Choice and Terminal Illness in the Assisted Dying Debate.

Mr MacDonald believes that if we base the argument for assisted dying on anything but choice we devalue certain lives. So, for instance, if we say only the terminally ill can be assisted to die we devalue the lives of all terminally ill people because we have endorsed the view that life with such a condition may not be worth living. He believes the Commission has admitted as much by arguing that legalizing assisted dying for the terminally ill (but not assisted suicide for the chronically ill or disabled) “would send a clear message that disabled people’s lives are valued equally.”  If this logic is sound, MacDonald claims, it must apply to the terminally ill under COAD and DiD’s proposed legislation.

We can only avoid devaluing certain lives, MacDonald argues, if the sole criterion for accessing assistance to die is an individual judging that their life is valueless. The implication seems to be that if we treat everyone the same by respecting everyone’s “choice”, all lives are valued equally.

If I understand the argument correctly, the logical outcome of MacDonald’s position is that assistance to die must be available to everybody in society, regardless of diagnosis or prognosis. So a heartbroken eighteen year old with no health problems could be assisted to die if they had capacity and had judged their life valueless. This is not a society I would like to live in, but that’s not the point here.

Although choice and autonomy are important, I think they should be balanced against other competing values and that the weight they are given will depend on the context and the “choice” in question. More weight should be ascribed to choosing one’s religion than one’s brand of washing powder. Believing people have the “right” to exercise choice in one situation does not mean you have to believe they should have such a right in every situation, or that the right to choose will trump all other rights or considerations.  So when we’re considering who should be eligible for legalised assistance to die, the choice of different “categories” of people (say the heartbroken, people who are chronically ill, people who are terminally ill) does not have equal weight. 

There is a difference between allowing someone to choose how and when they die when they are terminally ill and thus, by definition, dying, and allowing someone who is not dying to choose death over life. In bureaucratic-speak it is the difference between having choice over process and outcome. It is this which, I believe, prevents assisted dying for the terminally ill from sending a message that the lives of the terminally ill have no value in themselves. Assisted dying for the terminally ill acknowledges a fact beyond the control of law or medicine – that these people are dying – and allows them control (choice, if you like) over that process.

Comments below.

For the original blog, see:

The Commission on Assisted Dying is embarrassingly wrong! How did they manage it? – Choice in Dying, Eric MacDonald, 23 Jan 2012.