny to give to them - whereas the less wealthy may be prepared to endure far greater personal discomfort in the hope that they will be able to return a role as carer and provider for their family. Let's not assume that wealth is too ennobling, here.
 
 
redtara
14:06 / 09.11.06
I keep trying to post to this and for one reason or another I've been interupted. I think the universe has been getting me to calm down a bit, so here goes with a calm, reasoned post.

I would remind everyone that the thread description and Natty's subsequent addition of the story about neonatal euthanasia, which inevitabley would have a eugenics agenda, specifically looks at NONCONSENSUAL EUTHANASIA. I think there is a general consensus so far that the right to assisted suicide should be afforded to anyone who desires it. The notion of nonconsensual euthanasia is a completely different matter calling up serious ethical questions.

The idea that Doctors are better placed to make desisions when they take no part in carrying the burden of those choices is terrifying to me. That an emotional engagement in whether a child lives or dies should make you unfit to participate in the final choice makes me feel sick. This concept is in keeping with a long history of women's emotions being seen as antidotes to widom. Include in this the inherantly patriarchal culture of western medicine, the tradition of ignoring/disparaging women's choices within this traditions, the aloofness of consultants in neonatal units, and the culture of outlining the worst case scenario lest they be sued. This is not the environment where less autonomy should be given to parents (or other family members in the case of SO and parents facing a prolonged, painful death).

Life is painful. Having children is agonising and filled with tough choices for the duration of their lives. How dare they tidy up on our behalf, imposing their values of what is endurable. It is a condition of life to endure survive. Let me be clear. I am not advocating the measures to prolong life no matter what. The question is emensely complex and there will always be situations where the wisdom to be found in other cases is inapropriate. What I find apauling is the justification that sparing the parents from a difficult descision is somehow going to make things easyer on them. The idea of killing a child before their parents have come to terms with the fact that indeed things are hopeless seems monstrous. It also absolves consultants of responsibility for cultivating trust and helping to convince parents that the end has arrived. The last thing western medicine needs is more power to do things to people instead of with them.

I know there are instances between parents where one feels the end has been reached where the other struggles to find support for the continuation of treatment. I think it is right that in these very painful situations the matter is taken before courts where the cases for and against can be examined and drawn to the attention of wider society. To make these desicions despite the cares of parents in the unobserved insular cultures of hospitals is not healthy.

To address some of the points made by other posters; the fact that life can crop up even in volcanoes only increases my wonder. I think we do just see things differently, however, I have not proposed any legislation that might curtail your rights. I am mearly wishing to protect my own, as a parent and some day some one who is vulnerable and unable to have those who care about me and might care for me, speak for me.

i've got to go and pretend to do some work now but I'll complete this post tonight...
 
 
ONLY NICE THINGS
15:13 / 09.11.06
I would remind everyone that the thread description and Natty's subsequent addition of the story about neonatal euthanasia, which inevitabley would have a eugenics agenda, specifically looks at NONCONSENSUAL EUTHANASIA.

I don't think it does, actually. The article Natty Ra Jah links to appears to be about giving mothers the freedom to consider euthanasia as one of their options in the event of their child having one of a small number of profoundly disabling medical conditions.

Quote:

A very disabled child can mean a disabled family,” it says. “If life-shortening and deliberate interventions to kill infants were available, they might have an impact on obstetric decision-making, even preventing some late abortions, as some parents would be more confident about continuing a pregnancy and taking a risk on outcome.”

It may be nonconsensual from the point of view of the newborn, but that doesn't seem to be what you're arguing, as your point is about the woman's opinion rather than the child's:

The idea that Doctors are better placed to make desisions when they take no part in carrying the burden of those choices is terrifying to me. That an emotional engagement in whether a child lives or dies should make you unfit to participate in the final choice makes me feel sick. This concept is in keeping with a long history of women's emotions being seen as antidotes to widom. Include in this the inherantly patriarchal culture of western medicine, the tradition of ignoring/disparaging women's choices within this traditions, the aloofness of consultants in neonatal units, and the culture of outlining the worst case scenario lest they be sued. This is not the environment where less autonomy should be given to parents (or other family members in the case of SO and parents facing a prolonged, painful death).

As such, I think the Nazi button may have been pressed a little early. If we are talking about a proposition by which doctors get to terminate newborns on a whim and against their parents' wishes, then we are, as far as I can tell, talking about a proposal that has not been made. I would be happy to agree that, on the whole, it sounds like a bad idea.
 
 
redtara
14:09 / 10.11.06
You are right Haus. The Neonatal peice did not reference Euthanasia without parental consent. I miss read this statement to mean that parents should be spared the burden of making a final desicion.

The college is arguing that “active euthanasia” should be considered for the overall good of families, to spare parents the emotional burden and financial hardship of bringing up the sickest babies.

It did however quote a medic and a disability spokesperson who seemed to think that the Eugenics issue was still raised and as such I think my Nazi reference is valid.

However, John Wyatt, consultant neonatologist at University College London hospital, said: “Intentional killing is not part of medical care.” He added: “The majority of doctors and health professionals believe that once you introduce the possibility of intentional killing into medical practice you change the fundamental nature of medicine. It immediately becomes a subjective decision as to whose life is worthwhile.”

If a doctor can decide whether a life is worth living, “it changes medicine into a form of social engineering where the aim is to maximise the benefit for society and minimise those who are perceived as worthless”.

Simone Aspis of the British Council of Disabled People said: “If we introduced euthanasia for certain conditions it would tell adults with those conditions that they were worth less than other members of society.”



(Incidently, I think that the propaganda I posted is not a comparable image to pictures of aborted foetus, images of the dead or dieing in the death camps would be a closer afront to your sugested image.

As it goes you make great use of your understanding of logic and language to express your position. I am someone interested in the image and how it impacts on opinion and behavior. I will continue to use images, which as far as I know are allowed on this forum, when I feel they are appropriate to my arguement and on-topic. I think to ask me not to or refer to them as props is as daft as doing the same for your philosophical training.)

Back on topic - I personally don't think that life should be maintained at any cost. Medicine is outstripping our ability to come to terms with the implications of quality set against quantity of life. This leaves me wondering where those lines are for me and how can societies legislate so as to protect everyone's potential wishes in these shitest of circumstances. Plus the wider effect of conditions that appear on the 'OK to kill' list resulting in a negative social attitude from society for those who live with those conditions already or for those parents who choose to persue life.
 
 
ONLY NICE THINGS
14:18 / 10.11.06
Images are allowed, of course, as are props, be they images or otherwise, in moderation. However, as a moderator of the Switchboard I would ask you to read the last hundred or so threads and see how often Nazi propaganda is used, by whom and to what effect. You may feel free to do the same with "language". Since I have no formal training in logic, I must although flattered confess my unworthiness to be credited with such a skill.
 
 
ONLY NICE THINGS
14:52 / 10.11.06
Now, regarding Simone Aspis' comment - this is an interesting one. In a sense, these arguments feel far more immediate at the beginning rather than the end of life. The decision about increasing pain management medication to the point where human life ends seems a more logical bargain if that life is 90 rather thhan nine minutes old. On the other hand, that nine minute old child may be as much in _need_, on a medical level, of pain relief to the same extent. However, there is a political statement there which is almost independent of the needs of the child, and also a moral one. to put it another way - if one were compos mentis and able to express a preference, would one rather live in constant agony than end that agony, even if the cost of ending the agony is the risk or the loss of one's own life. Tricky.

However, the idea that a child who is born with a particular condition who is not euthanised will be seen as less valued or valuable somehow than one who is... I'm not sure that I agree. For starters, mortality is a sliding scale. A foetus has a certain chance of living till birth, and a certain chance of surviving the process of birth itself and the immediate aftermath, and so on. Decisions are made all the way through this process which might affect the foetus' chance of survival. The decision of the mother, in the case of a child with a condition that makes agonising pain and early death likely, would fit in as one of those decisions.

Put another way, I suppose - how much value do we place on the potentiality of consciousness? What is it that makes distinct a woman's right to terminate a pregnancy at 24 weeks and a mother's right to end the life of a baby born at, say, 7 months who will otherwise be expected to live, let's say, for six months in incredible pain? Is there an arbitrary distinction that we have to draw as to when life has to be protected? Presumably, yes - otherwise we would have to cope with the idea that mothers could end their progeny's lives at a year, or two years. What is it that makes the difference? The presence of medical professionals? The provision of expert medical opinion? The age of the child? The location of the child as inside or outside the womb?

That's achingly tricky. However, does it follow that a child who is not given euthanasia should be seen as less valuable? I would probably say not. I think these are smokescreens around the real issue, which is just how far a woman's right to choose extends.
 
 
ONLY NICE THINGS
01:15 / 13.11.06
On a related topic - the Church of England, in the form of the Bishop of Southwark, has submitted its thinking to the debate - report .

The church's submission counsels parents against expecting too much from medics, and asks doctors to refrain from giving parents false hope. 'The principle of humility asks that members of the medical profession restrain themselves from claiming greater powers to heal than they can deliver,' it said.

'It asks that parents restrain themselves from demanding the impossible from the medical profession and indeed from themselves and their own capacity to cope.'



This is, to a degree, back to the withdrawal of treatment without the consent of the parents - by sugesting that in certain situations parents may not be equipped to make decisions about their severely premature chldren's lives, and so that a standard of viablity may need to be introduced to give doctors more of an idea of when to take action. Even then, though, how confident can one be that a premature baby will a) not survive or b) survive in such torment that its life is not worth living? That's a huge question, especially if one supposes that medical science may advance to improve that child's quality of life at any point. Charlotte Wyatt, the child mentioned in the article linked to, has lived to be three in defiance of medical opinion - theoretically, she might continue to survive. However, she is unable to see or, arguably, hear, is in constant pain and will apparently never be able to live without oxygen. She appears to have the neurological development of a three-month old child - so, she is unlikely ever to be able to understand the circumstances that mean that she is in that constant pain. Does that situation allow somebody a) to take action to end her life (at this stage, presumably not), b) to fail to take action that results in her life ending (the do not resuscitate option) or c) to express regret that she was resuscitated on each of the three occasions when it was necessary after her birth?

Were I a religious leader, I'd be, frankly, terrified of getting into that.
 
  
Add Your Reply