Hugh McLachlan: Moral minefield in the debate on assisted suicide

MARGO MacDonald's End of Life Assistance Bill should be welcomed as a stimulus to the debate about euthanasia and assisted suicide. Even if it is rejected by MSPs, it might still serve as a useful stage in the formulation of future legislation that will be acceptable.

If people ask for our help, we are not always obliged to give it. However, we should treat their requests with consideration and compassion. We should retain legislation that makes it illegal to aid them as they wish only if we have very good reasons for doing so.

With regard to public policy, it matters not merely what we do, but why we do it. Hence, it would be unfortunate were MSPs to reject the bill for inappropriate reasons. In this category, we should place the frequently expressed objections that legalised assisted suicide would lead to a reduction of palliative care and that people might feel pressurised into seeking aid to kill themselves because they feel they are a burden to other people.

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Palliative care is not a substitute for euthanasia or assisted suicide. The sorts of unhappiness and other emotional states that might lead some people to want to die are not all caused by the type of pain that medical treatment can alleviate. In any case, pain can still be unbearable to some people even in its alleviated form. Medication cannot remove all the pain that it can reduce.

Palliative care is expensive. Assisted suicide is cheap. It is possible that the legalisation of suicide might lead some people to advocate a reduction in the resources and effort devoted to palliative care. Let them so argue. Such a possibility is not a reason for keeping assisted suicide a criminal offence.

If assisted suicide were legally permitted, it does not follow that there would be an inevitable reduction in the palliative care available on the NHS for those who required it. The offer of one sort of service is not a substitute for, and need not be at the expense of, the provision of another.

Furthermore, even if, somehow, the legalisation of assisted suicide were to lead to a reduction in the provision of palliative care, that is not a good reason for saying that assisted suicide should remain illegal. After all, more resources might be directed towards palliative care if, say, old age pensions were reduced or abolished. That is not much of an argument for reducing pensions, far less for making them illegal.

People might feel pressurised into killing themselves if assisted suicide were legalised, particularly if they felt that they were a burden on their family, friends or the state. They might be pressurised into killing themselves. That would be unfortunate, but it is not a good reason for keeping assisted suicide illegal.

It is not plausible to say that, because some people might resort to assisted suicide for misguided reasons, no-one should be allowed to have access to legally assisted suicide. Furthermore, it is far from clear that it is misguided to choose to die in order not to be burdensome. In any case, it is not the business of the state to decide for us that this is an inappropriate reason for ending our own lives.

People often are a burden, although it is wrong to point out to people persistently or aggressively how burdensome they are. For instance, children can be a burden to their parents, whether or not parents regard their children in, or exclusively in, such terms. Children sometimes leave home and get married in order not to be burdensome to their parents. It would be absurd to say that marriage should be illegal because some people might resort to it in order not to be burdensome. It is no less absurd to say that euthanasia or assisted suicide should be illegal because some people might resort to it for similar reasons.

People might, for whatever reason, feel pressurised into taking their own lives. That is hardly an argument for reverting to the situation where suicide and attempted suicide were, paradoxically, crimes.

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A more reasonable objection to Margo MacDonald's bill is that euthanasia and assisted suicide are contrary to the central role and professional duty of doctors; in other words, healing, curing and comforting in particular ways.

It is in the general interests of both doctors and patients that the legal position is clearly maintained that doctors are not entitled to kill patients or help them directly to kill themselves. Otherwise, there is a danger that some patients will trust doctors less than they do at present. The status and reputation of doctors might be endangered if their roles appear to be ambiguous.

Furthermore, the issues concerning trust are complex and confusing. Some doctors and some patients have an unhealthy, inappropriate, inflated, grandiose view about the role of doctors. It could be inflated even further if doctors – and particularly if doctors alone – were allowed to kill people or help them to die. Doctors can be trusted too much as well as too little for a proper relationship between doctors and their patients to exist.

If doctors were permitted to help their patients to die, would they be placed under pressure to encourage their patients to end their lives in order to reduce public expenditure? I do not think so. Nonetheless, some people might entertain such a fear, which could be corrosive to the delicate bond of trust between doctors and patients.

If we reject this particular bill, we might remain open to further proposals. For instance, to say that assisted suicide should not be available on the NHS is not necessarily to say that it should remain illegal.

Similarly, one might argue that, in some circumstances, it should be legally allowable to kill people or to help them to die, even if doctors should not be allowed to kill their patients or to help them to kill themselves.

Even if we have misgivings over the bill, we might still support it despite them. We might have even greater misgivings with the current state of affairs. Issues such as this are not like problems with solutions or questions with answers but dilemmas.

The best we can do is to choose the least uncomfortable position to adopt.

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• Hugh V McLachlan is professor of applied philosophy at the School of Law and Social Sciences, Glasgow Caledonian University.