Kevorkian's ghost

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Christopher Lyons

Christopher Lyons has written an excellent commentary on a recent article by two bioethicists who argue that poverty, homelessness and having problems receiving medical treatment, should not hinder decisions for euthanasia.

Wiebe and Mullin's argument for radical autonomy with respect to (MAiD) euthanasia are deeply troubling in their implications and flawed in their considerations. 

Lyon's summarizes the argument by Wiebe and Mullin in the following manner:

In a nutshell, Wiebe and Mullin argue that MAiD can be a ‘harm-reducing’ embrace of individual autonomy to avoid prolonging suffering in oppressed people who cannot access adequate socioeconomic resources... They argue that even though a person may be poor or have limited options, they can still hold and express autonomy to request and receive death. Death, in their formulation, is the least bad option for people suffering social inequality in an unjust world.

Wiebe and Mullin are not making a new argument. In fact Kevorkian used it, too.

Thirty years ago, the American murderer Dr MJ ‘Jack’ Kevorkian, a euthanasia and assisted suicide advocate and illicit provider, expressed cruder versions of the same positions, claiming that ‘autonomy always, always should be respected, even if it is absolutely contrary, the decision is contrary to best medical advice and what the physician wants…’ and that a mere request for death is justification alone for provision, regardless of circumstance.

Kevorkian death van

Lyons continues:

It is also worth noting that Kevorkian disproportionately killed or assisted death for women, many of whom may not have had any physical illness and claimed ‘that only medical men should decide’ on MAiD. Aside from his blatant and lethal misogyny, his statements highlight a central but unacknowledged problem in Wiebe and Mullin and similar individualistic formulations of MAiD: the tension between the patient's autonomy, the clinician's autonomy, and society.

Wiebe and Mullin consider it paternalism to prevent killing.

Wiebe and Mullin, however, call it ‘paternalistic’ to prevent people from accessing MAiD but make no comment on the brutal paternalism of a privileged and empowered actor representing the state who judges someone’s eligibility for death and then may kill them. Why is clinician autonomy discounted? The privilege and power of assessors and providers is a major persistently unaddressed flaw in the reasoning of these kinds of patient autonomy-based arguments.

Wiebe and Mullin are asserting a radical autonomy that is obsolete.

... their definition of autonomy appears to be a repackaging of the obsolete ‘homo economicus’ model human actor from neoclassical economic theory, where people are understood to be ‘unswervingly rational, completely selfish, and can effortlessly solve even the most difficult optimization problem’. Research in neuroscience, biology, psychology, public health, sociology, and other disciplines has long since established that our relative autonomy and agency are products of myriad internal and external biophysical and social experiences, relationships, circumstances, and systems. None of us exists in hermetic vacuums of rational reason.

Lyon challenges Wiebe and Mullin on their view of autonomy.

By voiding a person’s relational context, the impact of their death on others, and the autonomy of the people who must assess and approve death from consideration, Wiebe and Mullin and their ideological colleagues idealise patient autonomy. Like Kevorkian, they construct euthanasia or assisted suicide (non-culpable homicide and suicide assistance under Canadian MAiD law) as virtuous though ‘tragic’ expressions of self-determination and ‘harm reduction’. Do they consider the harm to others from MAiD deaths as illegitimate or irrelevant?

How euthanasia may lead to eliminating people with disabilities and those who are poor.

Societies that find intellectual reasons to euthanise or kill the poor, sick, disabled, or socially oppressed groups commit atrocities. A former MAiD provider has even sounded this alarm in the wake of eligibility expansions. Despite claims that a lack of support for people is a ‘deep injustice’, the vision of society painted by Wiebe and Mullin is dystopian, where injustice may be morally permitted to flourish so long as others with greater autonomy judge oppressed people to have enough autonomy and ‘engaged hope’ to kill themselves or have themselves killed. Indeed, they even argue that medically provided death-for-oppression is a suitable and just response ‘to a world that currently does not exist and is unlikely to emerge in the near future’. Thus, in addition to MAiD for both chronic and terminal physical illness and disability, and official consideration or arguments for mental illness, children (‘mature minors’) and infants, we now see Kevorkian’s liberty-or-death mantra re-emerge as a new slip on the expansionist slope as an argument for MAiD for people whose sole condition is the experience of forms of deprived liberty. Wiebe and Mullin’s and allied proposals, hopefully unwittingly, thus serve the construction of an intellectual foundation for eliminating rather than emancipating the poor and oppressed by an empowered (medical) elite. MAiD, in this way, is ultimately a political, not a medical, project. We have seen versions of this before and we know how it ends.

Christopher Lyons, a Canadian academic in York, UK who writes about euthanasia and assisted suicide.