Should people be allowed – or helped – to take their own life when it becomes unbearable due to terminal disease? And is the question a moral one?
In the Supreme Court, yesterday, lawyers representing right-to-die campaigners suggested that it was not, at least as far as the court is concerned. “The question is not one of right or wrong,” said Paul Bowen QC. “It is a question of weighing relative risks that can be objectively ascertained from evidence – that is a question that the court is as well if not better placed to answer [as Parliament].” It is not the court’s role, he said, to resolve “moral and ethical” arguments.
The judge disagreed. “Sanctity of life” is not a “question of evidence” but “a fundamental moral construct”, he said: “I am not suggesting that it is conclusive or even entitled to have very great force but it is likely to be an issue which can’t be ignored.”
I can’t speak for the legal role of the court. But any discussion of the right to die which doesn’t take into account the moral questions is an arid, incomplete one. “Evidence”, however defined, has a huge role to play in the national decision-making process, but it is a secondary, supporting one: first, we have to decide what our moral priorities are, and then assess the evidence to determine what course best fits them.
For some people, it’s true, human life is utterly sacred, and that’s the end of the discussion: no competing imperative can outweigh it. The judge is absolutely right that this has to be taken into account.
But the “anti” side of the debate doesn’t have a monopoly in moral argument. There is a moral imperative that human beings should have autonomy over their own bodies – the right to do with it what they want. There is a moral imperative that we should do our best to reduce suffering. Sometimes, these imperatives clash: sometimes, declaring life sacred means denying someone autonomy over their own body, imprisoning them, denying them freedom; sometimes it means forcing someone to continue to suffer, against their wishes.
If human life is sacred to you, above all other considerations, then that’s the end of the argument. Likewise if human freedom and bodily autonomy is your only moral consideration. You have implacably opposed moral concerns, and that’s the end of that: you know the corner you’ll be fighting, so get to it.
But for most people, it’s more complex. Human life is indeed sacred, but not to the point that it always outweighs every consideration. (Self-defence and just wars are two obvious counterexamples.) Freedom and autonomy is important, but it must have limitations, to avoid a Hobbesian war of all against all. And suffering should be minimised, but not at all costs. Assisted dying is a true moral dilemma: it is impossible to achieve a moral gain without imposing a moral cost.
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This is where evidence can affect our moral decisions. Some people will feel that the autonomy of the individual could outweigh the sanctity of life in most cases, but would worry about people being pressured into an early death by greedy or overwhelmed families. Some might want to know whether the availability of euthanasia will undermine good palliative care, and so actually increase suffering generally. These are empirical questions that can be answered with evidence and will then affect moral decisions.
This is a wider point about evidence-based policy in general, not just assisted dying. For instance, I write quite regularly about the public health benefits of, say, smoking bans, or drug legalisation, or whatever. That’s because I assume good public health is a goal of government. If people agree, then the evidence is important – but if someone thinks that drugs are a moral evil, or that smoking in pubs is an unalienable right, then the evidence is irrelevant to them. (Besides, no one sensible thinks that public health is the only concern.) Evidence-based policy is always a supporting act to moral reasoning.
Regarding assisted dying, I suspect that the line at which autonomy and the sanctity of life will be drawn, for many people, is between allowing death and directly causing it. Interesting studies into our moral instincts show that we don’t assess moral impact through bland arithmetic – one death caused, two deaths avoided – but through a more intuitive calculus, based on how active we are in causing and preventing those deaths. For instance, in interviews, people tend to think it’s morally acceptable to divert a runaway train off its current track, where it would kill five people, onto a siding where it will only kill one. But they’re not OK with throwing someone off a bridge to stop the train, even if it would result in precisely the same number of lives saved and deaths caused. By analogy, a doctor injecting a patient with the lethal dose might be unacceptable, but providing them with a deadly draught which they can keep in their medicine cabinet – which, as Terry Pratchett points out, is what they do in Oregon – for when they decide to use it might be all right. This is another empirical question – what do most people think of as “moral” and “immoral”? – and one that has a part to play in any legislation.
But the important thing is that, first and foremost, this is a moral argument. The lawyers in the Supreme Court are right that assessing competing risks is important. But unless you know what your moral stance is, the risks and benefits have no context: they’re just dry numbers, without grounding. And if the pro-assisted-dying side – my side, for the record – abandons the moral debate to the antis, and tries to make its case with empty statistics, then it’s already lost.
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