Assisted dying and coercion

[ArabellaScott]

This is live right now, so I'm not sure how well linking to it will work. Copy-pasting below, aswell.

https://www.bbc.co.uk/news/live/cy5k0qyled2t

'Rachel Clarke, a palliative care doctor, opts to answer a question about coercion and whether some MPs are right to feel concerned about this when considering the bill. (Earlier, MPs heard how medical and clinic staff are trained in safeguarding, though a retired GP acknowledged coercion was hard to spot.)
Clarke says she'd "strongly push back" on the suggestion coercion is something all medical staff are trained in spotting.
"I'm the kind of doctor who believes there is nothing to be gained by sugar-coating reality...about shortcomings, failings, areas where my profession the rest of the NHS are getting things wrong", she tells MPs.
"It is my clinical experience that not only are the majority of doctors not necessarily trained in spotting coercion explicitly, they're often not trained explicitly in having so-called advanced care planning conversations with patients around the topic of death and dying."'

Great post @Grammarnut

You are right, your reasons are selfish. You only hope there will be safeguards for the vulnerable but so far this Bill has shrugged off such safeguards. And you are also right that you might die at a moment not of your choosing - because life is like that. But life is sacred and we should not give doctors, or families the right to end people's lives. This Bill raises the possibility of copping out of the long-term care and suggests that such a life - in a wheelchair, coping with drug addiction, being depressed etc - is worthless. Canada's MAID should give us all pause because assisted dying has been offered to homeless people rather than solve their other issues, and Canada had all the original safeguards that this Bill says it will have. It is not civilised for a country to say that some people are better off dead as a matter of state policy. It's barbaric.

Eugenics by another name.

No, of course it's not civilised for a country to say some people are better off dead as a matter of state policy. Yes, of course that would be barbaric.

But that's not what this is about. Not at all.

When a person I dearly loved, having lost the power of speech, suffering acute physical and psychological pain (and other things I won't detail), wrote slowly but distinctly (couldn't speak any more ...) to ask me (beg me) to help with suicide and I was unable legally to do so, that was barbaric.

And further ... It would be civilised for me to say, of myself, that I would be better off dead in certain circumstances ... it would be civilised because it would allow me the autonomy to choose for myself. Would it not?

I can't choose for you what you want to do with your life and death. What on earth do you think gives you the right to choose for me? That presumption on your part - that your feelings trump mine, that my beliefs and wishes don't count - that's barbaric (and, yes, supremely selfish). Really.

But you are deciding what I should do - you are saying not letting people commit suicide is barbaric. I am saying that every life is valuable and worth saving and that we should not put in place legislation which suggests lives that appear on the outside as pointless (the old woman with no friends but her cat (and it dies); the rent boy with HIV and depression; the disabled man with Parkinsons etc.) can have the problem of their existence solved by offering assisted suicide (let's call it that).
And this bill is saying to some people 'the state thinks you are a burden and it would be better if you were dead'. Why do you think that disabled charities have protested and put up amendments and pointed out the dangers here for disabled people? Why do you think that women's groups have also protested pointing out that older/ill women are often the victims of 'mercy killing' mainly by intimate partners? Those groups are not being selfish but worried for vulnerable people because the state is opening the gates to telling such people 'go away and die'. That's why they have intervened - and mostly been shrugged off. Examples from abroad - and Canada's MAID system comes to mind - now routinely offer the disabled and the miserable assisted death.
Yes, there are hard cases - but hard cases make very bad laws. And why did your friend want to die? Because they felt themselves a burden? Because their life was a burden in that no-one alleviated either their pain or their despair?
It's good palliative care and good care for the disabled that we need, not a get-out clause that just happens to be more economical. It's eugenics by another name, as another poster has pointed out.

Adding to my post, I meant to cite @RedToothBrush re eugenics.

Eugenics was regarded as progressive at the time.

In the wake of WWI we encoded liberal views which made all people have equal value in law and safety guards to ensure this. These are human rights.

The entire debate we have now, which isn't taking these concerns about safeguarding seriously is the unpicking of the core principles of human rights and it's the most vulnerable who were most at risk.

Attitudes about less value in life and being put out of misery are ones that wouldn't be out of place in many conversations about eugenics and that's why it's so concerning.

Emotive examples deliberately seek to ignore this and appeal to our fears rather than allow us to recognise other examples which put the most vulnerable at risk.

Across the board I am seeing attempts to undermine human rights. A right to die is not a human right. It is the anthesis of human rights. We have a right to equality and to dignity and protection from death. That we don't seem to be able to centre this point at the heart of any debate about assisted dying is the truly concerning bit.

@RedToothBrush I entirely agree with you. Eugenics was thought a good idea because some people were seen as less worthy than others. It only hit the buffers because of WWII and the Holocaust. I count among the losses for human rights attempts to have abortion legal up to term for any reason (obviously there are medical reasons why a baby is 'aborted' so late in a pregnancy, but it's not these sad viccisitudes that legislation seeks to make possible) - this strikes me as commodifying both women (seen as womb havers) and children (who are either a commercial product or an expensive nuisance or a resource).
Human rights are under threat and we are fed emotive reasons for removing safeguards of the most vulnerable, who include children, women, the disabled of both sexes, the old, the mentally ill - those with little or no agency and little or no voice. That disabled charities and women's organisations oppose Leadbeater's bill highlights how very dangerous it is - and no-one will listen. I await real eugenics hitting us, meanwhile the Assisted Dying Bill and the attempts to legalise abortion for any reason up to term are good stand-ins.
Sadly, the people with horror stories about their friends, or thinking they might want to die if totally incapacitated play straight into the hands of those who would like to make dying a human 'right'. They are naive, at best.

I actually think that one of the next political movements ahead is a greater eugenics movement due to generational rifts and an aging population and the reality that a shrinking work force is going to struggle to provide for elderly relatives AND be able to feed and house themselves.

We can already see the foundations of this and it will be interesting to see if this actually happens.

Politically speaking theres a very real split in political views and age groups - with middle aged women holding a particularly significant role in this in terms of how they a) take on caring responsibilities b) take on these financial burdens most c) conditioned to be sensitive to appeals to emotive arguments d) are a key group of swing voters.

Farage is keen to take us out of the ECHR. So theres a political target point right there which begs many questions. But I don't see the only threat to our membership of the ECHR coming from the right. Theres also undertones coming from parts of the left too.

I agree, but I think demographics will kick in before the young decide the old must die at 60 or 70 - as it has before e.g. in the 40s, but it took a world war to do it, unfortunately. Nature has a way of thwarting us in surprising ways.
The ECHR is in the sights of the authoritarian left as well as the right. I worry more about the attack from the left because it will be projected as 'progressive' and 'the right side of history' etc, whereas the right is seen by many as red in tooth and claw and thus to be wary of.
Part of the genesis of such attacks is the commodification of everything - including women's wombs and water without which none of us can live.
I worry for my DC, GDC and GGDC.

Disagreeing with a law proposal is disagreeing with a law proposal, something we all have the right to do. That poster isn’t responsible for you and your life. Many people have reservations about this law, and are concerned by the cavalier attitude of many of its supporters towards safeguarding the truly vulnerable in our society, and emotional blackmail of the nature we regularly get from trans rights activists isn’t going to sway them. I’m sorry for your troubles, but with all due respect it’s not actually all about you, other people count too.

concerned by the cavalier attitude of many of its supporters towards safeguarding the truly vulnerable

Yes: I wrote up the recent history of the British AD movement to help understand how this can very quickly go wrong. Major campaigners spent the 1980s offering a criminal death service to the public (mostly vulnerable women), publishing a how to manual where all safeguards failed and it was quickly used by people not in the 'vision' for assisted death, and trying to free the violent men who killed their dependent wives. It's a grim toll and of course completely forgotten about.

https://otherhalforg.substack.com/p/the-killers

"But you are deciding what I should do ..." Hmm.

I think your intention here is a good one: "what's sauce for the goose ...", "Universalise maxims ...", "do unto others as ..." are individually useful tenets in moral argument. (They express something essential to right-and-wrong.) But something doesn't quite sit right, does it? Are you really being even-handed? Let's see.

It's sometimes useful to look at argument structure if we want to see the ethical wood as well as the moral trees. I suggest we try here.

Suppose A says, "My autonomy entails you shouldn't stop me doing X to myself"; suppose B rejoins, "My autonomy entails I should be able to stop you doing X to yourself." (A: me; B: you.)

OK, now try to universalise. A is OK; no obvious structural difficulties there: "for every P and Q, P's autonomy entails Q shouldn't stop P doing X to P".

Try B: "for every P and Q, P's autonomy entails P should be able to stop Q doing X to Q". This is problematic, since stopping someone doing something denies that person's autonomy, doesn't it? (That's what autonomy is, you might say.) So B is making two contradictory claims: that everybody should have his or her autonomy respected, and that everybody can have their autonomy denied.

B's rejoinder can't stand as a moral principle - it could not be true, because when universalised it both asserts and denies a person's right to have her/his autonomy respected. Do you see, @Grammarnut?

In short, you are mistaken.

As for society or the state arrogating to itself decisions of life and death (and this includes eugenics), this is a straw man here. No-one is saying (certainly I am not saying) the state should decide whose life is valuable or worthless.

We all agree there need to be safeguards. Of course we do. (Which makes many of the arguments put here and elsewhere on this matter simply insulting.) But this should not - does not, cannot - override my autonomy, and hence my choice, as a basic moral principle deciding matters of my own life and my own death.

That argument takes you to Margaret Thatcher and her "there is no such thing as society" position and is indeed where we are heading. The astonishing thing is that it is being led by the left this time.

Fact is, we dont exist in our own personal island. We don't just let people do what they like in lots of areas of life. We cant even choose not to wear a seat belt in the UK because of the wider implications beyond our own personal safety.

The debate is therefore where we draw the lines. Even in a supposedly "free" society like America they intrude on people's abilities to do whatever they want.

But herr the push is away from collectivity and towards personal choice. Trans rights are one area. Surrogacy. Abortion. Benefits for the disabled. And now assisted dying. Society cant believe bothered, doesn't want to help, so find your own personal solution which involves you doing what you want and never mind anyone else.

People who disagree are fighting back - but it is the conservatives, who traditionally were pro personal freedom who are now anti this free choice agenda and the left who are pushing it. Interesting times.

But you seem to be saying that I don't count at all. Surely you don't mean that?

Would you agree, at least, that I have a prima facie right to help if I want to kill myself? (That is, all other things equal, supposing safeguards to do with coercion and so on are in place, assisted suicide would be acceptable?)

It seems to me unarguable that I have this right, just on account of the morality of human autonomy. Do you disagree? Why, if so?

"That argument takes you to Margaret Thatcher and her "there is no such thing as society" position" No it doesn't. Not at all.

I want to live in a society in which I can be helped to die peacefully and painlessly if I so choose. I want that for all my family, my friends, my fellow citizens, for all humankind.

I am not an atom; I am not an island entire of itself. And the nature of your death may diminish me as much as its fact.

On the basis of this and my presence in society, I agitate against surrogacy, against restriction of abortion, in favour of increased benefits for the disabled, in favour of assisted suicide ... Within society, enabled by society, considered societally ...

(Trans nonsense is a red herring: important in its own way (that it be seen for the nonsense it is) but irrelevant to this particular issue.)

You do count. So do other people who are more vulnerable than you because they don’t have the agency you do. State assistance to end your own life isn’t a human right. The right to life is a human right.

I don't disagree with any of this.

But do you agree I have a prima facie right to end my life the way I see fit, with state assistance if required? And if not, why not?

No, I don’t agree that there is a prima facie right to assistance in killing oneself. I think the harms of this bill outweigh the benefits. There’s no point trying to coerce me to take a view I don’t agree with.

It’s my right to have a view on something I consider harmful to society, and I will do. It’s not personal. It’s nothing to do with you what I think about it.

Do you agree I have a prima facie right to kill myself unassisted, at least? Or do you think we should return to criminalising attemped suicide?

And if I have a right (prima facie) to kill myself, why no assistance allowed, (prima facie again, still)?

[Incidentally, have you never changed any of your views? Seems strange, if so.]

What is the point of this line of argument, exactly?

I’m not going to change my view based on either your attempted gotcha twisting my words to serve your own argument or emotional blackmail, so I’ll save you the effort there.

The point of prima facie agreement is that once it's attained, we can focus on where disagreement really lies.

For example, when you said, as you did earlier, "the harms outweigh the benefits', we could agree or disagree about that (and what to do about it, if the latter), while still agreeing that, prima facie, assisted suicide was overall acceptable or even desirable in certain cases.

If you think assisted suicide is not acceptable, even prima facie, there is a very different argument to be had. Some people - certain religious believers, for instance - think suicide itself ought not to be allowed, even prima facie.

[Often prima facie agreement goes with what are known as ceteris paribus ("all rest/others equal") considerations.

Would you agree with the claim that assisted suicide might be acceptable, ceteris paribus?]

Because the state involvement raises questions about individuals who are vulnerable to pressure from the state.

Human Rights laws are all about protecting vulnerable individuals from abused of power and authority. So government, large corporations or any other organisation which has considerable influence.

Thus your base working point is always the most vulnerable in society not more privileged individuals who have the ability to advocate for themselves on whatever matter it happens to be.

Given the nature of this particular subject being literally life or death, the state much always air on the side of protecting the most vulnerable from death. If only because more able in society are better placed to advocate for better palliative care and pain relief. We can't do it the other way round because it risks governmental obligations under human rights.

It's not about any party being more important than another. It's about working from the point of greatest vulnerability. The death of someone is irreversible so that has to be taken into account.

This is why the state effectively becoming involved in the sanctioning of death is so contentious (and part of the reason executions are not permitted by signatories. of the ECHR).