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Locked-in ethics?

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William Crawley | 10:50 UK time, Tuesday, 20 July 2010

_48414033_imagesoftonynickleson007.jpgTony Nicklinson wants to die. If he could end his own life without direct assistance, it is possible that he would already have done so. Following a stroke in 2005, he suffers from "locked-in syndrome". He blinks and nods to spell out words with the aid of a Perspex board and letters, and, beyond that, he is immobilised. Tony, who is 56, says he does not want to "dribble his way into old age". His legal team are now seeking a judicial review to clarify the law on assisted suicide in a case like Tony's. Yesterday, his wife Jane read out a statement from her husband in an effort to explain why he feels that death may be his only way out of his perceived bodily imprisonment:

"I am a 56-year-old man who suffered a catastrophic stroke in June 2005 whilst on a business trip to Athens, Greece. It left me paralysed below the neck and unable to speak. I need help in almost every aspect of my life. I have no privacy or dignity left. I am washed, dressed and put to bed by carers who are, after all, still strangers. I am fed-up with my life and don't want to spend the next 20 years or so like this. "Am I grateful that the Athens doctors saved my life? No, I am not. If I had my time again, and knew then what I know now, I would have not called the ambulance but let nature take its course."

Tony Nicklinson wants his wife to help him to die, but he fears that she would then be liable to prosecution for murder. His request raises profoundly difficult questions for all of us. In the classic case of murder, an assailant takes a victim's life against the will of the victim, and with a demonstrably malicious intent. Supporters of Tony Nicklinson's request say his case is different: he would be consenting to his own death, and his wife -- if she were to assist him -- would be acting mercifully, in his best interests. Tony has the capacity to give informed consent to any assistance in respect of his own death; to permit that assistance if to recognise his autonomy.

Opponents say a change in the law (or the prosecution policy) to permit Jane to assist her husband to die without any risk of prosecution, would threaten the security of many vulnerable people. They say it is better to allow a court to consider the particulars of indiividual cases; and, in many cases, when a British jury considers a case of mercy killing, it will express compassion to the accused. In other words, we don't need to change the law, because the law, as it stands, permits mercy to be shown to a person who takes another's life as an act of mercy. If we change the system, it is possible that some could abuse the liberalised rules to act maliciously against the stated wishes of vulnerable people.

These are the main ethical arguments so far deployed in this debate; there are cultural and theological arguments too. But it would be a mistake to stereotype religious arguments, as if to suggest that all people of faith find themselves on the same side of the debate. Some very vocal Christian leaders have expressed their opposition to any liberalisation of the law to permit assisted suicide or any form of euthanasia (passive or active). But some theologians have also argued that some forms of euthanasia, and some instances of assisted suicide, are gracious acts which are consistent with responsible Christian discipleship.

What should the law in the UK say about cases like this one? And what role should theological and biblical arguments play in the current public debate?

Comments

  • Comment number 1.

    I cannot begin to imagine the plight of Mr Nicklinson and others who are in a similar position.

    A person who fulfils the request of another by killing them out of love should not be treated like a criminal. A person in Mr Nicklinson position should have the comfort of knowing that he can be killed in a humane way by his loving wife and that she will not become a murder suspect. Perhaps Terry Pratchett's idea of euthanasia tribunals would be a step in the right direction?

  • Comment number 2.

    newlach,

    I agree with you and cannot understand why the legalities cannot be sorted out before any action is taken to prevent any case being brought afterwards. The assisted suicide could be pre-approved. Surely that is the humane way to treat adults in these cases.

    I would have to say that biblical arguments are difficult to factor in. Why should biblical arguments have anything to do with decisions which are made by non christians or by christians who have decided not to obey the biblical teachings on this matter? Why should an atheist, for instance, be bound by scriptural beliefs? If christians want to follow their beliefs and not make use of any legal mechanism to allow assisted suicide they are under no pressure to do so.

  • Comment number 3.

    If someone had a pet who was suffering intense pain and agony and had no hope of recovery they would surely contact the vet and have the animal put to sleep as it is the most humane action, yet a human being is suffering in the same way and that option is not available. I can't even begin to imagine what Mr Nicklinson and others who suffer from conditions like this are going through. Of course anyone who has love for another person does not want to see them suffer unneccessarily, but until the law is changed there would always be the fear that those who assisted the suicide of someone in a position like this would end up as a murder suspect, but surely the other person's wishes and their medical condition should be taken into account? The argument about the sanctity of life is used quite a lot but at the end of the day surely someone's spirit is more important than their body? I think treating a person with compassion is more important than any doctrine.

  • Comment number 4.

    What has been said so far is absolutely fine about the legality of assisted suicide. Clearly we ought not think of assisted suicide as akin to murder, and it is right that the law reflects this.

    Looking at it from a broader perspective, however, my one concern with all of this is the idea that allowing people to die is an acceptable solution. Can we collectively assert that we're going to make the problems of paralysis, terminal illness and severe disability go away by giving their victims the freedom to end their suffering?

    As part of any attempt to rule in favour of assisted suicide, I would want an insistence on broader research into the development and deployment of assistive technologies and corrective procedures. The problem, here, is not that we are stopping him ending his suffering, but that we accept his suffering is not something that can be mitigated given his biological condition, and demand that he go through it anyway.

    I doubt, personally, that Mr Nicklinson is really as useless as he seems to want us to believe. If he wrote that letter above, what we have is an articulate and thoughtful individual with an active mind, whatever the state his body might be in, and what we owe to him is not the freedom to die but liberation from the shackles of a damaged biology. Eye tracking and speech synthesis technology would give him an independence that he seems to be lacking in his life; the freedom to articulate on one's own terms.

    Why, for God's sake, is this man communicating through a 3rd party and a whiteboard?!? That is what we should be asking.

  • Comment number 5.

    "The wise man will live as long as he ought, not as long as he can." (Seneca) Even the 'biblical' suicides, i.e. Judas and Ahithophel, display an honour-shame element in untimely death.

  • Comment number 6.

    It's wrong to kill yourself and it's worse to get someone else to do it for you.

  • Comment number 7.

    mccamleyc
    It's wrong to kill yourself and it's worse to get someone else to do it for you

    wrong? by whose definition? People can decide for themselves what is right for them just as you can for yourself. No one is suggesting that anything changes for you to follow your own values, why should other people be governed by your values?

  • Comment number 8.

    Dave (#7)

    By the definition of the Church! Silly.

    Don't you get it? We have to live (and die) by the morals and ethics of the politically dominant religous sect of the day even if you don't agree with them and you're part of a majority that don't either.

    It's called -Tradition-, and curses on you for daring to suggest otherwise. People will be sacrificing their own children and engaging in forbidden and tempting practices if we don't hold to Tradition.

    /sarcasm

  • Comment number 9.

    Dave,

    The notion of "wrong" simpliciter, as in something just being wrong, regardless of opinion, can't be rejected that easily. We could liken it to "mistake" - for instance, it is a mistake to think that one can expect, of others, that they will provide unconditionally for your every need at no personal expense, and thus wrong to base one's actions on that principle. We could also consider obligation - if one wishes a contract to be upheld, one must satisfy what one has committed themselves to in that contract, and it is thus wrong to break contracts while demanding that others do not.

    These aren't "values" - they're just consequences of the structure of social interaction. This doesn't apply to taking one's own life, of course, since a successful suicide carries no consequences whatsoever to the individual in question beyond their own death, but perhaps it does to assisting people who want to die but lack the ability to do it themselves.

    The argument runs like this: civilisation exists to limit the dangers of the state of nature and allow people to live safely in a social environment. By rejecting life, one is also rejecting civilisation. Thus, it is neither the duty nor the right of a civilised society to facilitate death at its members' request - those who seek it are acting outwith society's purpose.

    It may not be wrong here to just ask someone to do it, since in seeking death, one has already stepped out of civilisation's perview and is thus no longer beholden to it, but it is wrong, in both the "mistake" and "obligation" senses, to ask that they do so and be immune from society's retribution.

    That's argument, anyway. I suspect it's not a fool-proof one for the following reason: the death of the person might be considered by society to be beneficial from the perspective of overcoming nature's cruelties. But something seems off with this way out, as suggested in my earlier thought. Isn't having the person alive and able to contribute to research and dialogue much more likely to further the goal of protecting others from a similar fate?

  • Comment number 10.

    Hi Paul,

    By rejecting life, one is also rejecting civilisation. Thus, it is neither the duty nor the right of a civilised society to facilitate death at its members' request - those who seek it are acting outwith society's purpose.

    But the people in question (usually!) are NOT "rejecting life". Everyone dies - that is a fact (ta-da!) and acknowledging that fact is not rejecting life, so why should choosing the manner of your own exit be regarded as such? Most people that I know who would consider voluntary euthanasia *love* life, but they want to have some degree of control over how it ends, and in what circumstances. "Life" is not a THING that we have or don't have - it is a PROCESS with a beginning and an end.

  • Comment number 11.

    Dave, does your subjective morality have any boundaries? Can I decide that rape is okay for me, maybe a little breaking and entering?

  • Comment number 12.

    Natman,

    I think you know my tongue was in my cheek

    PaulR,

    I think I understand what you are saying but you seem to be postulating a secular version of a church with a set of moral absolutes which transcend personal choice. The point of being an intelligent sentient being is to be able to make decisions which affect oneself and the state/civilization should only interfere at the point where personal choice adversely affects another person.

    Generally when someone reaches the point where their life is so compromised that they feel that it should end and they have not the capacity to commit suicide they have already reached a point where their contribution to civilisation is meaningless. I really don't mean that cruelly, just that their contribution for what remains between that point and the point of 'natural death' is not for civilization to covet at the expense of the personal wishes and dignity of an individual.

  • Comment number 13.

    mccamleyc,

    As long as you only rape yourself and only break and enter your own property, I have no problem with it.

    The state should only intervene when an individuals actions adversely affect another.

    I guess if you call my morality subjective you are insinuating that yours is objective. From what I can see from your previous posts your morality is neither you simply blindly accept what you are told and expect everyone else to look at it and go "wow that's fantastic lets all just believe that - saves all that thinking and stuff - leaves more time for a bit of praying".

    In effect you have no morality of your own just fear of purgatory and hell to keep you in check and assume every one else is the same. Thankfully they are not.

  • Comment number 14.

    First, Helio, RE: "Most people that I know who would consider voluntary euthanasia *love* life, but they want to have some degree of control over how it ends, and in what circumstances."

    I didn't mean reject Life, capital L. You don't have to be a nihilist to consider suicide (though it helps!). I meant "deem of no or negative value the remainder of their own life", or somesuch.

    That one chooses to terminate the process in a manner of their choosing does not mean such was all the value that was there. Let's put it like this: Isn't it a waste for a 16 year old to take their own life? Or do we assume that suicide was what their life ultimately amounted to, and thus to speak of "waste" is meaningless, given that it ended when it decided to?

    Then Dave, RE: "The point of being an intelligent sentient being is to be able to make decisions which affect oneself and the state/civilization should only interfere at the point where personal choice adversely affects another person."

    The Harm Principle just formulated has a critical problem when it comes to a particular class of Moral Dilemma. Let's suppose (for whatever stupid reason we might think of) a Policeman can (and would) stop an enormous natural disaster by stealing something from an unwilling citizen who would be otherwise unaffected by the disaster. Oughtn't the prevention of extreme harm to many justify the seizure of property? Yet if one accepts that the state is forbidden from intervening except in the prevention of harm by personal choice, this would not be authorised.

    A similar dilemma could be posed that would affect any given formulation of the harm principle; the reason being that there are at least some instances where the needs of the many outweigh the needs of the few. That's clearly not a general rule, and state power needs to be properly tempered by sound and informed judgement, but ruling it out completely isn't worth the damage caused by those instances where its use would prevent disaster.

  • Comment number 15.

    Given that we are all interconnected and no man is an island - all that we do/say and think affects the whole. So there is no such thing as doing something that does not affect others - that is an illusion -everything we do affects the whole. Just that most can't live with that degree of responsibility so we just ignore that or pretend we don't affect the whole in all that we do/say and think.

    Just because someone ends their physical life does not mean the end of life - the spirit will reincarnate and the issues that were not healed and not dealt with in this lifetime will be there to be dealt with in the next one. So whilst ending it may appear to be an escape - its not really. One option is to heal the underlying issues that caused the conditon in the first place and then pass on having cleared those issues so in his next life he doesn't have to deal with them. Also for him to come to know that the body isn't it. There are consequences to all that we do - no hell or damnation or anything like that - but consequences that all to work towards healing our separation from God - if one so chooses. So each path - the premature ending of life or dying naturally will both have consequences for his next life but there is no escape from our choices.

  • Comment number 16.

    William: Tony Nicklinson wants his wife to help him to die, but he fears that she would then be liable to prosecution for murder. His request raises profoundly difficult questions for all of us.

    William's comment here reveals the heart of the problem. I suppose there are some people who may possibly wonder why there is even a debate about this, judging by the tone of certain opinions I've encountered about the issue of assisted suicide and euthanasia (as well as certain other moral issues). Perhaps they consider that Tony Nicklinson's right to die at the hand of a loved one is self-evidently valid, and only those reactionaries who are resisting the secular construct of 'natural moral progress' would question this right.

    I have nothing but sympathy for Tony Nicklinson, and I hesitate to jump to any conclusion. I admit that this is a moral dilemma, and life throws up many moral dilemmas (and, as a Christian, I believe that this is something to which the Bible attests - I can reel off a few references if anyone's remotely interested).

    However, this is not really about Tony Nicklinson, is it?

    As William wrote; "His request raises profoundly difficult questions for all of us."

    Let's suppose that Tony Nicklinson manages to obtain his request. The law is changed to allow his wife to assist him to die. Once that has happened then we would no longer be debating the rights and wrongs of the case of Mr Nicklinson. What we would have is a law on the statute book, which lays down a clear precedent that, in certain circumstances, it is permissible under the law to take a person's life (although, sadly, we already have a law which has, in principle, taken away the right to life of certain people, namely, the unborn - something any true humanist should be weeping about).

    Now once we are in this position, the morality is no longer 'self-evident', is it? How do we then apply this law? How do we define the circumstances in which this law can operate? How do we judge the appropriateness of a request to die? How do we define 'assisted suicide'? Would it simply be applied in situations where the person wanting to die could not actually physically kill himself, or could it extend to situations in which one person helps another vulnerable person to kill himself?

    I imagine that one answer will be: the consent of the one making the request defines the circumstances in which this activity can be permitted.

    But that is just not good enough. The issue of mental illness has to be factored in here. What if a person, due to, say, senility or dementia, could not reasonably give his or her consent, but a relative imagines that they have done so? How many of us, at some time or other, have said "I wish I were dead" or some such words? What if a flippant comment like that came from some incapacitated mentally ill person, who was not expressing what he really wanted, but such a comment was a fleeting expression of frustration, but is then interpreted in a certain way by a weary and harried relative? Once the law of assisted suicide is on the statute book, then there is always the possibility that such a course of action could be insidiously suggested to a vulnerable and deeply troubled person.

    The individual cases we read about - such as the case documented here - stir up powerful emotions of sympathy for those who are suffering. I acknowledge that this is a difficult issue. But a law cannot be enacted on the basis of individual cases, but on the basis of the effect and implications of that law on the whole population under its jurisdiction. And once we recognise that, it is clear that the objections some people raise are not so 'reactionary' as may at first appear. One only needs to think about the liberal way the 1967 abortion act has been applied to realise that the 'slippery slope' argument is a perfectly valid one.

    Perhaps if, in this country, we could find a way to abolish the concept of 'legal precedent' (I don't know how!), then some accommodation could be made for people like Tony Nicklinson without the state's response to his case becoming formative for society as a whole. In the current system I find that highly problematic, to say the least.

  • Comment number 17.

    PaulR,

    I don't think that we are comparing like with like. Your example of the policeman commandeering something from and individual to prevent a disaster affecting many people is not the same. The policeman is not interfering with the actions of the individual based on a set of values, he is making a judgement call to take action against the problem which is generating most harm. Even if harm is caused to the person the item was removed from, it does not violate the harm principle as greater harm was averted.

    The problem would arise in your scenario if the nature of that harm was based on values which come from personal bias or religion. If the greater harm was, in the policeman's eyes, say a dilution of religious faith and the item was a piece of evidence which showed that faith was flawed would it be right for him to remove that piece of evidence. So I would say a lot depends on how you define and evaluate harm.

    I would also say that the assumption that your scenario could be ported into every situation is flawed. I cannot see a situation where a persons value to the state (at the time were their quality of life is at the stage where suicide is contemplated) could ever be seen or measured as more important. I can see a scenario where someone would say that allowing someone to take there own life diminishes society or is against a moral precept but these are value judgements which vary from person to person and if the person wishing their life to be terminated does not subscribe to those morals why should they be beholden to them.


  • Comment number 18.


    Dave

    Interesting conversation between you and Paul. I'm a little unsure, though.

    "The policeman is not interfering with the actions of the individual based on a set of values, he is making a judgement call to take action against the problem which is generating most harm. "

    How is, "making a judgement call to take action against the problem which is generating most harm", not "based on a set of values"?

    And how is your comment, "Even if harm is caused to the person the item was removed from, it does not violate the harm principle as greater harm was averted." not based on a set of values?

    You then say, "So I would say a lot depends on how you define and evaluate harm."

    But isn't any such definition going to be based on a set of values?

  • Comment number 19.

    2manypeters,

    I do not disagree that they are based on values, but the example has rather shifted away from the point,

    It is up to the individual to decide his future based on his own values not the values of others, religion or society. When it comes to the individuals right to chose the time and mechanism of his death when they are at the stage where life is meaningless for them, I cannot see what overriding harm to anyone else (including civilisation) there can be. That being the case and the person is physically incapable of committing suicide than I see no reason why they should not ask for and receive assistance if such assistance is available. In order to minimise stress and anxiety, I also see no reason why such an action cannot be adjudicated on in advance so that there is no legal proceedings afterwards. This is a very specific set of circumstances.

    In the more general case which we moved on to were a 3rd party is making a judgement call between the potential harm to two other parties, then there has to be a value framework and a mechanism to measure harm. It would have to be consensus not one set of values ruling all. It then becomes a complex equation about values (personal and agreed societal) and the actual mechanics of the situation.

    eg Is it right to kill a person to save 200 others. Well that will depend on the circumstances, the personalities of the people involved, the authority of each of the people involved not just morals or values. In reality, we as a society have already agreed circumstances under which this OK and have ensured that no one will be arrested afterwards for carrying out such an act in very specific circumstances.

    It is a much wider subject than this thread and maybe should be taken to the open thread.

  • Comment number 20.

    What is it about the human condition that make us susceptable to being delusional fantasists by believing in supernatural religion?

  • Comment number 21.

    Before anyone jumps in with a quick opinion , why not try and walk a mile in Mr. Nicklinson's shoes ?! Until then nobody is even qualified to comment, let alone judge. And even if one could , with all the powers of imagination, feel what he is feeling, the fact remains that he is a grown up man with the right to have his life and wishes respected ...
    and this is the point: he has chosen death over life BECAUSE he respects himself, not out of disrespect for life.
    As for his wife, aiding someone we love die must surely be the hardest thing anyone will ever have to do, but I am sure that even with the prospect of prosecution hanging over her head, she would go ahead because she respects and loves her husband.
    This is not a ' situation' or a ' dilemma' or a theoretical subject to be discussed by the moral black/ white thinking corner, these are real people with real lives who surely are the only ones who are in any postion to know what is best. And sometimes ' best' has nothing to do with right or wrong!

  • Comment number 22.

    Ever Hear of a Rope and knot he could kill himself instead of depending on others. or else go off to where that Boy went [who only got a sore leg]
    and get it done with your own money instead of asking the NHS To Do it.





  • Comment number 23.

    Dave, RE both of your posts, particularly "Even if harm is caused to the person the item was removed from, it does not violate the harm principle as greater harm was averted." and "In the more general case which we moved on to were a 3rd party is making a judgement call between the potential harm to two other parties, then there has to be a value framework and a mechanism to measure harm."

    And also Globetrotter, "This is not a ' situation' or a ' dilemma' or a theoretical subject to be discussed by the moral black/ white thinking corner..."

    The central point in all of this is that we're dealing with laws, not with cosmic, universal principles here. Everyone can acknowledge that if Mr Nicklinson's remaining quality of life is negative, then he has the freedom to choose to end it if he pleases. Everyone can also acknowledge that there is at least some sense in which his wife would be Justified in so doing for him, acknowledging his wish out of devotion and love.

    That law involves an approximation of the prevention of harm, both direct and indirect, is beyond question - the core contention is to what extent the law is supposed to be such an approximation, or whether it deals with an analysis of people's individual attempts to approximate it. Utilitarian analyses favour the latter, shifting the conception of the "value" to the conception of the "valued". The problem with applying the methodology of the latter whilst maintaining the illusion of the former is that the confidence that one has correctly grasped what causes harm, what prevents it and what reverses it, is misplaced, since it is not a universal principle that peoples' Utility calculations are grounded in anything other than sentiment and wishful thinking.

    Whenever you said "I cannot see a situation where a persons value to the state (at the time were their quality of life is at the stage where suicide is contemplated) could ever be seen or measured as more important", I think you showed something important. Isn't there a coming apart between an individual's valuation of their own quality of life, the State's valuation, and the actual quality their life might yet have? This difference is what, I think, is really central to my contentions. The law isn't about doing what people want it to - it's about establishing a set of principles that best organise society. Sometimes, that means having a law that some people, even maybe most people, don't like.

  • Comment number 24.

    RJ,
    If he was physically able to commit suicide then maybe he would not want to and as for going to Switzerland he probably would, if he was able, and could be sure his wife was not arrested on her return to the UK. That is were this debate is.

    I suspect though that you actually don't care either for him or this debate.

  • Comment number 25.

    PaulR

    The law isn't about doing what people want it to - it's about establishing a set of principles that best organise society

    I would disagree, the law is not about establishing principles to organise society, it's only purpose is to protect people/property etc from harm from others and to provide a framework of a definition of harm, judgement and retribution. Law should not restrict any individuals freedom to decide their own future except where that adversely affects others.

    It is not for the state to value someone's life it is for the individual to value there own life and what quality of life may be achieved in the future in coming to a determination of whether they wish to end their life now. The state has no role in this determination.

    Suicide and attempted suicide are lawful acts in the UK, the only issue here is that when someone no longer has the physical ability to carry out this lawful act, but has the mental capacity to make the decision, is there a mechanism which can be found to allow someone else to help them.

  • Comment number 26.

    I think we're going to have to agree to disagree on this, Dave. Although I have a number of issues with what you've just said, I think this comes back to my original thought: namely, that in order to achieve "success" in the endeavour you've set out, your philosophy of requires a full trust in the ability of people to know how to not cause harm and that they'll refuse to do so given the passive-aggression of the threat of punishment. I disagree with both of these assumptions; indeed, I vigorously oppose the dictatorial nature of the second.

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