Tuesday, October 11, 2005

Shades of Grey

Third Avenue and Laban Tall both comment on the soon-to-be debated Assisted Suicide Bill. Laban is, as you would expect, pretty strongly opposed to any notion of assisted suicide or euthanasia. Not without justification, I might add - supporters of the Bill may argue that a case like Harold Shipman is exceptionally rare. Yet any potential legal justification for his dreadful acts should be avoided at any costs, both on ethical grounds and if we wish to retain any trust in our doctors whatsoever. Any euthanasia bill would have to be incredibly well-written to make sure that the rights of the dying are respected without giving the chance for more evil, worldly motives to take over.

His argument, that consists of the line "The Lord giveth and the Lord taketh away. Blessed be the name of the Lord.", however, is much more shaky in my opinion. The Lord giveth and the Lord taketh away, certainly. Yet he has given us the power to terminate life at short notice; it is our own moral minefield to negotiate how we use that power. As John Steinbeck might agree, "thou mayest triumph over sin" - did the Lord really intend the perpetuating of suffering? Whether we like it or not, any moral guidance on these matters cannot be absolute, and it must always exist in shades of grey.

Third Avenue's viewpoint is very interesting indeed. He argues against the legal right to an assisted suicide, but believes that judges should be able to turn a blind eye to the law in the right circumstances. So far, that is justifiable, if somewhat against the legalistic times in which we live. What is far stranger is his position regarding the imposition or otherwise of life-support treatment:

A fundamentally different question, however, is the right not to receive or continue to receive medical treatment: and it was this that was at the heart of the Terri Schiavo case here in the States earlier this year (although the issue was muddied by a deeply distressing family dispute). There is no question in my mind that a competent patient, or their competent next of kin, should be able to decide whether to accept treatment, even if its refusal would have a terminal outcome. The alternative, indeed, fills me with dread. For the law to oblige me or my loved ones to accept continued treatment, however horrible, however painful, however much against my or their express wishes, is to open up a new and disturbing view of the relationship between the individual and the state.

I still fail to see the moral difference between killing someone through a direct action, or through killing someone through failing to perform an act that would keep them alive. That is the issue at hand when the Terri Schiavo feeding tube case, for example, is discussed. If a course of action that will certainly result in death is acceptable, then why is a different course of action with the same result different? (And, to turn back to Laban Tall for a minute, if the Lord has given us the power to keep a person alive through a feeding tube, does that mean it should be used?)

A relative of mine was in that situation earlier this year. I was too far away to visit; however, other relatives did visit. The story they brought was terrible - of someone left unable to speak and in obvious pain through the removal of treatment, even if there was little doubt that the results of withdrawal were the most humane. Why subject someone - anyone - to a level of suffering through starving them to death, when a lethal injection, for example, could alleviate the pain?

We are queasy about legislating for this because it appears that the state is legislating for death. Bush's empty rhetoric about creating a "culture of life" has its appeal. Death scares us all, and God forbid we should ever be in a position where these sorts of judgements have to be made. Yet simply because they are grisly doesn't mean we should put them to the back of our mind - as a failure to confront this inconsistency does. They do arise, they cause strife well beyond the patient, and they are impossible to deal with except on a case by case basis.

Of course, as Third Avenue points out, in a legalistic world, that often won't do. If things go wrong, we want someone to blame. If we want someone to blame, people have to have duties. If people have to have duties, then they have to be codified. That leaves us with the unappealing prospect of judges becoming the arbiters of these decisions. No-one wants to leave their lives, or the lives of their loved ones, in the hands of seemingly unaccountable - and certainly remote and distant figures.

The question that should be asked, of course, is - why should they? Why don't we give legal protection to our doctors, that in cases where second or even third opinions have been taken, and extensive consultation with patient and/or next of kin has been sought, and all parties have agreed on the same result, that euthanasia can be allowed? There would still be legal recourse in the case of dissent. But it seems to me that in most cases neither party wants to take it to court. And if it's made pretty clear in any ruling that it's the practicalities of the case that should be decided, not the broader principles, the fear of judicial legislation that is so prevalent in the States should be avoided too.

Most of the time, this could be settled without a recourse to the courts. They are needed as a safety net in any law of this kind, naturally. Yet if we give the legal capability for assisted suicide, then to a certain extent we can take the courts out of a process we don't want them to be involved in anyway. Whilst it remains illegal, we are prolonging suffering, even when making a swifter death an inevitability. If we give the legal capability of assisted suicide, then it can be left, as far as is humanly possible, as a matter between adults, their relatives, and their doctors. And when we're dealing in shades of grey, that's the best solution we can hope for.