Friday, 5 February 2016

Legally Assisted Suicide. A response to Jim.

The tomb of  William Larnach, the builder of Larnach's castle. He was a Member of Parliament who shot himself because of financial and family difficulties. His tomb is based on the design of First Church, Dunedin. Late last century this tomb was vandalised and Larnach's skull stolen. The skull, complete with bullet hole, was later found in a student flat. The tomb has since been restored.

My friend and colleague Jim White has made a thoughtful submission on the petition of Maryanne Street's and others to legalise medically assisted suicide. Much of what Jim says I agree with. He bases his argument on the morality of suicide, saying that while suicide is usually regarded as morally repugnant, there are times when it is not. He mentions, for example, Father Maximillian Kolbe who, in Auschwitz, willingly went to his death in order that another man could be spared. Indeed, Jesus says that the greatest expression of love is to lay down one's life for one's friends, and the basis of our faith is that Jesus does precisely that, in going willingly to the cross on our behalf.

F Scott Peck defines love as “... the will to extend one's self for the purpose of nurturing one's own or another's spiritual growth... Love is as love does. Love is an act of will -- namely, both an intention and an action. Will also implies choice. We do not have to love. We choose to love.” I have never found a better definition of love. Love is giving ourselves for others. The noble suicide can be seen as the ultimate expression of this: Captain Oates wanders off into the Antarctic Blizzard, giving his life in the, unfortunately futile, attempt to enable the lives of his comrades; Jesus stands at the tomb of Lazarus knowing that to call Lazarus forth will cause such publicity that his own death at the hands of the temple officials will be a certainty.

The very antithesis of love is the desire to diminish others in order to further our own ends. And the ultimate expression of this anti-love is murder whereby we extinguish someone else's life in order to further or protect our own. So we bump off our spouse to collect the insurance or shoot the shopkeeper to facilitate our escape, and at the extremes of this continuum of love and not love it's fairly easy to assess the good or otherwise of the action. The trouble is most of the times when we wish to make such a moral judgement the circumstances are not so clear cut. And making a call as to when we should assist someone to carry out their determination to end their life (for their own good or the good of others) is usually one of the most ambiguous circumstances of all.

Jim submits that  " should be legally available to any individual who is terminally ill who makes a rational and sustained decision that they want to end their life." But here is the rub: how easy is it for a dying person to make a rational and sustained decision?

Dying sometimes happens quickly, and in these cases there is no argument. But death sometimes doesn't come quickly, and it is in these cases that the need for assisted suicide is under debate. Death is a process of surrender. Over a long time, usually far longer than we recognise, people begin to end their lives, piece by piece. Our bodies betray us and we stop doing things that once gave us pleasure and meaning. There is a last time for everything, and as we give up our treasures one by one, our horizons get smaller. Some of the things we give up - say, the ability to run or turn cartwheels or our capacity for international flight - cause us regret but some of our surrenders -for example the loss our sight or hearing, or our sexuality, or our ability to remember - are so great that they diminish our very sense of self. These endings are often incremental and so gradual that they do not overwhelm us; but over the years they can give us a creeping sense of diminishment and cause us to question the worth of life.

For most people these diminishments are not suffered in isolation. We live in the network of friends and family and as we give up control and autonomy it is picked up by those around us who gradually take on the responsibility for our own decisions, including some so intimate (when and what we eat, when we go to the toilet, what we wear) that the exercise of them is a burden for all concerned. So the mechanism of making a rational and sustained decision is seldom the sole preserve of the dying person. It belongs to the community of those who surround the terminally ill person, and is subject therefore to complex and conflicted self interest.

So when is the medically assisted suicide loving? That is, when is it the willed extension of oneself for the nurturing of one's own spiritual growth or that of others? When is it not loving? That is, when is it the diminishing of another in order to free myself of a burden, or to facilitate the advancement I may receive upon the other's death? My own experience of dying, by which I mean the imagined  contemplation of my own death and the witnessing of the deaths of others, tell me that in the overwhelming majority of cases, these issues are so complex and so entangled that it would be impossible to make the call. Sometimes the motives are crass. I know of the staff of one Dunedin rest home, for example, who were asked if it would be possible to speed up the impending death of an aged parent in order that their child might attend an overseas wedding. Sometimes the motives are subtle and longstanding. A family wearied by years of caring for the dying, and the dying person themselves, ashamed of the weight they place on those dearest to them, are in no position to make this call.

On the face of it, it seems just to allow people to make a reasonable and sustained choice for death. But the circumstances in which we find ourselves at the end of life are usually so fraught that such choice is impossible.


Clyde McLeod said...

Nice piece of work Kelvin

Philip Clark said...

It is indeed complex. At one stage last year my life was so limited and lacking hope that I said to my family "if this is how my life is to be, I want no more of it." Had I been offered a way out, thinking only of myself, I would probably have taken it.

Suicide also suggests that hope can be completely absent, which I don't believe. That is perhaps easy for me to say now, as I have exceeded my best-case prognosis, and enjoy good health. There was a time when I had little or no hope, or faith - I simply did not have the energy. I was like the paralysed man in Mark 2, whose 4 friends brought him to Jesus because he was unable to do so himself. It was the prayers and faith of many others who sustained my hope and faith. I was never alone, and surely those who have given of themselves on my behalf deserve some say?

Kelvin Wright said...

Thanks for this response Phil. As you have so wonderfully shown, hope is possible in even some "hopeless" cases. And, as you and I know, the diminishment and fear which comes from serious illness makes decision making hard. One factor is the natural grieving process we all go through when faced with loss. We grieve the loss of life itself, but also each of the little deaths which precede it. This grieving process takes on a natural and predictable flow through a number of emotions - denial, anger, depression and so forth which has all been catalogued a thousand times. So when someone is facing what seems like an endless succession of these griefs, and is processing each of them individually, and sometimes several at once, and is therefore subject to a whole slew of emotions who can say when they are able to make a completely informed and rational choice? The end (ie its finishing point and its purpose) of grief is acceptance and those who are dying can and do find it. Even for those for whom there is no hope of health and restoration, life in the final stages, diminished as it is,can be meaningful.

Kathryn said...

Very wise words Kelvin.

David Bell said...

Many of the terminally ill people I have ministered with are much more rational and capable than I am. I am not persuaded Kelvin...apologies.

Kelvin Wright said...

Yes David. I agree. But very many are not. And the trick is , how do you spot the difference?

Kelvin Wright said...

...and I refer you to the comments of Phil Clarke above. Last year Phil was diagnosed with oesophegal cancer and told he had weeks to live. He had a feeding tube fitted. He faced a certain and humiliating death.He has, against all medical precedent made an astonishing recovery and has returned to a rich and meaningful life. As he says, if there was anyone who would have fitted any conceivable set of parameters for assisted dying it would have been him.So while this intelligent man and his family were engulfed in the shock and grief of his original diagnosis he should have been helped to die? Really?

Nell NZ said...

Nuanced and aware of the sudden and particular. Thanks, Kelvin.

Father Ron said...

Kelvin, I wonder if you would concede that even the Roman Catholic Church has changed its attitude towards those who have committed suicide. At one time they could not have received a Christian burial, nor given space in a Catholic burial ground. Today, that attitude has changed - to the point where the death of a suicide is treated with more humane dignity. How, I wonder, should this affect our Church's attitude towards people whose lives have become intolerable! Does God want them to suffer more, do you think? Mercy has a strange quality when it is withheld from the desperately afflicted.

Jeremy said...

Father Ron, have you even read any of this blog or the responses from Philip and Kelvin? Nothing of their arguments have at all been based on the idea of suicide as sinful, and yet you begin your comments by bringing up the RC changes in view on suicide.

The idea that death is mercy when applied by the state is seductive in its simplicity and selective compassion, but I think that Kelvin and Phil have both made undeniably strong arguments to the effect that we cannot with all confidence stand and deliver such 'mercy' without fear of irretrievable mistakes. I note that advocates of assisted suicide and euthanasia tend to argue exclusively based on 'best case scenario' thought experiments. That is, they assume every person who will attempt to access an early death will be of sound mind, with strong and loving family support, competent and fulsome health care and advice, and with a definite terminal illness with unbearable symptoms they will never recover from. This is obviously not the case, with clear examples available from Kelvin and Phil (in the comments) and to be honest, many, many sources beyond this page. Unless euthanasia advocates can outline protections that can ensure that no person would ever be killed under euthanasia laws because of undue pressure from family, the medical system (including costs of continuing treatment) or incorrect diagnoses or prognoses, then we cannot possibly consider approving a system that allows us to kill people as a matter of course. If we refuse to permit capital punishment for fear than an innocent person would be killed, then we must apply the same reasoning to this issue.