On February 6th, 2015, the Supreme Court of Canada ruled that sections of the Canadian Criminal Code banning physician assisted suicide violated Section 7 of the Canadian Charter of Rights and Freedoms which asserts the rights to life, liberty, and security of the person. The Court reasoned that a) to deny a person with a terminal or chronic illness that is causing them unrelievable pain the right to physician assisted suicide is tantamount to forcing them to commit suicide on their own (and is thus a violation of their right to life), and b) a violation of the values of autonomy and dignity that underlie the right to security of the person.
The judgement reads: “Insofar as they prohibit physician‑assisted dying for competent adults who seek such assistance as a result of a grievous and irremediable medical condition that causes enduring and intolerable suffering, ss. 241(b) and 14 of the Criminal Code deprive these adults of their right to life, liberty and security of the person under s. 7 of the Charter. The right to life is engaged where the law or state action imposes death or an increased risk of death on a person, either directly or indirectly. Here, the prohibition deprives some individuals of life, as it has the effect of forcing some individuals to take their own lives prematurely, for fear that they would be incapable of doing so when they reached the point where suffering was intolerable. The rights to liberty and security of the person, which deal with concerns about autonomy and quality of life, are also engaged. An individual’s response to a grievous and irremediable medical condition is a matter critical to their dignity and autonomy. The prohibition denies people in this situation the right to make decisions concerning their bodily integrity and medical care and thus trenches on their liberty. And by leaving them to endure intolerable suffering, it impinges on their security of the person.”
While to some people the ruling is obviously correct in its underlying moral foundations and practical implications, the decision has, unsurprisingly, proven politically and ethically controversial. As so often in the age of instant reaction and commentary, the critical responses generally worry that “the sanctity of life” will be compromised if Canada allows rational adults to choose to end their lives rather than continue to exist only to writhe in pain. What is meant by life and its sanctity, however, is typically assumed rather than explained. The sanctity of life is indeed a bedrock moral principle, but, as the following theses hope to prove, is not in any way threatened by the principle (and carefully governed practice) of physician assisted suicide.
1) Life is the foundation of all value in the universe. If there were no living things conscious of their existence and their environment as a field of life-support, the universe would not matter, because there would be no creatures capable of valuing it as the origin and basis of their lives. Once there is life, there is striving to continue in existence, and therefore valuation: of life as such, of that which supports life, and of the universe as a whole as the ultimate source of that which sustains life. With the emergence of life, material nature is trasnformed into what McMurtry calls the “life-ground of value”: “the connection of life to life’s resources as a felt bond of being.” (Unequal Freedoms, p.23).
2) The objective value of life is thus proven in the first instance not by philosophical argument (or religious belief) but by the actions, interactions, and struggles of living things to survive and reproduce their lives, and to maintain and improve (to the extent that different species are capable) their conditions of life, in a present which opens onto an open-ended future.
3) The value of particular lives is not a fixed quantity but increases or diminishes in accordance with the quality of the activities through which it is expressed. Since human beings have a greater range of life-capacities than an amoeba, our lives are, correspondingly, more valuable. That is not to say that the amoeba is without life value, but that the life of an amoeba would not be tolerable for a human being. As the distinctive features of human life: social-self-conscious agency, community engagement and connection, a wide-circle of care and concern, the capacity to love and be loved in turn, the capacity for creative work that contributes to the satisfaction of other people’s life-requirements- degrade and disappear, that life loses life-value.
4) That which is often referred to by the vague phrase “quality of life” is the range, depth, and life-value (for self and others) of the expressed life-capacities of human beings. Quality of life may be determined by application of McMurtry’s Primary Axiom of Value to concrete cases. The axiom reads” “X is value if and only if, and to the extent that, x consists in or enables a more coherently inclusive range of thought/feeling/action than without it; where these three ultimate fields of value are defined as: thought = internal image and concept (T), feeling = the felt side of being (F)/ senses, desires, emotions, moods, action = animate movement (A). (Philosophy and World Problems, Volume 1: What is Good, What is Bad: The Value of all Values Across Time, Places, and Theories, p. 213) By stipulating that the growth of life-capacities must be “coherently inclusive,” the axiom rules out forms of life-capacity expression and enjoyment that unsustainably destroy the natural environment or depend upon the exploitation or oppression of other people. Any form of enjoyed expression of such capacities are not life-valuable, but rather exclusive and destructive forms of individual self-maximization rooted in a confusion between the desires of self that ignores its dependence on nature and interdependence with others in society.
5) Human individuals are not isolated atoms but socially self-conscious agents who must reflect continually upon their needs for resources and people outside of themselves as well as the future implications of their individual activity. Not everything that it is possible to do is good to do. When that which it is possible to do would damage life and life’s conditions, either our own or others’, the materially rational and life-valuable choice is to refrain from doing it. Just because metabolic activity can be sustained by mechanical means does not entail that the life that remains retains any value, much less sanctity.
6) Materially rational decisions require the adoption of a philosophical disposition towards life. The proper course of conduct is rarely obvious, but demands inquiry into the forces determining any choice-space and the range of alternatives available. This philosophical disposition must be cultivated early. Because the need to make hard choices can arise at any time, people must constantly reflect on the fundamental principles that make a good life possible, and prepare themselves to make the life-valuable decision in any situation.
7) All human choices are framed by our mortality. The most general fact about individual human life is that it will end in death. Of all the things a philosophical disposition towards life must comprehend, the inescapability of the death is the most important. “We must live each day as if it were our last,” goes the cliché, and like all clichés; it contains some truth. The truth it contains is that we must always strive to make the right decision and live according to the right principles, so that, when we die, we have made ourselves into the best person we could have been; that is, we have created a life that was valuable to ourselves and valued by others as having made real contributions to their development and enjoyment.
8) The best person is not necessarily the longest lived. There is no essential connection between a good life and a long one, although, other things being equal, a long life is better than a short one. Nevertheless, to believe that maintaining mere biological functioning is the same as living a meaningful and good life is a failure of philosophical reasoning. Once our capacities for sentient experience, animate motion, thinking and imagination, and mutually rewarding relationship have been destroyed by disease, meaningful life has ceased (even if assisted respiration has not).
9) It does not follow from this claim that the lives of those with disabilities are without value. Ability and disability are two ends of a continuum along which all real people lie. All living beings face limitations, but the power of human beings to invent forms of life-valuable expression is such that people with physical and developmental disabilities can–provided social resources are used to create accessible environments– find innumerable ways to express and enjoy the capacities they do have and thus to create lives as valuable as any other. Disability alone is thus not grounds for suicide– physician assisted or otherwise, because it is not the total negation of life-value. Only once bodily damage has passed the point where further human activity is impossible does suicide become a life-valuable option.
10) In this context, Socrates’ claim that philosophy is a preparation for death takes on a new meaning. (Phaedo, 64a-b) Once we have properly understood life-value, it becomes clear that with the on-set of a debilitating, excruciating, incurable illness, the choice to commit suicide, with or without the assistance of a physician, is a life-valuable choice, even though it ends one’s life somewhat sooner than otherwise. By understanding life-value as expressed and enjoyed activity, experience, and relationship that contributes to others’ capacities for the the same, we realize that we do not lose anything by committing suicide, but remove a source of real life-disvalue — irremediable suffering of oneself and one’s loved ones.
11) That dying often entails prolonged suffering (for the self and one’s circle of intimates and friends) and, in private (or poorly resourced public) health care systems, enormous expenses does not generate , as John Hartwig argues, a duty to die. There is a responsibility to reflect upon the limits of human life, the fact that everyone must die, and to prepare oneself (as far as one can be prepared), to make rationally informed decisions about end of life care. (Is There a Duty to Die? pp. 126-7). One legitimate decision can be to die sooner than if one simply let the disease ‘run its course.’ But this is a decision that the dying person must make (in dialogue with whomever she feels needs to be involved), and not one that can be imposed by a generalized duty to die so as to relieve others of suffering or spare families the expense of prolonged treatment. The later problem can be resolved by adequate public funding of health care, the former is a cross that some people and families may legitimately choose to bear.
12) By like reasoning, there is no duty to prolong one’s life past the point where one’s existence is nothing more than pain making life-valuable expression of human capacities impossible. There is nobility in suffering, as Nietzsche argued, but only in such suffering as one chooses to endure. (Beyond Good and Evil, p.171). To be forced to suffer prolonged agony by the law is tantamount to torture– knowingly and systematically inflicting needless pain on another human being. Everyone can bear the cross he or she chooses; no one should force another to carry one whose weight he or she rejects as too much.
13) By like reasoning, no one may relieve another of the burden of suffering if that person has chosen to bear it, or if they have not clearly expressed their preferences on the matter before hand. The disabled community— long treated as objects by scientific medicine and the broader community– has good historical grounds to worry that this decision could make their lives more vulnerable to doctors and even family members who decide for them that there lives are not worth living. The Robert Latimer case looms large in their concerns. Their worries can be obviated if the letter of the Supreme Court’s judgement guides the writing of the new law. The Court is clear that only competent adults may chose physician assisted suicide for themselves. Unless, therefore, there is a clear and unambiguous written or verbal choice to die, there can be no physician assisted suicide. By its very definition, “suicide” means “choice to take one’s own life.” If there is no choice, there is no suicide, but rather homicide, which is not, obviously, what the Court’s decision, allows.
14) Every attempt to translate principle to practice involves hard cases which opponents will try to exploit as reasons that invalidate the principle. Sufficiently clever people with enough time on their hands can always think up slippery slope arguments. For example: what about the case of a person who is in a near vegetative state but who can still communicate with hand gestures. His care giver asks: “Do you want to die by physician assisted suicide?” He gives the gesture he had been giving for ‘yes.’ The court accepts the gesture as a sufficient expression of consent. But now we have a form of consent that is neither verbal nor written. This opens the door (here is the slippery slope) to people claiming, like Robert Latimer claimed about his daughter, to “know” what the person would want even in the absence of any capacity on their part to express their preferences. And thus we have other people choosing death for those who cannot speak for themselves. Hard cases like this one are important means of testing the implications of principles, but the slippery slope arguments derived from them are fallacious. The fact that a worst case scenario can be imagined does not prove that it will arise. Hard cases should not undermine principles that are otherwise life-valuable, but make us attentive to the possibility for mis-interpretation and abuse.
15) The argument that physician assisted suicide violates the sanctity of life because it interferes with death as natural process is absurd. Every living organism is threatened by death every moment. If life-value requires accepting death as a natural process, then it follows that no organism should ever do anything to prevent its own death– any interference with it being, on their argument, unnatural. As Hume pointed out more than two centuries ago, if suicide is morally objectionable because it is an “unnatural” shortening of life, then so too is medicine morally objectionable as an “unnatural” prolongation of life. ( “Of Suicide,” in Dialogues Concerning Natural Religion, p.100-101). It is beyond comprehension how people who proclaim the sanctity of natural death (by which they sometimes mean death when “god chooses”) can reconcile their absolute subservience to mechanical means of prolonging biological functioning (and/or chemical means of reducing pain) with their conception of “natural.”
16) The death of individuals is not bad in and of itself and therefore need not be fought against as one fights against an unjust enemy. All things which are– and not only living things– come to be and pass away in time. Not even the universe is immortal. All individuals have valuable capacities to share with others, capacities which, when realized in coherently inclusive ways, make life good. But the future belongs to those who are not yet, and all people must at some point stand aside so that new perspectives on the universe- new beings–can come into existence and feel and see and think and act and connect and create in ways that would never come to pass if those new individuals were not born. The deep reflection required to ask for help dying once one’s potential for life-valuable activity has been exhausted affirms the value of life as enjoyment and contribution. The sanctity of life is not a biological fact but a value which we honour by living well, striving to ensure there is a future for new life, while accepting the limitations of our own.