Killing is never a mercy to society: Freedom to choose is not a concept that can safely be applied to the euthanasia debate

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The Independent Online
WITH relief I came to paragraph 237 of the report of the House of Lords Select Committee on Medical Ethics. It is here that the committee decisively rejects the arguments for voluntary euthanasia as being not 'sufficient reason to weaken society's prohibition of intentional killing'. That prohibition is 'the cornerstone of law and social relationships' and, the committee adds, 'dying is not only a personal or individual affair'. The paragraph concludes: 'We believe that the issue of euthanasia is one in which the interest of the individual cannot be separated from the interests of society as a whole.'

That the committee should have rejected voluntary euthanasia was predictable. That it should have rejected any moves to liberalise the law relating to passive euthanasia was less predictable but, given the perfectly workable present legal position, entirely reasonable. But that it should accompany these rejections with an insistence on the public reality of the individual's life, even at the point of death, was almost too much to hope for. Wisdom, it seems, can sometimes be found even in blue HMSO booklets that cost pounds 12.95.

For the reality at the heart of the euthanasia debate is to be found in this confrontation between what is public and what is private - not just in the sense of what belongs in those spheres, but also in what defines them.

The argument for voluntary euthanasia - usually categorised as 'liberal' - is compelling and is becoming more so. Increasingly we have the technology to prolong life in the most extreme circumstances. People can now be kept alive in the face of the most appalling bodily or mental deterioration. The conclusions of many lives are now marked by months, maybe years, of abject dependency, suffering both for patients and for those close to them, and dementia; all of them frequently accompanied by fantastically expensive medical treatment. Why, argue the proponents of 'mercy killing', bother? Why not provide a neat, peaceful end as an alternative to these messy indignities?

And even involuntary euthanasia has to be confronted as potentially the only humane option. For patients beyond sense or reason, might not an active decision to end life be a last kindness? Perhaps in some sense we all agree with Nietzsche when he said: 'One should die proudly when it is no longer possible to live proudly.'

There is a further painful issue to be faced. I know two families well that have been put under almost intolerable pressure by 'heroic' medical intervention to save life. In both cases incredible, superhuman efforts were made by doctors to save the lives of children. They were successful, except that both families were left with appallingly brain-damaged sons with no hope of improvement in their condition and a lifelong need for 24-hour care. Such cases will become more common as technology allows us to preserve the lives of ever more premature babies. The human cost seems unpayable. Perhaps we should offset our scientific ingenuity with the legally established option of a peaceful, early exit from an unimaginably difficult life. After all, we already routinely abort foetuses that show signs of handicap.

All of which is to say that the anti-euthanasia argument is not an easy one, and it becomes more difficult to sustain the closer you stand to the human reality. In reasonable health and surrounded by healthy friends and a healthy family, nothing could be easier than to condemn, even to be disgusted by, the pro-euthanasia campaigners. But when the time comes it is not so simple, and an opiate overdose or an injection of potassium chloride might seem a small thing set against your own or somebody else's terminal sufferings.

However, the straightforwardly practical reasons for rejecting any liberalisation of the law are equally compelling. The healing role of doctors would be compromised, pressure - maybe unspoken - would be put on people to choose death for the sake of others, controls, however rigorous, would be difficult if not impossible, and beyond all that would lie the danger that death would be chosen as a convenience, even a cost-saving exercise. We'd be embracing a right to be killed as a possible first step on the road to a compulsion to die.

Liberalisers will insist that it is the controls that are the point. But in the pressure of these extremities of experience any control can be abused. Abortion is a precisely parallel example. Abortion law was liberalised with the insistence that the decision to abort was still a serious one. But are the motives for the thousands of abortions that now take place really as serious, as high-minded as we would like to think? In the real world the expedient quickly invades the territory of the morally serious.

Nevertheless, it is probably true to say that, in purely practical terms, the arguments are too finely balanced for anybody to adopt one position or the other with an excess of passion or certainty. A simple, utilitarian balance of pros and cons does not, as in so many areas of public debate, point clearly one way or the other.

But, as Ronald Dworkin, Professor of Jurisprudence at Oxford, has rightly pointed out, in the areas of abortion and euthanasia the argument cannot really be understood in these simple terms. People are not for or against in either case because of a careful weighing of the benefits and consequences. They are for or against because they have a general, possibly unstated, conviction about the nature of the whole of human life.

Dworkin's recent book, Life's Dominion, is an attempt to resolve both the abortion and euthanasia debates by showing that both sides can reasonably agree that human life is 'sacred' in either a religious or secular sense. Accepting this, they might also agree that the two sides can draw quite different conclusions. The liberals might say that, precisely because it is sacred, it must be cared for in the best way we can manage, and that might well involve abortion or euthanasia. The conservatives might say that the word sacred means that we cannot so intervene and that both euthanasia and abortion are therefore forbidden. The two can coexist just as religions coexist and the state and law have no role in determining which we choose. Freedom is the over-arching principle.

Dworkin himself is a liberal, and he gave evidence to the Lords committee. The report says they gave 'much thought' to his view that 'for those without religious belief, the individual is best able to decide what manner of death is fitting to the life which has been lived'. Indeed, that crucial paragraph 237 appears in the report specifically as a rejection of this Dworkin view. The insistence that 'dying is not only a personal or individual affair' represents an absolute refusal to accept the terms of Dworkin's individualism.

The committee is right because neither Dworkin's conception of freedom nor of the sacred are remotely adequate or convincing. His obvious desire is to elevate the liberal position from one of mere expediency to one that embodies a high conception of the nature of human life. But that high conception seems to involve a dilution of the concept of the sacred to the point where it cannot meaningfully be said to interfere at any point with the conviction that we can do what we like. If the sacred is to mean anything it must involve some degree of public limitation on freedom. As a purely private conception the sacred cannot possibly survive. Dworkin may hope that liberals like himself will behave as if human life were sacred but he cannot really give any coherent reason why they should nor, in the real world, why they will.

In this space I am necessarily abbreviating this argument. But, as succinctly as possible, the point is that the sense of the sacredness of human life springs directly from what we are, and what we are is a public matter. We do not spring into the world in some condition of romantic selfhood, in a state of Rousseau-esque perfection, we acquire selves from the language and culture into which we are born. From such a culture we may acquire the view that we are no more than thinking machines to be born and to die with maximum efficiency and convenience. And we can, of course, create such a culture by abandoning all prohibitions in the name of a spurious notion of freedom and an ineffectively dilute conception of the sacred. But we have not yet done so and, all being well, revulsion at the idea of any such culture will prevent us from ever doing so.

Perhaps the key to Dworkin's position as expressed to the committee is the phrase 'for those without religious belief'. His point is that if we cannot have a single moral view then there can be no real argument against an individual's freedom to choose his fate. My point is that without some degree of consensus, some level of individual awareness that we are part of something larger than ourselves, especially at the extremes of life, then there can be no long-term defence against the crudest demands of expediency.

In that context the committee's report is an entirely healthy document. It defines one prohibition - the prohibition of intentional killing - as too fundamental to the law and to society to be negotiable in any terms. It is rare, these days, to hear such a genuine absolute asserted in public life. And it is very rare indeed to hear one expressed in terms that paraphrase the most decisive of all conservative convictions: that 'no man is an island, entire of itself'.