The tortuous attempted passage of assisted suicide from "choice" to medicine.

By Gordon Friesen
President, Euthanasia Prevention Coalition

Gordon Friesen

Considering the enormous harms of treating assisted death literally as medical care; and further considering the apparent democratic support of assisted death conceived as a personal choice: it is important to insist on the logical illegitimacy of binding these two together in the hybrid MAID construct.

Indeed, it is entirely mistaken to suggest that the respect of personal choice might justify a medical paradigm of assisted death.

This is because (as I believe we will all agree) the choice to end one's life is intensely personal and subjective. There is no objective way to account for why one person will wish to end their life, while another, in apparently identical circumstances, will obstinately seek to survive.

By way of contrast, however, the medical justification of assisted death absolutely requires an objective foundation.

There is, therefore no coherent logical bridge between the two.

Let us consider, for example, the completely natural attempt to justify some limited class of assisted deaths by distinguishing between ordinary (pathological) suicide, and a second suggested form resulting from legitimate rational thought.[1] [2]

There are, certainly, a number of weaknesses with this theory.[3] [4] In particular, there persists the stubborn fact that we can never really know whether an eligible person is actually requesting death for the reasons alleged, or for entirely different ones.

(Some persons in Canada, for example, have apparently used their medical eligibility, for MAID, in order to escape poverty.)

Similarly, any apparently acceptable requests might still, nonetheless, mask choices which are not rational at all (but are the fruit of mental disturbance).

And yet, the crucially important significance of "rational suicide", in the present context, lies not in these, but in our reaction to people choosing differently in the same situations.

For it is difficult to maintain that one person is behaving in an objectively rational manner (in choosing assisted death) without also concluding that another person, making the opposite choice (of continued survival under similar circumstances) would be acting "irrationally".

Under a paradigm of sovereign personal choice, such problems simply disappear in the shrouds of subjective mystery. But in the medical world --where clearly indicated actions are unambiguously deemed rational to pursue, and irrational to avoid-- these same difficulties are intractable.

In the end, the common enabling mechanism of MAID --as both choice and medicine-- lies merely in the canonical application of politically established eligibility criteria.

As a matter of choice: any eligible patient's desire must be honored.

As a matter of medicine, however: doctors are expected to consider the proposition and prescription of euthanasia as an objectively beneficial treatment for all eligible patients, including that vast majority who do not embrace the rationality of their own deaths, and who would never spontaneously make such a request.

Clearly, the second of these propositions cannot reasonably be derived from the first.

And so also, assisted death as essential, guaranteed medical care, cannot coherently be derived from assisted death, as a subjectively justified liberty of choice.

In short, medicine cannot possibly moderate the ills of choice. Nor can choice justify what is done in the name of medicine.

Through the evil alchemy of Medical Aid in Dying, the faults of each are simply added (and even multiplied) one with the other.

[1] Giwa, Al, A complete treatise on rational suicide, Icahn School of Medicine at Mount Sinai https://www.elsevier.es/en-revista-bioethics-update-232-articulo-a-complete-treatise-on-rational-S2395938X1930021X

[2] Friesen, Pheobe, Medically Assisted Dying and Suicide: How Are They Different, and How Are They Similar?, The Hastings Center Report, 18 February 2020 https://doi.org/10.1002/hast.1083

[3] Stephen Ginn, Annabel Price, Lauren Rayner, Gareth S. Owen, Richard D. Hayes, Matthew Hotopf, William Lee, Senior doctors' opinions of rational suicide, Journal of Medical Ethics, September 2011, 37(12):723-6 https://www.researchgate.net/publication/51678637_Senior_doctors'_opinions_of_rational_suicide

[4] Cynthia M.A. Geppert, Rational Suicide? Case Consultation and Quiz Commentary, July 27, 2015, Psychiatric Times, Vol 32 No 7, https://www.psychiatrictimes.com/view/rational-suicide-case-consultation-and-quiz-commentary