Anti-Euthanasia Apologetics

(See also Rough notes on TRTL presentation)

Opening questions (goal: set up tension between suicide prevention/assistance):

• What do you think of assisted suicide?
  • What do you think about suicide?
  • Are there any situations where you think we should offer people suicide prevention rather than suicide assistance?
    • Trot out the Teenager: If someone supports assisted suicide as a matter of freedom/choice/autonomy, ask whether or not a suicidal 19-year-old¹⁾ should have access to assisted suicide

There are three possible positions to take in response to the suicidal:

1. 100% Assistance: Everyone deserves assistance
2. Assistance/Prevention: Some people deserve assistance, others prevention (most popular)
3. 100% Prevention: Everyone deserves prevention (the pro-life position)

The goal of this apologetic is:

• to move people from Position 1 to Position 2 by reaching for intuitions that there are at least some situations where suicide should be prevented
• to move people from Position 2 to Position 3 by showing that Position 2 is untenable/ablist/discriminatory

Key question: Who gets suicide prevention and who gets assistance?

If it's really about autonomy/freedom/choice/control, why should we ever prevent someone from committing suicide?

• Is it really about autonomy? Or do we only say that when we agree with someone's suicidal thoughts, when we agree with them that they might actually be better off dead?
• Doesn't offering prevention to some and assistance to others reveal a judgment that some lives are worth living but other lives are not worth living?
  • It's not really about autonomy them, or else we'd never intervene to prevent suicide. Isn't it about a judgment call that some people are better off dead?

1. Among the terminally ill, we can see that a will to live changes frequently
   • According to the studies undertaken by professor Chochinov of Winnipeg, 80% of people who ask for death have bad pain relief and 60% are gravely depressed (Harvey M. Chochinov (dir.), Handbook of Psychiatry in Palliative Medicine, Oxford University Press, 2012).²⁾
   • The Economist
     • “The current medical model of suicide, which has spawned such a great increase in suicide-prevention and intervention efforts, denies absolutely that suicide, except for the terminally ill, can ever be a rational choice, and claims that society has an obligation to stop someone with an unbalanced mind from destroying themselves just as it would try to stop them from doing other harmful acts. The fact that suicide is utterly irrevocable just adds to the obligation to intervene.”
     • “There is a great deal of evidence for this view. Most people who fail at suicide, or who are rescued after an attempt, do not try to kill themselves again.³⁾ Anti-depressant medication and counselling have helped many people banish suicidal thoughts. And yet the terminally ill also often have great difficulty in coming to a rational decision about whether they want to live or die. A study of 168 terminal-cancer sufferers published last month in the Lancet by researchers at the University of Manitoba in Canada found that their desire to go on living fluctuated greatly, depending largely on their experience of distressing symptoms. Given this, should not society reinforce the taboo against suicide and resist even a relaxation of laws against euthanasia?”
   • The Lancet, Harvey Max Chochinov, Douglas Tataryn, Jennifer J Clinch, Deborah Dudgeon, September 1999, Volume 354 (Issue 9181), p.816-819
   • NYTimes
     • “study by Canadian researchers suggests that in the weeks before death, cancer patients show substantial fluctuations in their will to live. And the factors that contribute to a loss of that will shift over time, the researchers found, and often involve suffering that can be alleviated through treatment.”
     • “Dr. Chochinov and his colleagues studied 168 cancer patients admitted to the hospital for end-of-life care. The patients were screened to make sure that they had the mental competence and the physical strength to participate in the study, which involved filling out a questionnaire twice a day – a process that Dr. Chochinov said took about a minute – and continued until shortly before death. The participants were asked to rate themselves on 100-point scales measuring pain, nausea, appetite, activity, drowsiness, sense of well-being, depression, anxiety and shortness of breath. They also rated the strength of their will to live.”
     • “Most of the patients in the study were elderly, although the youngest was 31 (and the oldest 89). On average, the participants survived for 18 days after entering the hospital. One woman, however, survived for more than 150 days.”
     • “Over a 12-hour period, Dr. Chochinov said, the patients' will to live could fluctuate by 30 percent or more. Over a 30-day period, the shifts were even larger, on average up to 60 percent or 70 percent.” “These large fluctuations suggest that will to live is highly unstable,” the researchers wrote.
     • “In the period just after a patient entered the hospital, a decrease in the will to live was most strongly associated with anxiety, perhaps as a result of the psychological shift required in moving from out-of-hospital care, Dr. Chochinov said. One to two weeks afterward, the researchers found, depression was the symptom most strongly associated with decreased will to live.”
     • “But in the final days of life, physical distress – specifically pain and shortness of breath – repressed patients' will to live more strongly than psychological suffering.”
2. We need to look at the real reasons that people take assisted suicide
   • people think that pain is the #1 reason, but it's not in Oregon⁴⁾, for example, 1998-2014 data, published 2015:
     • 92% losing autonomy
     • 89% less able to engage in activities making life enjoyable
     • 79% loss of dignity
     • 50% losing control of bodily functions
     • 40% burden on family, friends/caregivers
     • 25% inadequate pain control or concern about it
     • 3% financial implications about treatment
   • physical pain (or fear of) is not the main concern
   • “These are disability issues”⁵⁾
     • graphic of person in wheelchair with ramp to assisted suicide and stairs to suicide prevention program

These are fundamentally disability issues.

• Quality of Life
• Unbearable Suffering
• Incurable
• Terminal (?)

Dialogue techniques:

• Wheever someone brings up terminal illness, ask them about a non-fatal disability
  • ASA: “Well, if someone is terminally ill, I think they should have access to assisting suicide because of unbearable suffering”
  • PL: “What about if someone is suffering from a disability that's not terminal, should they have access too?”
    • People might agree as a first instinct, but as you tease out the ablism, this is actually quite powerful for people when they realize their initial instinct was so ablist
• When ever someone draws up a specific case, ask about the exact same case without the disablity:
  • e.g.
    • ASA: “Well, what if someone was a quadriplegic with early onset Alzheimer's?”
    • PL: “What if someone had early onset Alzheimer's but wasn't quadriplegic?”
  • e.g.
    • PL: What if someone was wheelchair-bound, and wanted assisted suicide because they found life unbearably isolated and difficult?
    • ASA: Well, maybe they should have access too, they shouldn't be denied
    • PL: What if someone wasn't wheelchair-bound, but wanted assisted suicide because they found life unbearably isolated and difficult?
    • ASA: I mean, you have to ask why they're feeling that way, try to get to the root of the problem
    • PL: Why would you treat someone differently in the same situation just because they're in a wheelchair?

Any attempt to offer suicide assistance to some and suicide prevention to others is fundamentally ablist, it's discrimination against a class of people. If you're able-bodied and suicidal, we'll step in to prevent you from harming yourself. If you're facing disablity issues and suicidal, we'll help you kill yourself.

The overall point is that everyone has an equal right to suicide prevention. Everyone deserves to be prevented from harming themselves. Suicide is the ultimate self-harm. And we can see that suicide is always a symptom of some unmet need, even for the terminally ill. Our duty to other people is to meet this need, to support people in finding meaning in their lives amidst suffering rather than validating their despair and aiding their self-harm.

Key question: Is there ever a case where we should prevent suicide? (If yes, back to Position 2)

• Is suicide ever a tragedy?
• D = S - M
• Up until now, suicidal ideation has been a diagnostic criteria for depression. How are we supposed to distinguish between being rationally suicidal and being suicidal as a symptom of depression?
• How can suicide be rational?
  1. “sound mind” (subjetive)
  2. good reasons (objective)
  • How do you determine whether or not someone has a sound mind or good reasons? The only way you could see them as being rational is if you're already made a judgment about whether or not they're actually better off dead (back to Position 2)
• What is your responsibility to your fellow human beings?
  • https://www.lifesitenews.com/blogs/i-might-want-to-be-euthanized-too-if-my-children-did-this-to-me
  • Would it not truly be suffering to realize that those very closest to you, those you loved the very most, would like you to kill yourself, or support your suicide?
  • Suicidal people often reach out to others, often let someone know about their plans. By telling people they are contemplating suicide, they are letting out one last cry for help—I’m going to kill myself…are you going to stop me? Is it not possible that many elderly parents may be suggesting assisted suicide in the desperate hope that their children will reject such a situation out of hand? That their children will tell them how much they are loved, will promise to come see them, will offer to find them the care that they need? What if the suggestions of some elderly or sick people that suicide is the best option is not so much a suggestion as it is a question: How much do you love me?
  • Which leads to more questions: Love is not proven until it is tested. As those we love suffer illness and the many afflictions of old age, what is our responsibility towards them? A loved one with Alzheimer’s, for example. It is easy to love someone when they can love us back. But does our responsibility suddenly vanish when that person is not capable of loving us in the same way? Does mental illness, old age, or disease relieve us of our responsibility towards them, eliminate our duty to care for them, or change the fact that we love them? Too often the idea of euthanasia is not about releasing the suffering one from pain. It is about releasing those around him from their responsibility.
  • Do we have a responsibility to decrease the will to die?
  • Is mercy killing about releasing the person who is suffering from suffering, or releasing the people around them from responsibility?
  • Peter Singer: love > his philosophy

• The pro-life position is not vitalism, getting every last beat out of that heart
  • extraordinary vs ordinary care, refusal of treatment
• The pro-life position isn't just saying no to suicide, but it's offering positive forms of care instead
  • Dignity Therapy