Anti-Euthanasia Apologetics

https://mobile.nytimes.com/2016/12/22/upshot/how-social-isolation-is-killing-us.html?smid=fb-nytimes&smtyp=cur&referer=

(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. Total Choice: Everyone deserves assistance
2. Mixed Assistance/Prevention: Some people deserve assistance, others prevention (most popular)
3. Total Prevention (Pro-Life): Everyone deserves prevention (the pro-life position)

The goal of this apologetic is:

• to move people from Mixed to Pro-Life by showing that the Mixed position is untenable/ablist/discriminatory
• to move people from Total Choice to Mixed by reaching for intuitions that there are at least some situations where suicide should be prevented

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?

Trot out the Teenager

Most of the reasons people give why some people should be eligible for suicide assistance break down into these four reasons why we'd “quit” on the suicidal:

• Quality of Life
• Unbearable Suffering
• Incurable Illness/Condition
• Terminal Prognosis

1. Test the Limit: How close to death do you need to be?
2. Transient Will to Live: Dr. Chochinov studies
3. Unreliable Prognosis: John Norton story link
4. Assess for Ablism: Is it really terminal illness, or are they just appealing to the hard case to justify assisted suicide for people who aren't dying? Test with their response to a serious, permanent but non-fatal disability. What if someone has an incurable illness or disability that's non-fatal?

This leads into the next item, but suggests that it's not only for the terminally ill but that people are just appealing to a hard case to justify all cases. Pursue to see what their reason really is

1. Test the Limit: How long before we abandon ship and do a 180 and give into suicidal despair?
   • story of Alice via Stephanie Gray from book, Dr. Will Johnson: “When death is a solution, creativity goes out the window”
2. Compare with other Incurable Conditions: death of a spouse/child, loss of limb, etc. If the person accepts other solutions to move forward in life despite these conditions being “uncurable,” then why not for other situations? Isn't there always a way to move forward with non-fatal conditions?
3. Possibility of future treatments: how certain are we that any given illness is actually indefinitely incurable?
4. Assess for Ablism: What about the wheelchair? Set up situations with an without a wheelchair, e.g. with and without quadriplegia, then down syndrome. Are we treating people with disabilities differently? Would we fail to prevent their suicides in the same scenario?

1. Test the Limit: How much suffering? How do we measure? How long a waiting period? Only physical pain or suffering, which is psychological, as well?
2. Physical Pain
   • When we can manage pain: Pain management, palliative care, double-effect reasoning around morphine and hastening death
   • When we can't eliminate pain: EB and Jonathan Pitre, alleviate suffering but not eliminate sufferers, Victor Frankl MsfM e.g. p. 113 on our response to unavoidable suffering
3. Psychological Suffering
   • suffering is psychological, not physical. How do you quantify/measure? Get a definition, e.g. from RGP3207H
   • And what other kinds of psychological suffering qualifies? Depression? Anxiety disorder? Being tired of life?
     • BIID example: real psychological suffering, but is the solution to assist with self-harm or to prevent it?
   • Suicidal ideation is one of the diagnostic criteria for depression in DSM V (?)
   • D = S – M
   • If someone is cutting themselves, would you take away the knife? Or would you assess their suffering to see if it's unbearable enough to warrant self-harm,? Would you get them a more efficient weapon to assist them in inflicting self-harm?
4. Assess Ageism: people have more of an instinct for young people in a turbulent time of their life, but they don't recognize that old age can also be a turbulent time. Test to see if someone would offer suicide assistance to an elderly person who believes life has nothing left for them, compared to a young person who believes the same. Should people not have an equal right to suicide prevention based on their age?

1. Test the Limit: So, no terminal illness or incurable condition or unbearable suffering, is there are certain quality of life that could allow someone to choose suicide in a way that we wouldn't prevent it but would assist? e.g. tired of life, or unable to enjoy the things we enjoy in life or is this always the subjective choice on top of UIT?
2. Oregon Public Health: reasons that people choose assisted suicide, “these are disability issues” – the suffering that people experience to measure how likely someone is to commit suicide, count the number of losses in their life
3. Suicidal Regret: suicide is a permanent solution for a temporary problem
   • data/studies on failed suicide attempts and regret, e.g. Golden Gate bridge ( there is some conflicting data, that past suicide attempts are predictors of future, but that does that necessarily contradict regret? Or does it just mean that, despite regret, those who have attempted before are still at increased risk for attemping again?)
   • anecdotes from those who were suicidal: John Norton, Nick Vujicic, Mark Davis Pickup1, etc.
4. PVS and non-voluntary euthanasia:
   • if someone is incapable of finding meaning in life, they are also incapable of giving consent
   • related to incurable condition, there's the possibility it's not permanent, examples of people coming out of comas that were thought to be permanent
   • Christopher Kaczor, The Ethics of Abortion, Jennifer Anniston thought experiment: people in PVS retain a right not to be raped, so why is it absurd to think they also retain a right to life?

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

• chronic depression?
• suffering is subjective: what about extreme anxiety?

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)

Michelle: If someone is in great suffering, are they in the condition/right mind to make a permanent decision about suicide?

• 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

Why would we put animals out of their misery, but deny that to human beings?

• Euthanizing non-human animals is actually a sign that we respect them less, not more than human beings
  • We don't give the family dog chemo. We don't spend as much money or go as far to care for our pets as we do our relatives
  • Maybe this is because humans are different from non-human animals and warrant more care and respect; or maybe we're wrong about this and we should care for our other animals more
  • But it's not true that euthanizing pets is more compassionate, it's actually a sign that we value their lives less (whether rightly or wrongly)

BIID