Monday, December 1, 2014

Commercial Assisted Suicide Industry

This article was published on National Review Online on November 30, 2014.

By Wesley Smith

Wesley Smith
Human logic goes where our first principles and fundamental premises take it.

Assisted suicide’s core premise is that being killed to stop suffering is a fundamental human right. In other words, terminal illness may sometimes be potically expedient entry point to euthanasialand, but it isn’t the point of legalization.

And now, in the journal Bioethics, bioethicist Roland Kipke argues that if assisted suicide is a right of autonomy, we should permit entrepreneurs to go into the business of making people painlessly dead, what he calls “commercially-assisted suicide” (CAS). From, “Why Not Commercial Assistance for Suicide?”:

‘CAS’ means that persons who wish to commit suicide are supported in a businesslike fashion, for remuneration. In the majority of cases, the core of this support might consist in providing a lethal dose of a drug to enable the person to kill herself. Furthermore, the assistance can consist of counselling, accompanying the suicidal person during the dying process, and further services connected with the suicide. 
‘Businesslike’ means that the suicide assistants intend to provide their service on a continuing basis and to earn (a part of) their livelihood from it. CAS, as it is understood here, is, therefore, not a one-off act and it is not (only) done as a favour…However, as it is understood here, CAS is only provided by non-physicians.
This isn’t a new idea.

  • Jack Kevorkian made this very proposal back in the early 1990s.
  • Scotland’s pending assisted suicide legalization legislation would create “licensed suicide facilitators,” who would presumably be paid for helping usher in death and clean up afterwards.
  • Switzerland already allows non-profit suicide clinics whose owners still do very well – thank you very much–by making people dead (about $9000 a pop).

Kipke thinks having suicide professionals would weaken the arguments against legalizing assisted suicide, for example, taking the “corruption of medicine” concern out of the equation. And, it would eliminate resistance from doctors opposed to assisted suicide so that the suicidal would not be impeded in their intention to become dead:
Another problem that is specific to PAS would also fall away. According to the prevailing view of the proponents, doctors (on the condition of permission for PAS) would not be obliged to provide assistance to suicide. 
Whether the individual physician provides such assistance or not is to be left to his own personal decision. 
Although this practice seems to be well justified by the principle of autonomy it could be very problematic for persons who seek assistance for their suicide. Whether their wish is fulfilled or not does not depend on clear, generally applicable criteria, but on the personal attitude of the physician…Obviously, this problem would not occur with commercial assistants.
But what about the problem of suicide entrepreneurs having a stake in the deaths of customers? Well, doctors might dissuade! (How paternalistic of them!) More:
The role of commercial suicide assistants would be in contrast to this. They might not experience this general credit of trust and most people might be more skeptical about their judgments. Therefore, the risk of unreflected interference would be smaller.
But, what about assisted suicide reserved for only last resorts? As anyone who has read this blog or my other work surely knows, it never is now. Anywhere.

But Kipke doesn’t think such concerns should logically impeded the creation of the new death industry:

However, the argument has another problem: it is based on a concept of the good; more precisely, on a notion of a desirable social condition that is probably not even shared by all people. Such an argument can hardly be put forward from a liberal point of view.

For, according to the prevailing liberal conviction, the good is significant only for the individual or for a particular community and should not be the basis of generally binding rules. This is certainly the case for concepts of the good that go beyond fundamental assumptions and represent concrete ideas of a common good. In particular, it applies to concepts of the good that do not enjoy general approval. The right has the primacy over the good, and the state has to be neutral with regard to these concepts of the good.
This accurately summarizes the sterile and reductionist Dworkinian view of liberal society, demonstrating how contemporary progressives betray liberalism’s once-fundamental purpose of protecting the vulnerable and defenseless. (For a powerful argument about why liberals must oppose assisted suicide to be true to their calling, see Robert J. Jones’, Liberalism’s Troubled Search for Equality. (Here’s my review.)

Kipke closes with an important point:

If one has no general objection to assisted suicide, there are many more reasons for CAS than for PAS to occur. To reject CAS while endorsing PAS is, therefore, not ethically justifiable: it is not a coherent ethical position. 
Therefore, the position of the liberal advocates of PAS has to be revised. Either they have to expand their advocacy to include CAS and therefore radicalize their position considerably or they have to revise their rejection of some arguments that are generally raised against assisted suicide. In both cases, it would no longer be the same position. 
If one does not want a society in which suicide and its support is normal and taken for granted like other services, and if one wants to adhere at the same time to the claim of coherence for their own ethical position, the only possibility is to reject PAS. Those who do not endorse CAS cannot endorse PAS, either.
Indeed. Moreover, Kipke’s article demonstrates why assisted suicide/euthanasia isn’t medicine! Those who pretend otherwise merely seek to harness the authority of the doctor in service to the culture of death.

Will CAS ever be permitted? If we allow assisted suicide, I don’t see why not. Indeed, as noted earlier, it has already been proposed in Scotland. And in Oregon, a psychologist planned to go into the assisted suicide business – before being stripped of his license for unrelated ethical reasons.

I have no idea whether Kipke favors or opposes assisted suicide. But his arguments are logical and flow directly from the legalization premise.

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