It’s been a couple of weeks since the parliamentary report on medically-assisted dying was released. Andrew Coyne has IMO written some pretty perceptive columns on the the topic; for example, he accurately foresaw the impossibility of limiting medically-assisted death to the (ostensibly) limited conditions set out in the SC’s Carter decision — and lo the parliamentary committee recommended very permissive / little regulation of medically-assisted death. We’ve now heard that the Catholic Archdioceses state that it will not offer medically-assisted death in its hospitals, the Royal College released a framework for its physicians in January in advance of the report…. etc.
I don’t normally write on normative topics (it’s not my strength to the extent that I have any strengths), but this whole debate has really reminded me of Isaiah Berlin’s famous essay on negative and positive liberty. I wrote to Coyne at one point suggesting that medically-assisted death must (despite the SC’s assurances) ultimately rest on a positive right (and I think brewing tensions with Catholic-governed hospitals and conscientiously-objecting doctors must eventually bring this dilemma to the SC’s doorsteps). Here’s what I wrote to Coyne after one of his topics on the subject (one that predicted that medically-assisted death would become normalized in the sense that it would be available to all and at public expense).
Dear Mr. Coyne,
I thought your column on assisted suicide was interesting & provocative, and it was the penultimate sentence that I thought most interesting & provocative: “No longer something to be discouraged, stigmatized as an act of individual aberrance, it will henceforth be a social act in which others are expected to assist.”
The last clause in this sentence (“in which others are expected to assist”) is especially noteworthy because it suggests that what we are wrestling with is – at the limit – the recognition of a positive right to assisted suicide, and not merely a negative right that those assisting in a suicide be free from state prosecution.
My own thinking on this matter is that the latter, the negative right to assist a suicide free from state prosecution, is logically insufficient to meet the demands of those who want death with dignity. If A, who is wholly incapacitated, requests assistance from B to end A’s life, and B refuses (perhaps because B has a strong moral objections to participating in any suicide), then A does not in any practical sense have a right to assisted suicide. Such a right can only be secured if the state compels B to assist A — and this implies that B’s liberty is sacrificed to A’s right.
Now it might be argued that A could always find another actor, C, to help end A’s life, but this clouds rather than pins down the precise nature and limit of A’s right, and it allows us to avoid contemplating how we ought to weigh A’s request against B’s moral autonomy, and what ought to be the state’s role in balancing A’s right and B’s liberty.
I have not seen much consideration of this aspect of the issue. instead the argument is cast in terms of the individual’s freedom – from the state’s interference, no less – to end their life as they see fit. The irony – if my analysis is correct – is that what is really being requested is, in fact, for the state to actively involve itself in helping people end their lives. And if we grant that B’s refusal to assist A has merit, then the state’s involvement in such affairs risks being quite illiberal.
Epilogue: Let me humbly suggest that this is a topic on which every one of us will, at one point, be hypocrites. It’s just a tough, tough issue.