‘False Autonomy’ – The Libertarian Case Against Assisted Suicide
The following article by RTL Executive Officer Peter D. Williams appeared on the libertarian CfL website last week in the wake of the defeat of the Marris Bill. Peter was writing in a private capacity, and whilst RTL does not endorse any particular political party or philosophy, we think his post should be of interest to any right-to-lifer in its rebuttal of the ‘autonomy’ argument for introducing assisted suicide.
Today, the Assisted Dying Bill of Labour MP Rob Marris received Second Reading in the House of Commons, and was emphatically crushed by 330 votes to 118.
The argument for the passing of this Bill, and its legislative cousin the Falconer Bill (introduced in the Lords by former New Labour Attorney General Charlie Falconer), used ideas familiar to liberal-minded folk – ‘autonomy’, ‘choice’, and the consequent concept of the ‘right to die’. Perhaps as a result, some people with impeccably libertarian credentials, such as Rory Broomfield of the Freedom Association, have supported the idea on the grounds that it represents an expansion of individual freedom.
Recently, James Johnson made a similar argument, advocating not only assisted suicide but outright euthanasia.¹ The truth, however, is that the case for enabling people to kill themselves (or indeed killing them in a medical context), like the practice itself, is profoundly illiberal and indeed founded on unsoundly left-wing premises. For that reason, conservatives who truly value liberty should oppose it.
The case in principle for assisted suicide (or, to use its lobby’s Orwellian euphemism, ‘assisted dying’) has been formed around the idea that people who cannot choose to end their own lives lack the autonomy they ought to have, violating their ‘right to die’. If this really were as liberal an idea as it sounds, we would expect this assertion of a ‘right’ to be referring to a freedom – that is, a ‘negative liberty’ of the individual to do something without external restraint. Yet this cannot be what is envisaged, because autonomous individuals are already free to attempt to end their own lives without legal censure. The law as it stands in this area is based on the Suicide Act 1961 which, quite rightly, decriminalised failed attempts to commit suicide, acts that were hitherto punished with a prison sentence.
So, if the law will not penalise us for attempting to commit suicide, to what does this ‘right to die’ refer? The clue is in the name: assisted suicide. Indeed, as Johnson candidly states, “[t]his is about empowering people”. The argument is that those people who cannot kill themselves have the right to be enabled to do so. With euthanasia it goes even further – the ‘right to die’ is the right to be killed. So far from being ‘negative’ liberties; both are ‘positive’ rights. They are not freedoms; they are entitlements. This should be enough to dissuade us of any sentiment that this issue is somehow about freedom, for if libertarian conservatives assert that someone should be free to do a thing, we never then argue that they have the ‘right’ to be enabled to do it such that the Government is obliged to provide them with assistance.
The advocates of assisted suicide, however, argue that the health system should be obligated to provide patients with the lethal drugs and physician oversight that would enable them to take their own lives. If this is not a fundamentally statist proposal, it is difficult to see what would be.
Worse than this apparently liberal but really deceptively welfarist argument, is its abuse of the concept of ‘autonomy’. For autonomy is not the state of being enabled to do whatever it is you desire. Rather, it is the right or condition of self-government; the individual ability to freely try to attain what you want by your own lights, free from external restraint. Yet suicide is decriminalised – we are already autonomous when it comes to trying to determine the span of our own lives (though circumstance may frustrate us), and assisted suicide does not extend that legal reality one whit. It is simply mistaken to allege that doctors and politicians have power over our life and death simply because they do not allow someone else to help us kill ourselves, or kill us at our behest.
Indeed, a realistic appreciation of the autonomy of individuals should lead us to reject the legal enabling of someone to kill themselves, in any form. After all, the people that ‘right to die’ advocates want to provide with assistance to end their own lives are precisely those with the least personal autonomy – the terminally ill to begin with, and then (as in countries like Belgium and Holland), the elderly, the disabled, and the depressed. So far from enabling personal autonomy, assisted suicide is readily abused precisely due to a lack of it.
Anyone who has experienced serious illness, whether in themselves or in others, or is even sufficiently well-read on the issue to be basically cognisant of what it involves, knows that those in that situation are most often at their least mentally free and independent. The debilitating effects of being sick tend to not only cloud the clarity of our desires, but significantly erode the strength of our will. The same is true of the tiredness of many in old age, those who are miserable and dejected, and those who struggle with disability. What assisted suicide does is open up thousands of such people who exist in a personally compromised state to the possibility of being pressured into death.
When we look at countries that have legalised assisted suicide, we see this danger playing out. The system that ‘right to die’ advocates want to introduce to the UK is that of the US State of Oregon. In that State, between 1998 (when the ‘Death With Dignity’ Act came into effect), 13 per cent of patients cited fear of being a burden on their family as a reason for why they were committing assisted suicide. The latest figures for 2014, show that figure has inflated three-fold to 40 per cent.² In Washington State, which uses the same system, that figure is 59 per cent.³ ‘Choosing’ to commit suicide based on the effect of your existence on others hardly qualifies as an exercise of ‘autonomy’, and no-one should want to live in a society that enables such a grim corruption of care for the sick.
The situation is even worse in countries much closer to us, not only geographically but demographically and culturally. A 2007 study of Holland showed that 500 patients were given a lethal injection in 2005 without request,⁴ and a 2010 study of assisted suicide and euthanasia in Belgium found that 66 (32 per cent) of 208 euthanasia deaths in the region of Flanders were carried out without explicit request or consent, with life-ending drugs sometimes being administered by nurses (as opposed to physicians) in some of the cases of euthanasia, operating “beyond the legal margins of their profession.”⁵ Even more disturbingly, recent research has shown that organ donors in Belgium (including 23.5 per cent of all lung donors) had been euthanised, raising concerns that patients are given an emotional inducement to be killed, believing that they can be better use being killed and then ‘harvested’.⁶
Quite clearly, assisted suicide does not promote or extend patient choice; it invites and enables coercion. This is not speculative hypothesis; it is evidenced reality.
This risk of even subtle coercion of vulnerable people is precisely why our law exists as it does. The Suicide Act criminalised assisting someone else to commit suicide, on the basis that this practice carries the possibility of unscrupulous individuals pressuring vulnerable people into death, or perhaps killing them and faking their suicide, for some personal benefit. To detect and punish this, or more preferably to dissuade it from occurring and thus protect vulnerable people, the law exists so that any assistance in suicide can be investigated as to criminal wrongdoing.
As Baroness Butler-Schloss, the former President of the High Court Family Division, once put it, “Laws, like nation states, are more secure when their boundaries rest on natural frontiers.” The natural frontier of life and death in law is: ‘Thou shalt not kill’. And lest someone accuse me of making a theological point: this is not about moralistically imposing a religious belief to do with the ‘sacredness of life’ on those who believe otherwise. This is about asserting a fundamental principle of law that serves to protect vulnerable people from lethal coercion.
Borrowing language from the criminal law, killing someone else or involving yourself in their death is malum in se (an evil in itself), not a malum prohibitum (an evil because it is banned). Maintaining the criminalisation of assisted suicide is not like prohibiting or regulating alcohol, tobacco, sugar, or narcotics. Still less is it a cultural totem, as with the State definition of civil marriage. It is about establishing a premise in statute that protects everyone from the most ultimate abuse, and which protects those whose autonomy is most easily violated. It is the expression of this idea, one which chimes entirely with the non-aggression principle that most libertarians take for granted, that leads us to prohibit assisting someone to kill themselves.
Granting the concept of an entitlement to be assisted in killing yourself, would not only formalise into law and medicine a statist concept foreign to libertarian sensibilities, but remove literally vital individual protections. Suffice it to say then, assisted suicide is not the “next social development” of this country. It is a retrograde corruption of medical practice that violates rather than supports personal freedom. Introducing it would involve removing a law that has the best flexibility possible to protect the most vulnerable and least autonomous people, whilst allowing for compassion in cases where prosecution is not in the public interest.
If it is true that there can be no freedom without choice, it is also true that there can be no true choice without the self-governing and independent strength of will that constitutes genuine autonomy. As a system that so profoundly violates this, assisted suicide should be rejected in whatever proposed form it comes, and the balanced law and proper care embodied in our laws should be ever supported. This is the stance that is most natural and sensible for anyone who truly cares about the dignity, liberty, and right to life of the human individual.
¹ The difference between ‘assisted suicide’ and ‘euthanasia’ is that the former involves enabling someone to kill themselves, whereas the latter involves someone (most usually a doctor) killing a patient. The divergent element between the two is who does the killing.
² Oregon Public Health Division Death with Dignity Act Report (2014), Table 1: ‘Characteristics and end‐of‐life care of 857 DWDA patients who have died from ingesting a lethal dose of medication as of February 2, 2015, by year, Oregon, 1998‐2014’, sub-heading ‘End of Life Concerns’, page 5.
³ Washington State Department of Health Death with Dignity Act Report (2014), Table 2: ‘End of life concerns of participants of the Death with Dignity Act who have died’, page 7.
⁴ End-of-Life Practices in the Netherlands under the Euthanasia Act, Van der Heide et al, New England Journal of Medicine (2007).
⁵ Physician-assisted deaths under the euthanasia law in Belgium: a population-based survey, Chambere et al, Canadian Medical Association Journal 182:9 (2010).
⁶ Initial experience with transplantation of lungs recovered from donors after euthanasia, Van Raemdonck et al, Applied Cardiopulmonary Pathophysiology 15:38-48, (2011).