Inescapable Ethical Dilemmas

In terms of a potential to generate controversy and heated debates, euthenasia is probably right up there alongside abortion. Or is it? (This is after all a very Vatican-like way of categorizing these issues.)

In over 9 countries in the European Union, Prof. Maurice Adams from the Tilburg University of the Netehrlands and the University of Antwerp in Belgium notes that there has been a common trend in rising levels of acceptance of the practice for the past twenty years. Leading the pack with almost 100 percent levels of acceptance are Belgium, the Netherlands and Denmark.

While the United Kingdom and France demonstrated the same pattern of a rising trend, the changes were not as dramatic over the years. Italy and Spain showed a similar rising trend but in less significant levels. The most significant change in Italy noted though is that in the year 1984, the level of acceptance was virtually zero.

I find that discussing euthenasia or what is also called "assisted dying," "patient assisted suicide" (when it is done with the assistance of the medical professional), people tend to be more open about the practice or at least more accomodating in their views when confronted with the specific cases. (Of course there are exceptions to this phenomenon of empathy and the recently controversial case of Shriver in the US comes to mind).

It is a difficult decision and I think I'm not so comfortable with changing that too much. How is that changing? One big way I think is through legislation and legalization. When Prof. Adams speculated that the levels of acceptance probably rose in part because of the new laws in countries like Belgium and the Netherlands.

While I consider my own views on "assisted dying" divergent from the hardest held views against it (say the Roman Catholic position), I found it difficult to accept what Prof. Adams considered as the value of legislation. Legalizing euthenasia, a practice which people already acknowledge as happening out there, seemed to have a purpose of setting standards, thereby (according to Prof. Adams), providing a degree of protection. But who does law here really protect? I would venture to say it protects doctors by relieving them of any "guilt" they would otherwise feel or liability they could otherwise face if ever an accusation comes out regarding the illegality of the act.

While this is no means important, in situations where there is a "common sense" about opening ourselves up to the possibility of cases where euthenasia is the most humane intervention, why should it have to be law and not say professional ethical guidelines that address these issues doctors are confronted with? Law reform can at best not criminalize the practice as long as ethical guidelines are observed but why fix those guidelines in "legal" form?

It was ironic that Prof.Adams was responding to a question about "vulnerable" groups when he made this categorical statement about law. Prof. Flood also raised the argument of relational feminists who also ask whether becoming too liberal around our views about this issue also reflect a perverse trend of "autonomy." Does assisted dying in each case make it easy for the person who is ill or the persons saddled with the care of that person?

In recent years, the same countries where euthenasia has been legalized in cases of competent persons requesting the same, questions have also been raised about the right of children and other disabled or even psychiatric cases to assisted suicide. In his words: "legalization provides protection for the vulnerable by making the problem visible."

So much faith in "law" to provide protection is of course in part explained by Prof. Adam's own observation that in the Netherlands and Belgium, the political system is accessible and that these societies (including Denmark and Switzerland) have reached "post materialist" value systems. He described these post materialist societies as having more emphasis on participation and political processes than material matters (since all basic needs and more are available). He also noted that there is a big and well supported "movement" in the Netherlands advocating for "the righ to die."

I honestly found this theory a little bit unsettling because it is founded upon an assumption of heirarchy of values (who has the better more advanced values than the other) that is so totally based on economic materialist conceptions! It is one thing to claim that because all the needs of these Nordic states' citizens are taken cared of but altogether another to say that those who have less in life and who are saddled with governments who don't give them as much space, are less capable of forming progressive judgements. He didn't exactly spell it out but it was out there, hanging.

I don't know politics in the Netherlands, Belgium or Denmark but didn't the Neo-Nazis make a recent comeback (big time) in Swiss politics? I know it might not exactly be fair to bring this up here but to me these and other things seem to indicate that accessible or no, "politics" doesn't in anyway seem ideal when such types of bigotry prosper.

In another class it we discussed the purpose of "guidelines" in health and medicine, particularly abortions in cases of fatal fetal abnormality and I tend to agree with what Prof. Erdman said. Guidelines don't change behavior but really just provide a basis for doing something the practicioners are already doing. I understand this as somewhat different from how law can "justify" an act because after all it is "a guideline," not really something that sets out a fixed format or procedure. It aids the process of decision making without really removing the aspect of agency in deliberating the specific cases.

This is what upsets me (perennially) about legalization or law-focused strategies I suppose. Affixing a standard as "law" from which deviation is not always possible (if not precluded altogether) has a clear tendency to substitute judgment with pre-defined boxes and categories of thought.

While framing something in law sometimes serves a symbolic purpose of promoting ways of thinking and acting, I still think that most of the time however, the inherent danger of "law" lies in becoming a barrier to thinking. Its as if "legality" of something "saves" us from the trouble of ethical deliberation.

Hannah Arendt's reflection on "compulsory standards," is I think helpful in this respect:

"This categorizing and ordering, in which nothing is decided except whether we have gone about our task in demonstrably correct or incorrect way, has more to do with thinking as deductive reasoning than with thnking as an act of judgment. The loss of standards, which does indeed define the modern world in its facticity and cannot be reversed in any sort of return to the good old days or by some arbitrary promulgation of new standards and values, is therefore a catastophe only if one assumes that people are actually incapable of judging things per se that their faculty of judgement is inadequate for making original judgements, and that the most we can demand of it is the correct application of familiar rules derived from already established standards."