In Support of a Fundamental Right to Die: an argument from personal liberty

The right to die movement is well under way in a number of developed nations across the world, with several countries having established assisted suicide laws, and yet more countries in which this is a subject of intense public debate.

However, I would argue that the approach that has been taken thus far to securing this right has been too cautious, and too readily accepts the fundamental premises upon which opposition to the right to die rests.

The scope of the right to die laws that have been introduced in most countries that have so far established the right to assisted suicide are very narrowly focused on a small group of people in extreme circumstances. This group of eligible candidates is typically restricted to those languishing in the final stages of a terminal illness; often specified as a prognosis, verified by 2 or more doctors, of 6 months or less to live. Even in Canada, where the Carter commission recommended that assisted suicide be made available to people with non-terminal conditions and to include sufferers of so-called mental illness, Justin Trudeau and his pusillanimous Liberal Party failed to live up to its own sobriquet, and instead instituted a very narrowly focused MAID program available only to those whose natural death was deemed by doctors to be “reasonably foreseeable”; thus callously abandoning Canadians suffering from severe psychological torment and cravenly capitulating to the protests from religious and disability rights lobbying groups. Fortunately, Trudeau’s government has now reversed track on this somewhat, and now intends to make this service available to the mentally ill within 2 years. This progressive advance however, is under threat should the Conservative Party get back into power in Canada, as they propose to block any extension of MAID to the mentally ill.

Should this be successful, it will be a substantial step in the right direction for the many people who have an interest in this subject in Canada, and one further blow to be struck against the religious primitivism of suicide opposition. Unfortunately, here in the UK whence I am writing this article, we still await even the most modest of breakthroughs, as our parliament continues to cower and pander to the querulous disquiet of assorted ‘disability rights’ lobbying organisations and faith groups. However, I would like to take a different tack in this article, and argue for the right to suicide not as a privilege to be granted by the government, but rather as a negative right, from which we should be unfettered from undue government interference.

At the present time, the majority of discourse around the subject of assisted suicide concerns the terminally ill, as mentioned earlier. The argument for granting these people the right to die is fairly clear cut. Whereas with those who are not close to death there are arguments brought up concerning the individual’s potential for future happiness and the prospect that they could be basing their decision on a distorted mental state; in the case of those with a terminal illness, there is very little life left to foreclose upon and what little life they do have left is virtually guaranteed to be of deteriorating quality. In upholding the right to die for these people, we can show mercy to those at the end of life’s journey, but do so without invalidating society’s fundamental belief in the intrinsic value of life.

What the right to die movement has failed to do, so far, is to champion the view that the value of an individual’s life is something that should be defined only by the individual. That only the individual should be entitled to decide what, for them, constitutes an acceptable quality of life, or acceptable risk of coming to serious harm in the future. The right to die movement as it currently exists, is still predicated on the assumption that a standard life contains a certain amount of intrinsic goodness which can be affirmed and codified into law independently of the agreement of the owner of that life. It is also predicated on the belief that death itself (as opposed to the dying process) can be bad for a person because it deprives them of certain goods that may have obtained should they have stayed alive. In a future post, I will produce a detailed rebuttal of the so-called ‘deprivation account’.

If an individual is to be truly at liberty, and to be the owner of their own body, then they should be at liberty to determine what cost they are willing to pay for their own existence. Nobody else will have to endure this individual’s suffering; therefore nobody else is qualified to be an arbiter of what constitutes an acceptable ‘exchange rate’ between the amount of suffering to be paid, and the amount of life’s goods to be reaped in return. Nobody can objectively say that even so much as a hangnail would be a price worth paying in order to continue living, if the owner of the life deems otherwise. Of course, for as long as one remains alive, one has to contend with the risks of an inconceivably broad array of potential harms arising in the future, and one is never safe from these until death. The capricious nature of fate makes it such that a “good life” is something that can only really be judged in retrospect once an individual is dead, or at least on their death bed, as one can otherwise never rule out a period of prolonged suffering that would leave the person wishing that they had never been born.

To force an individual to continue experiencing the harms of conscious existence is to enslave this individual, and therefore the right to opt out of sentient existence must be considered to be the bedrock of personal autonomy. One cannot meaningfully own one’s own life, if one remains alive by compulsion, rather than by choice. For those who would rather opt out, if given the choice, there is no meaningful autonomy; as every choice that they do make is in an effort to try and make the best of a bad situation. To mitigate, as to the best of their ability, the liabilities inherent in sentient existence. They may still have choices in respect to what job they will work, where they will live, what they will do in their spare time, what they’ll spend their income on, and so on. However, they are compelled to make these choices in order to satisfy the needs and desires which society compels them to continue to have. This person is stuck in perpetual damage limitation mode. They are not living as a free individual. A free individual can choose to shuffle off their mortal coil whenever they perceive the putative ‘benefits’ of life as no longer commensurate to the price that they need to pay in order to receive them.

Libertarians are often keen on pointing out that one can never have a right which entails an obligation on the part of someone else to provide a service. But why is so little objection raised to the act of forcing someone to continue to need the services that only someone else can provide, when that person could terminate their involvement with the system altogether without demanding anything from anybody that this other party was not willing to provide.

I explored this issue on 2 different libertarian subreddits, to mixed results. Regrettably, the idea of granting individuals the fundamental liberty to decide whether or not they wish to experience life as a sentient organism was greeted with a reception of less than unanimous acceptance, with most responses citing concerns around mental illness clouding the individual’s capacity to provide meaningful consent. I’ll address why this is a philosophically and ethically problematic stance in more detail in a separate page. However, I have provided a link to both of the threads below, in which I address these concerns multiple times:

Can a true libertarian be against the legal right to suicide? from Libertarian

At the very minimum, the government should not be unduly interfering in the rights of citizens to end their lives, as to do so is a breach of the individual’s negative right to freedom from violence (as involuntary suicide prevention and detainment is an act of violence), and the right not to have their personal choices and liberties interfered with on the basis of an unproven religious/spiritual belief (namely society’s foundational shared narrative that all human life is endowed with intrinsic value, meaning and dignity). By restricting access to suicide methods, the government is also unjustly blocking the individual’s right to access goods and services willingly provided on the basis of an unproven and unprovable presumption that the consumer’s philosophical beliefs are inauthentic and are the result of impaired reasoning brought on by a “mental disorder” whose creation itself was never justified on the basis of any empirical evidence whatsoever, but rather by comparing an individual’s internal conscious experience to a normative standard which itself is not demonstrated to always be calibrated (by the intelligent design of God, or by the omniscient and omnibenevolent process of natural selection?) to optimal capacity for rational, informed decision making.

As you may see from the threads, the basic thrust of the argument that I received from self-identified libertarians opposed to the right to die can be paraphrased thusly: ‘We support autonomy, but only for people who have demonstrated the capacity for rational decision making. But if you don’t enjoy life, then by definition, you lack the capacity for rational decision making, and it would violate your right to life if we allowed you to act on this distorted and delusional perception that there’s something fundamentally wrong with life’.

So upon what basis can one assume that a rational mind will enjoy life, and always seek more life? If one is a believer that the universe, and life itself, was designed by an omnipotent, omniscient and omnibenevolent deity, then the answer is simple. God is the objective arbiter of goodness, and God imbued us with the instinct to live. Therefore, anyone who doesn’t desire to continue living is obviously defective in their ability to evaluate goodness, and thus we must intervene on their behalf in order to protect them from their own judgement.

It certainly worked well in the case of homosexuality, which was in the DSM up until the 1970s due to the fact that homosexuals practiced intercourse in such a way that deviated from the presumed teleological function of intercourse, which elicited feelings of disgust from the general public (undoubtedly including a great many psychiatrists), and this probably in no small part contributed to its eventual inclusion in the DSM. Much as is the case with depression today (along with the large majority of mental illnesses), there was nothing in the way of empirical evidence that would have warranted its categorisation as a mental disorder. But this is how psychiatry has always operated, as it has always sought to pathologise behaviour that is objectionable to social norms. For example, Drapetomania, which psychiatry medicalised as a “disorder of slaves who have a tendency to run away from their owners due to an inborn propensity for wanderlust”. When it was eventually removed from the DSM in the 1970s, neither was this based on any new scientific evidence. Rather, it was the case that institutionalising a moral stigma against homosexuality was becoming increasingly difficult to justify, and it was voted out as a disorder via a referendum. Psychiatry as a ‘science’ has scarcely moved on since the days of Drapetomania, of being used as a tool of oppression against women who dared to subvert or challenge socially ingrained gender roles by asserting independence of will and of homosexuality. All that has changed is that social attitudes have progressed, and psychiatry is not able to get away with the same abuses (operating behind veneer of unearned scientific legitimacy) today as it did in the past.

As was the case with homosexuality, escaped slaves and strong-willed women, the opponents of suicide also invoke these teleological arguments to suggest that, because we are ‘hardwired’ to want to preserve our existence; the existence of a desire which runs contrary to this instinct betrays prima facie evidence of severely compromised judgement.

Astoundingly, it is not only theists that have advanced these arguments in opposition to a legal right to suicide. Even self-professed ‘atheists’ have made very confused arguments of this sort (see an example of this here).

Those who wish the right to suicide without interference should demand objective evidence from anyone who claims the authority to know what is in their interests better than they do themselves. Given the enormity of the stakes involved in this type of interference with a person’s liberty (nothing less than slavery itself, I would argue), a very high standard of proof would perforce need to be met in order to provide sufficient ethical justification for this action. Not only this, but the authority responsible for making this decision should be legally required to outline exactly what they are intending to do in order to help that person to attain a mental state in which they are capable of meaningfully giving consent, and should be limited by law to a specified time period within which they are entitled to suspend the individual’s legal right to choose for themselves. Presumption of incapacity based on an unproven belief in life’s inherent value is not sufficient here.

An unfalsifiable diagnosis, based on normative assumptions and rendered without conducting any objective tests will not suffice. As far as I’m aware, there is no scientifically established link between any organic brain dysfunction or anomaly and suicidal thoughts. More to the point, I am also unaware of any scientific evidence which has ever proven the value of life; and thus I am unsure as to how one could scientifically establish a threshold to determine how much a rational person ought to be enjoying life under any given set of circumstances. In which case, there is no way to compare how an insane person would react to how a sane one would, and you cannot render a sound verdict that the suicidal individual has failed to evaluate life correctly due to cognitive distortions.

As we can see, there is no basis other than articles of religious or philosophical faith for codifying the value of human life into law when it pertains exclusively to decisions that an individual is making on their own account. Therefore, the existing restrictions on suicide may be viewed as a violation of the right to freedom from religion, and no state which upholds these restrictions can be considered to be a truly secular one.

The future of the right to die

As for what the right to die might look like, I will advance my own proposal. I am not averse to the idea of forming a compromise with those who have concerns regarding the impulsivity of suicide, and those who may make a choice after an episode of adversity, within a mindset not typical of their usual outlook. We would address these concerns by implementing a specified waiting period of perhaps a year for those who want to die due to non-terminal illness, and counselling could be required during this waiting period. This would give the health service sufficient time to direct the patient towards support services that may help to remediate any issues that are identified as factors contributing to the patient’s wish to die; and importantly, it would demonstrate that the patient’s will was settled and that they had sufficient time to reflect on, and give serious consideration to, alternative options to suicide. As for the actual suicide itself, this need not necessarily require the direct involvement of medical doctors. Once the patient completes their 1 year waiting period, then the doctor would provide them with documentary proof that they have met this requirement. They would then be entitled to access a service that would allow them a painless, and risk-free death, such as Philip Nitschke’s invention The Sarco, which the patient themselves would be able to utilise without the need for a doctor to assist them in contravention of any sincerely held personal principles. The actual service of assisting the person to die could be run parallel to the health service of the country.

Anecdotal evidence from Belgium demonstrates that even knowing that one has the exit door available can help to ameliorate distress that previously was intolerable, and thus the patient who was once desperate for death finds that their emotional resources are greatly restored. From a personal perspective, I feel that the greatest source of my psychological unrest is from the anxiety and fear of finding myself being burdened with a life that I never consented to having had imposed on me in the first place, but being denied a failsafe and dignified route out of this existence, should I choose to take it. I find it difficult to divert my mental energies to ways in which I can improve my living circumstances when I am constantly worried about trying to break out of my prison cell by tunnelling out through the walls whilst the guard’s back is turned. I believe that granting people the peace of mind of knowing that they cannot be indefinitely trapped in their circumstances against their explicit consent will affirm George Sterling’s famous quote “a prison becomes a home when you have the key”.

What are your views on the right to die? Please share your views in the comments section below. The full spectrum of views on this subject are welcome, and will be published unaltered, providing that they are submitted in good faith, with the desire to advance the discussion. Please note that, for legal reasons, I am unable to allow publication of any comments that provide information pertaining to suicide methods, or which explicitly advocate for suicide. Please subscribe using the form below, if you would like to be updated on future content.

existentialgoof 10th September 2021