Good Death Bad Death

The papers seem to be full of statistics about people's views on the right to die. According to the press the majority of people polled thought that people should be allowed to end their life early. But the question is actually not about the right to commit suicide but the right to assist someone without fear of prosecution.

In recent poll 85% supported the right to assisted suicide for specific circumstances and 13% for a blanket right. But be clear, it is not a discussion about the right to commit suicide but the right to assist someone to commit suicide.

What is interesting is the parallel subject of the death penalty. We currently do not support the right to assist someone to commit suicide. The reasons are fairly clear and that is the chances of abuse are non zero. There are safeguards that can be put in place but they are not fool proof. We avoid the death penalty because the loss of one innocent life at the hands of the justice system is seen as too high a price to pay for the benefits execution gives society in terms of deterrents and cost savings of holding prisoners for life.

The argument often goes that although there may appear to be absolute certainty in some cases and some crimes so horrific that there are a few who believe the person does not deserve the death penalty the issue is not those cases. The issue is that the cases are not black and white. There are no clear lines but a gradual grey scale of crimes. The killer who commits horrific crimes but who is mentally ill. Or who appears to be mentally ill, or who appears to have self defense arguments (battered wives). There are no clean lines. So we reject the death penalty in exchange for possibly not giving what certain criminals clearly and inarguably deserve.

So is the right to assist someone to commit suicide really parallel. Let's try and compare the circumstances.

1) If the death penalty was in place the decision would be long drawn out and based upon a legal process of jury and judge. The right to die argument has no such process in place.

2) The death penalty is carried out by the state. The right to assist suicide does not appear to dictate such restrictions. The current proposals vary but they could be in the hands of the individual (helping grandma drop the toaster into the bath), the medical profession, the private sector and the government. There is no understanding how the process would be regulated.

3) The execution of a prisoner, I would guess, is rarely done at the prisoner's request. They have no choice but to be put to death. For assisted suicides it is not clear how to determine whether the patient really wants to die. That is not to say there are not cases which appear clear via the media but for every clear case there are probably dozens of less clear cut cases.

There is no clear answer to these questions. What if the patient changes their mind? At what stage would you try to reverse the process? Is it restricted to only terminally ill patients? How long do you have to be terminally ill before you are allowed to commit suicide? If I someone has 2 years left to live when should they be allowed to die? Who makes that decision? Is it really for those with no hope? If I need a heart transplant in the next 2 years and will live in pain all that time should I be allowed to terminate my life to avoid the pain in exchange for the slim chance of getting a replacement heart match and potentially living in pain for the rest of one's life.

Who gets to decide what quality of life is worth preserving? Who decides what level of mental illness is allowed before the decision to commit suicide is taken away? What level of dementia?

There are lots of difficult grey area questions that simply cannot be answered in generality. Not that they cannot be answered its just that any answer is specific to each case and ultimately is only the opinion of one person. Without a universality to the answers each case must be dealt with specifically and by the right process and people. Neither the process or people to undertake this has been defined.

Another angle worth considering is not just the right to suicide or even the right to assist suicide but the right to prevent it. If you have one terminally ill patient and two children, one wants to assist, the other wants to prevent how is this to be dealt with. Down to the wishes of the terminally ill? Ok if they are fully aware but what about if their wishes are doubted.

The argument would seem to lend itself to the fact that the patient's will to die must be beyond reasonable doubt. But that level of evidence was deemed not good enough to execute someone for crimes.

We need certainty and in this world certainty is just not available and on that basis it would seem the right to assist suicide should not be permitted.

I would add as one final argument that the discussion of animals and pets often comes up. This is a grossly flawed argument. Euthanasia is different. That is about putting those suffering out of their misery. We put down dogs if the quality of life would appear to be too poor and the animal would suffer. I have heard several times in the media "I would not allow my dog to suffer this much (referring to a terminally ill relative) and it would be put to sleep.

But that is surely a very different argument. Are we proposing to move from voluntary suicide to killing the suffering (irrespective of their views)? This a is huge step beyond assisted suicide. It is impossible to go down this route due to the problem of marginal cases. Try and define what an animal is. If you base it on intelligence then you will find animals with clearly more intelligence than say mentally ill children. So are we saying it is ok to put mentally ill children out of their misery if they are suffering?

This is an impossibly hard set of questions to deal with and so the only way to err is to not go down this route at all. No death penalty, no assisted suicide.