Comments on: Rachel
Aviv, The Death Treatment: Should the incurably depressed be euthanized?, June 22, 2015, The New Yorker:
In the United States great controversy has surrounded the
legalization of physician-assisted suicide.
The United States Supreme Court in Washington v. Glucksberg (1997)
refused to find a fundamental right to physician-assisted suicide, leaving the
choice of whether or not to permit the practice with States. Since then, four States have legalized
physician-assisted suicide, with Oregon being the earliest and hence the
prototype law. Even with legalization
in Oregon occurring more than fifteen years ago, the number of people who use
the law is modest (although rising).
The law permits a doctor to prescribe self-administered lethal
medications to a terminal patient who makes several such requests. If either the prescribing or consulting
physician believes the patient’s judgment is impacted by a psychiatric or
psychological disorder, a referral must be made for a psychological exam. Under
the law, no lethal medication can be prescribed if the patient is “suffering
from a psychiatric or psychological disorder or depression causing impaired
judgment.”
According to The New Yorker, Belgium has taken the concept
of a right to die much further than Oregon.
Under Belgium’s approach to physician-assisted suicide, patients do not
need to be suffering from a terminal illness.
Physicians often directly kill the patients, which would be forbidden in
Oregon where the patient must perform the final act of self-administering the
lethal medication. Further, mental
illness, rather than a reason to refuse lethal medication, becomes the
justification for causing death.
The New Yorker article is filled with startling glimpses of
what Belgium’s approach means in practice.
For example, a professor of psychiatry “approved the euthanasia of a
twenty-five-year-old woman with borderline personality disorder who did not
‘suffer from depression in the psychiatric sense of the word….It was more
existential; it was impossible for her to have a goal in this life.” Her parents had begged the doctor, “’Please,
help our daughter to die.’” (pg. 62) In another case parents expressed concern with
the euthanasia of their bipolar daughter whose “pessimism” they believe would
have passed in a few months. (pg. 64)
Another prominent physician defended applying euthanasia to
patients who are “’tired of life,’” often due to a combination of “small
ailments” and because of being alone without family to care for them. (pg. 60).
The New Yorker explains that the Belgian approach to
euthanasia is viewed as “an accomplishment of secular humanism, one of seven
belief systems …officially recognized by the government.” The government pays for “humanist counselors”
as the “secular equivalent of “clergy, to provide moral guidance in hospitals,
prisons, and the armed forces.” Children
in state schools are also taught humanist values in ethics courses from first
to twelfth grade, with the topic of euthanasia introduced as early as second or
third grade. (“Religious students” can
instead pursue “theological studies.”)
A prominent physician advocate and practitioner of euthanasia gave lectures
in which, “[o]ver pastries and coffee,”
he “would discuss euthanasia with
teenagers,” with the lecture advertised on the web site of a youth
organization.
Yet, a prominent psychiatrist advocating euthanasia also
“believes that the country’s approach to suicide reflects a crisis of nihilism
created by the rapid secularization of Flemish culture….Euthanasia became a
humanist solution to a humanist dilemma.
‘What is life worth when there is no God?...What is life worth when I am
not successful?”
Of course there are a myriad of secular responses one could
make to Belgian’s “secular humanist” approach to euthanasia. It seems irrational to allow psychiatric
illness to be grounds for rational suicide.
Indoctrinating children and teens into a positive view of suicide seems
counter-productive when so many---perhaps most?---adolescents at some point
pass through an intense crisis or desire to die. Killing patients because they are alone and
feel hopeless seems more like an abandonment (or even a homicide) than it does
compassionate treatment.
Yet, the Belgian example does bring home the implications of
a fully “secular” humanist worldview, for in the end the Belgian approach seems
not so much rational but ideological, a reflection of a rigid denial of any
value or existence beyond our momentary experiences, and an attempt to find dignity
in being able to control the terms of one’s exit from existence. At one
point Rachel Aviv, the author, confesses to Vermeersch, “recently voted the
most influential intellectual in Flanders,” that she is afraid of death because
she is afraid of “not existing.”
Vermeersch replies: “Millions and
billions of years you did not exist---what was the problem?” When Aviv objects that she has now formed
relationships, he responds “brightly” that our relationships are “finished”
after death, returning us to “the state you were before conception.” For
Vermeersch, it seems, it is our capacity to exercise choice and control that
make both existence and non-existence palatable.
It has often been said that believing this life is all we
have would make us value it more. Under
the Belgian approach, it seems, it is not so much our lives that we value, but
our control over our lives, and our success at getting what we want from moment
to moment. If we cannot have life the way we want it, we
do not value it. Of course for the believer in God and an
afterlife, this life also is not an ultimate value, but a beautiful, yet often
painful, gift that points to the giver as the ultimate source and destination
of our existence.
The Belgian experience also points us to the difficulty of a
society being truly religiously neutral.
As Belgium increasingly develops the implications of its dominant
humanist ideology, the results are a seemingly cradle to grave indoctrination
in the beauty of killing the sick, hurting, alone, mentally ill and
vulnerable. This is no more religiously
neutral than holding onto the traditional prohibitions of killing which were founded upon a belief that human beings lacked the authority
to take innocent human lives---even their own.
From a legal point of view all arguments are “secular” or can be shaped
into secular legal language; from a cultural point of view, there is a
religious root and direction in policy and the law. What direction, pray tell us, should we go
in?
David Smolin
