West London Humanists and Secularists

Voluntary Euthanasia, Assisted Dying and the Idea of Dignity - 25/05/2011

Our speaker, Dr Piers Benn, is a writer and philosopher whose most recent academic post has been working in the interdisciplinary field of Medical Ethics at Imperial College. He made it clear he has no strong bias for or against voluntary euthanasia (ve), but rather wished to promote understanding of the difficult arguments. He did so through a lucid exposition of the legal distinctions, the ethical objections to ve, and the ambiguity of the concept of dignity.

In current English Law, he explained, a distinction is made between suicide in itself ( lawful since 1961), giving assistance to another's suicide (a crime but with no set tariff), and euthanasia, where the fatal act is carried out by someone other than the person who dies (murder in law, carrying a life sentence, however proper and strong is the request by the latter person). Dr Benn highlighted the paradox in the first distinction: that assistance to an act that is in itself lawful is a crime; but emphasised that the enforcers of this law are not making a moral judgement - though presumably the enactors were guided by moral constraints.

A further distinction is that between deliberately taking life and acting for a person's relief of suffering in a way that risks accelerating death. Dr Benn suggested that this distinction is of more ethical than legal significance because of the difficulty of proof. Where the only way to sustain life can be construed as harmful to the patient, "letting die" is accepted to be a question of medical discretion - and indeed to deliberately sustain life against the patient's known wishes in this situation is legally regarded as assault. The Hillsborough victim Tony Bland was cited as a well-known case where the "letting die" rule applied.

Our speaker identified two main objections advanced by the opponents of legalising ve: the "sanctity of life" argument, and the "empirical slippery slope" argument. He admitted that the first argument is usually cast in overtly religious terms, so would carry little weight with the audience that evening. However, he clarified the religious stance somewhat by pointing out that exceptions are usually admitted to this principle, for example the Roman Catholic church excepts self-defence, "just war" and (more controversially) capital punishment.

Your rapporteur remarks - certainly it is doubtful that any one present could see why anybody's religious beliefs should constrain dealings between other people not sharing those beliefs. However, religious beliefs often originate as hyped-up metaphors for secular beliefs, so we should maybe reflect whether there are sound secular or humanist arguments corresponding to the sanctity of life argument. To speak of the preciousness of life, for example, might enlarge the common ground.

Dr Benn devoted most attention to the "empirical slippery slope" argument. This is not to be confused with the "logical slippery slope" type of argument: that is, if A is (morally) wrong and B logically implies A then B must be wrong. Rather the empirical slippery slope is an argument that an action should be avoided, even if not necessarily wrong in itself, if it is likely to lead in practice to an action that would be wrong. In this case, legalising euthanasia in response to a properly received invitation is said to risk its performance in response to an invitation obtained improperly, e.g. under duress or without due clarity.

Our speaker pointed out that the use of such an argument implied that there was some motivation to depart "down the slope" from the status quo, and added that there are certainly cases where a slippery slope genuinely exists - such as the first drink of the evening taken by an alcoholic. The philosophical validity of such an argument can therefore not be judged except on the merits of a particular case. He suggested a response to it should consider two factors: firstly, the relative importance of the wrong that is occasioned by not moving down the slope and the wrong that would be occasioned by moving all the way; and secondly, how slippery is the slope in question.

He then considered the question of dignity in death. Here he felt that the general issue of the desirability of respectful behaviour to a dying person should be distinguished from the use of "dignity" as essentially a euphemism for ve. While there is certainly an indignity in being at the mercy of one's body, ultimately dying with dignity comes from within the patient. All medical staff can do is respect it, or not. He concluded therefore that the euphemistic use of Dignity as a label for pro-ve campaigners is essentially a moral evasion. (One might remark that the adoption by pressure-groups or charities of titles which advertise their moral standpoint is a widely accepted practice nowadays - Shelter, Pro-Life etc. "Self-Determination", if more precise than "Dignity", would presumably not be thought snappy enough.) An alternative view that was raised is that a person's dignity can be destroyed by sufficiently serious ill-treatment - as often remarked in connection with torture, for example - so cannot only be attributed to the individual.

The questions covered a wide range of issues. There seemed to be a consensus in the audience that the (empirical) slippery slope argument was not a convincing objection to ve, though the reasons advanced for this were varied. Changes in actual medical practice were discussed - for example the use of potentially fatal doses of diamorphine was much rarer since the Shipman case - and we were brought up sharp against the reality of the questions posed by the reminder that discussion of actual methods of suicide would be illegal if anyone present was seriously contemplating it.

Roger Haines 27.05.2011