In Defence of the Choice to Die: What the Assisted Dying Bill Gets Right

Pressure doesn’t invalidate the voluntariness of the choice to die

The central issue of the debate on assisted dying is whether the safeguards put in place will ensure sufficiently voluntary choices on the part of the terminally ill. Liberals and conservatives have chiefly been concerned with this alone. Unfortunately, the moral debate has evaded what voluntariness really is. We need to get a grip on its proper conception, and understand when, if ever, it is acceptable to implement rules which result in some people being mistakenly killed so others can make the free and voluntary choice to die themselves. It is my firm belief that the thin conception of voluntariness which comes out of such an ethical analysis, and the acceptance of rules which do not ensure 100% certainty of free choices, allows assisted dying to be morally permissible. 

Danny Kruger in The Economist has said the mere presence of assisted dying is ‘a terrible burden to place on people at their most vulnerable’ because of the pressure it creates on them. Kruger refers to two types of pressure. There is the self-pressure on the part of patients themselves thinking they are a burden on others. Then other-pressure arises from children, relatives and medical professionals suggesting and possibly arguing for why it should be embraced by the patient. Both pressures undermine the voluntariness of the choice according to Kruger: ‘This is not freedom’, he writes concerning the vulnerable choosing. Being intentionally killed when there is no voluntary choice amounts to murder, so, given we should be against murder, we should be against assisted dying too. An implicit thought to Kruger’s argument is the risk of murdering people via assisted dying is too high, because, I imagine he would concede many instances of assisted dying do arise from voluntary choices. 

The thick conception of voluntariness which Kruger employs is implausible. To begin with, we don’t take people conceding to strong feelings they should do something in other instances to mean their choice is not voluntary. When the homeless man comes onto the train and delivers his tale of woe many people strongly feel they should give money to him even if they know he’ll waste it on drugs, but no one thinks those that concede to this strong feeling are making an unvoluntary choice. Plus, many people can create this kind of internal pressure by presenting compelling arguments for moral positions, e.g., the vegan may argue with a carnivore eating factory farm meat is wrong, and, after dwelling on the argument, the carnivore may give up meat because of the force of it. Again: No one argues this internal pressure from the power of reason makes the choice unvoluntary. Parity of reasoning dictates then the internal pressure people feel in cases of assisted dying, because, it arises either through strong feelings which are irrelevant, or, reasons given by people to the patient, neither of which precipitate an unvoluntary choice. 

Pressure from others implausibly creates unvoluntary choice too. If a wife constantly badgers her husband to get a vasectomy so she doesn’t get pregnant again, and, he does, even though absent the badgering he’d stay unsnipped, we’d still call his choice voluntary. We don’t invalidate marriages if the man is marrying simply because he’s too embarrassed to refuse to say ‘I do’ when it comes to standing in front of everyone, because, we accept pressure from other people doesn’t eliminate voluntary choice. Similarly, the volunteers who entered the First World War entered through voluntary choice even though the humiliation of being called a coward was the alternative. The clear conclusion is external pressure on people to undergo assisted dying does not make their choice unvoluntary. Indeed: Were Kruger’s thick conception of voluntariness adopted then the knowing doctor carrying out the vasectomy on the brow beaten husband would have to be charged with gross bodily harm, because, there would be no actual consent to the procedure. No. That’s clearly false, hence, Kruger’s thick conception of voluntariness is too.  

The true conception of voluntariness simply requires an individual having an understanding of the act he is undertaking and its central consequences.  Almost all cases of assisted dying will meet this thinner conception of voluntariness which doesn’t implausibly rule out the above cases. In addition to the choice being voluntary, however, it must also be free. A free choice is roughly one made in the condition of having your own individual rights unviolated or not threatened with violation. Undoubtedly, a few people will not make a free choice to undergo assisted dying because their choice will be made under the threat of their rights being violated, e.g., a son saying he will kill all his father’s pets unless his father undergoes assisted dying; the doctor who kills this father would be acting on his unfree choice. Is stopping the unfree choice of death in any number at all warrant to stop all assisted dying? 

People make choices which could lead to their death which could solely be due to blackmail very often, yet, none of these choices are outlawed to stop the tiny number of deaths from such unfree choices. Take joining the army to fight abroad; fathers could be blackmailing their sons into doing that which leads to their death. Suicide too would have to be prohibited because this can often result from blackmail of the victim’s rights. We don’t ban either of these choices altogether, because, we accept a risk of unfree choice within civil society is the price which has to be paid for free choice overall. So: the tiny, tiny, tiny chance of the unfree choice to undergo assisted dying must be paid in order to ensure the free choice of assisted dying overall. I imagine this will be leapt upon by some as proof we liberals don’t care about humanity: It’s never acceptable to kill someone without being 100% sure of their fully free and voluntary consent which is expressly given, they will claim. 

This is very implausible. Imagine you worked at a meat processing plant and one of your colleagues fell into the meat grinder and was immediately in such immense pain he could not communicate his desires before his certain death. I take it would be okay to shoot this person, even though there is the chance they are Catholic and deeply opposed to the deliberate taking of life. This is because there is such overwhelming evidence he would consent to being shot if asked. Parity of reasoning dictates then we can deliberately kill people in assisted dying cases, because, the overwhelming evidence is for the presence of free choice too, even though a tiny number will not truly consent. If you’re still opposed to deliberately killing people because any number of people killed against their will is unacceptable; you must either accept it is wrong to shoot the man whose fallen into the meat grinder, or, give an explanation as to why you can kill him but not those in immense pain at the end of their lives who with all but certainty want to be put down. 

The thick conception of voluntariness employed by both opponents and proponents of Leadbeater’s bill is a phony notion which implausibly includes far too many actions in its gambit of unvoluntary choice. Pressure from oneself or pressure from others per se does not undermine voluntary choice at all, so, the vast majority of problem cases politicians such as Kruger cite are not so. Instead, only violations of rights, or, threats thereof, or, fraud, undermine the free choice to die which is required to undergo assisted dying. Yet even here we must accept the minuscule chance of the unfree choice to die is not warrant enough to restrict the freedom to undergo assisted dying: Free choice in the real world necessitates accepting the minuscule chance of unfree choice too.

Image: Wikimedia Commons/Ratel

Licence.

No image changes made