When Assisted Suicide Goes Too Far
Why it’s a mistake for the law to allow assisted suicide when death is not “reasonably foreseeable.”
Recent changes in Canadian law concerning physician-assisted suicide have raised a furor. Last year, the country’s medical assistance in dying (MAID) law was amended to allow doctor-assisted euthanasia for those whose death is not “reasonably foreseeable.” As a result, some younger people without terminal conditions are seeking euthanasia. Many find this abhorrent. Has Canada lost all respect for life?
Well, what makes life worth living? According to one perspective, which we may call the life-first perspective, there is no explanation of what makes life worth living. Living is intrinsically good, period. According to another perspective, which we may call the happiness perspective, life is worth living because it contains moments of happiness. Some of those moments of happiness are intense, but many are subtle: the simple pleasures of a sunny day or a cool drink of water. We could also defend a third, compromise position, which says that life is worth living both intrinsically and also because of the good things it contains.
If we think that life is worth living at least in part because of the happiness we experience, what should we say about pain and suffering? An obvious answer is that pain and suffering make life less worth living. And in extreme cases, a life might contain enough pain and suffering and too little happiness for it to be worth living. Unless we adopt the stringent life-first perspective, some lives may be so miserable that it would be better if they were over.
This is the moral logic behind euthanasia. The word “euthanasia” comes from the Greek words for “good” and “death.” It has an apt double meaning: euthanasia means giving someone a good (quick, painless, dignified) death, but it also means that the death is itself good since the life it ends is so bad. The paradigmatic example of someone who deserves euthanasia is an old person in the late stages of a terminal disease. They have only a few weeks to live, and those few weeks will be full of excruciating pain and further deterioration of their body and capacities. If the rest of their life will be so bad, then surely it would be better to end it now, with dignity, and save them the suffering. The choice should be theirs. If they want death, we should allow it. And if they are incapable of ending it by themselves, it’s not wrong to help them along. It’s not wrong to bring a bad thing to an end.
Applied consistently, the moral principles that permit euthanasia for the suffering old would also permit euthanasia for the suffering young. If a life is so bad as to not be worth living, it is better to end it. Why should duration make any difference? Indeed, if the duration of the bad life makes a difference, it seems to suggest that we have more reason to end a long stretch of bad life than a short stretch of bad life. Moreover, it makes little sense to insist that it makes a difference whether or not death is reasonably foreseeable. None of us are immortal. This is an uncomfortable fact, and one we are often reluctant to face squarely. But the only alternative to an early death is a later death; eternal life isn’t on the table. Every death is reasonably foreseeable.
So I find the moral logic of Canada’s new MAID law perfectly coherent. The problem lies in its application. Although ending a long and intolerably painful stretch of life is morally justifiable both from the happiness perspective and the compromise perspective, I doubt whether killing any person with decades left to live could be justified on these grounds. My overriding concern is not that this law will be abused to kill healthy people out of convenience. While that’s possible, my concern is more fundamental. Even if extreme care is taken to ensure that all euthanasia is conducted with the goal of ending a miserable life, the Canadian law would still suffer from two serious defects.
The first defect is epistemological. While ending a long life that’s certain to be miserable might be better than ending a short life that’s certain to be miserable, it’s much harder to be certain that a longer life will be miserable. If someone is in great pain and very likely to die within the month, we can reasonably foresee that this next month will be horrible. But if someone is in great pain and is not likely to die for decades, we can’t reasonably foresee that those decades will be horrible. Much can change over the course of that much time. They have ample opportunity to turn things around.
This point is deeper than the observation that the future is hard to predict. Humans are highly adaptable in the face of misfortune. Imagine what your life would be like if you lost a leg in a car accident. That would likely be the worst day of your life. The physical pain would be immense, and the psychological pain that comes from a loss of ability would be overwhelming. But how would your life be after two years? Or after twenty? You might experience lingering physical pain, and the loss of capacity will always be an inconvenience. But you’ll adjust to your new situation. The pain will become less acute over time.
That matters a lot. The compassionate case for euthanasia says that it may be better to end lives that will contain far more unhappiness than happiness. But if we can reasonably predict that the unhappiness that comes from some condition will lessen over time, then it’s quite possible—even likely—that at some point in the future, the unhappy life will start to be happy again. If misery lessens over time, then a miserable person with decades left to live is probably not actually facing decades of misery.
The fact that unhappiness diminishes with time is a general observation, not an ironclad law. Psychological study may one day tell us whether there are some conditions from which people’s happiness can never recover. Perhaps euthanasia could be allowed in the case of conditions that we can objectively establish will cause permanent suffering. But that is not how the amended law works. The Canadian criminal code 241.2(2)(c) allows euthanasia for a person that meets the following criteria: (a) they have a serious and incurable illness, disease or disability; (b) they are in “an advanced state of irreversible decline in capability;” that also (c) “causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable.”
Being in an advanced state of decline that cannot be reversed is a (relatively) objective criterion, which is good. But even so, a very wide range of medical conditions fit these criteria. Plenty of illnesses can be both advanced and incurable without meriting euthanasia. From the happiness perspective, what matters is the suffering those conditions cause. And the law encodes a subjective standard of incurable suffering. But an emphasis on subjective criteria fails to take into account the nature of depression. This is the second major problem with the new Canadian law.
Importantly, depression alone does not qualify a person for euthanasia in Canada (although this exclusion is set to be repealed in 2023). But depression makes everything seem worse. Even everyday, neutral things begin to seem vaguely unappealing or anxiety-inducing. In cases of major depression, this gets ramped up dramatically. Everything seems intolerable, and nothing is acceptable. Under the new Canadian law, any advanced and irreversible illness or disability is one that you can seek euthanasia for, provided that you are depressed enough about it. The recent controversy, for instance, was sparked by a troubled 23-year-old man with Type 1 Diabetes and vision loss seeking euthanasia. Those are conditions that cause an irreversible decline in capacity, and the man in question considered them intolerable. This qualified him for doctor-assisted suicide.
But depression itself can be a temporary condition, particularly if that depression is brought on by the onset of some new medical condition. As we learn to adjust to the condition, depression can lift. Consider again what your life would be like if you lost your leg in a car accident. This is both physically and psychologically traumatic. You would require extensive therapy, both physical and psychological, to recover. And perhaps you will never fully recover, but life will eventually become worth living again. Yet, in the weeks following the accident, you might become depressed about your misfortune and try to end your life. Should you? If you can’t go through with it, should your doctor help? And if they did help, would that be an act of compassion?
I’m a moral philosopher, not a psychologist. But it seems to me that the flaws in the Canadian law come not from a misunderstanding of morality but from a misunderstanding of psychology. If it really is the case that someone has nothing to look forward to in life but a long stretch of suffering with little or no prospect for happiness, then it’s sensible to think that death is the best option. But it’s hard—perhaps impossible—to know whether that is the case. We have good reason to think that happiness can recover over time, given adequate support. We ought to be trying to provide that support. If someone gets up on the ledge in their darkest hour, the compassionate course of action isn’t to give them a good, hard shove. It’s to talk them down.
From the life-first perspective, euthanasia is unjustifiable. From the happiness or compromise perspective, euthanasia is justifiable, but only if we can be reasonably confident that the life we are ending will contain much more pain and suffering than happiness. We can’t be reasonably confident that a long duration of life will contain much more pain and suffering than happiness. Therefore, there is no perspective from which euthanasia for someone with many years yet to live can be justified.
Matt Lutz is an Associate Professor of Philosophy at Wuhan University.
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