Tuesday 4 August 2009

On assisted suicide: the problem with choice

by Kim Fabricius

Kim had an abridged form of this letter published in yesterday’s Independent. It’s a response to the case of Debbie Purdy, the British MS sufferer who has just won a landmark decision in the Law Lords; theyve told the Director of Public Prosecutions to clarify how his department decides to prosecute in cases of those who expedite assisted suicides abroad. As a result of the ruling, pressure will inevitably mount for assisted suicide to be legalised in the UK.


On the subject of assisted suicide, let’s bracket the theology. Atheists will only sneer, not altogether unreasonably – Christianity has form on dogmatism – even though their own claim to ethical neutrality and objectivity is itself not only hopelessly doctrinaire but downright delusional, for there is no view from nowhere.

Let’s bracket too Richard Ingram’s observation (opinion, 1 August), though it’s literally right on the money, about the tempting market advantages of assisted suicide in a late capitalist economy of alleged scarcity, not to mention in a culture of youth, health and beauty. For the sake of argument, we can even bracket the idea – perish the thought – that the relatives and friends of the ill and aged might pressure them into an early self-dug grave.

But what cannot pass unchallenged is this notion of personal autonomy, as if my own desires and wishes were not themselves largely socially determined. I am who I am only in relation to others, and the view I have of myself turns largely on how others view me. If society as a whole no longer believes and affirms – unconditionally – the value of my life, if the signal it sends (not least in legislation) is that, ultimately, I am expendable, then I too will believe myself expendable.

In short, “I choose to die” may look like an assertion of freedom when in fact it is the cry of a person in chains: the chains of choice itself.


Saint egregious said...

'the view I have of myself turns largely on how others view me.' I don't see how this statement can be affirmed without the theology you have bracketed, Kim. When the mob was shouting for his blood, I am glad that Stephen looked up to heaven and had his identity turn not on how others viewed him, but on the view of his creator, redeemer, and sustainer.
So I appreciate your attempt to 'largely' bracket out theology, but I fear it is inadequate when faced with demonic evil, which, it seems, is precisely what this situation is describing. i.e. my family may tell me that I am precious, loved, affirmed, and the demonic logismoi of depression may tell me, contra the view of my most significant others, that I am worthless. Here I need God above all others, even above myself.
Suspecting you may agree....

Adam Kotsko said...

I'm not sure if this letter makes sense to me.

Anonymous said...

I'm confident enough in my independence of mind to decide for myself without the opinion of others. This letter makes no sense to me. I don't view myself according to how others see me.

steph f

Robert Minto said...

This letter makes a lot of sense to me. Thanks so much for sharing it!

Steph f, it occurs to me that your objection could be answered in Kim's own words. Is it possible that precisely some of the issues you might determine to confidently decide for yourself only present themselves as "choices" to you because you are socially determined to view those issues as indifferent or of only private import? "... the chains of choice itself."

Anonymous said...

Hello there,

Assisted suicide is not seen by the medical profession as a revolving door through which anyone who is feeling a little low can stroll, like some coffee shop in the Netherlands.

In places where it is established (eg. Oregon) it is a regulated medical service only available to the terminally ill, people who are suffering and have lost their sense of personal, human dignity who see no prospect of respite. The illness must be verified by several physicians and the person is screened for judgement-impairing mental illness. If approved the person can be prescribed lethal medication. In Oregon in 2008 2/3 of the patients went on to take the medication.

I can not agree that the wish of a terminally ill person to obtain this medication is socially determined. Nor is it strictly based in a wish to perish. It is often the wish to regain just the slightest feeling of control over a life and a body that is no longer completely their own.

These 'chains of choice itself' can be salvation to people in intense suffering, allowing them to dismiss their spirit in their lowest hour.


Anonymous said...

Robert Minto - I think I know exactly what Kim is saying and I don't agree with it at all. In fact I find it slightly arrogant to suggest that we are all socially conditioned and individuals are all incapable of thinking for themselves. I reject the implication that I conform to or am part of any social sub group. When I was younger I was influenced by my peers and felt pressure from those around me but I have since rejected it all.


Anonymous said...

more so I reject the implication that we are all subconsciously conditioned or chained. I don't know how he can possibly know that and I doubt he can.


Tyler Wittman said...


Consider Aristotle's fish, perhaps? You also have to admit that no one makes decisions in a vacuum.

I think the piece is succinct and to the point. Kim is not saying that you are strictly socially determined to the extent that you have never made a free choice. He is saying that the free choices you do make are made within a matrix of socially and technologically deterministic forces. I personally don't see how anyone can argue against this.

Consider the simple example of when it comes time to buy a new cell phone. The choices you are forced to make there are outside of your control and the decisions many of you make are based upon what you think is "right for you," when in actuality there are a number of invisible contributing factors to such a decision (i.e., whatever those advertising geniuses have pumped your heads full of, whatever you've seen certain people using, whatever your friends are doing, etc.)

Furthermore - and this is the real irony! - the very means you are using to communicate these protests of yours are themselves technologically determined. You are communicating over a web with people you likely have never met. This is the form of social interaction you are engaged in that no one would have been engaged in 50 years ago. Don't think the world has been transformed and driven by online networks of information? Just take a look at how we fight our wars.

I'm surprised more of you cannot see the simple truth in what Kim is saying. We are surrounded by a culture obsessed with the young and tired of the old; a culture hungry to remove both the minute they become an inconvenience. That this choice is even being debated tells it all.

Ben Myers said...

Hi Steph, I hear what you're saying; and I think Chris is also right to recognise that individual cases are not necessarily characterised by a mere exertion of autonomy or hubris. (This is obviously true of suicides more generally as well: Rowan Williams, for example, refers to one specific youth suicide as a kind of witness, a protest against the world's intolerable disorder.)

But if Kim's letter is taken in its immediate context, perhaps his point is not so much about hard social determinism as it is about the relation between legislation and the virtues that shape our common life. From this perspective, I think it's well worth noting that legal deliberations about assisted suicide are not merely private/personal decisions, since they potentially affect the whole fabric of the common life of a people. So although it's easy to sympathise with individual cases (especially where a person's suffering has simply been extended artificially and indefinitely through medical intervention), the wider social implications — what kind of people do we want to be? what are the things that we love and value? — would have to be considered when the question is one of legislation.

Anyway Steph, I'm not necessarily disagreeing with your observations, just trying to suggest a different way of reading Kim's letter within its immediate context.

Anonymous said...

Is it really about being obsessed by the young though? I don't doubt our culture is and I am appalled by our treatment of the old, but I mean in the case of assisted suicide. Although I can't summon a statistical heft on this, the only way to begin talking about it really, from media reports those desiring it seem to be people in vast amounts of pain, or suddenly disabled. They are not necessarily old. I think of the UK case of the rugby player Daniel James who had his spine crushed in a scrum collapse. Let's hear from his mother. http://www.timesonline.co.uk/tol/news/uk/article4969423.ece

“He couldn’t walk, had no hand function, but constant pain in all of his fingers. He was incontinent, suffered uncontrollable spasms in his legs and upper body and needed 24-hour care. While not everyone in Dan’s situation would find it as unbearable as Dan, what right does any human being have to tell any other that they have to live such a life, filled with terror, discomfort and indignity?”...“Dan had tried to commit suicide three times but this was unsuccessful due to his disability."

Now bracketing for a moment the language of rights there, which many here will likely object to, but at what point are the casual links you describe able to define that someone must continue to go on? That they must continue to live? This seems selfish on behalf of those who are alive rather than those who wish to die. Could one honestly look this human being in the eye and tell him that he is not prisoner to the body in which he is in, but rather a prisoner to the liberal abstraction of choice. This is deeply difficult stuff I feel, and can't be swept up in a standard knee jerk against choice as a concept.

Brad E. said...

Thanks for clarifying, Ben. The issue seems to be not whether it is possible, or even preferable, for an individual faced with this sort of situation to be allowed legally to make the decision to end one's life, but instead that the "freedom" embodied in that situation is impinged on socially by other factors -- one of which is in fact the making and presence of laws which forbid or allow it, which in turn has influence on the way "we" as society think of the elderly and their value as human beings, which in turn influences how "we" will think of ourselves once we become elderly, which in turn...

Anonymous said...

{ For teaching the Torah (the Talmud relates), the Roman occupation authorities executed Rabbi Hananiah ben Teradyon by burning him at the stake; but the Romans also covered him in wet sponges to prolong his death. As he suffered so greatly Hananiah’s students begged him to take the fire into his throat to hasten his own death, but the Rabbi refused to hasten his own death in this way because it is forbidden. However, he did allow a Roman soldier to remove the sponges and he died soon after. The Talmudic scholars commend the Rabbi for his brave martyrdom in teaching G-d’s word, they also praise the unknown Roman soldier for removing the sponges.} I put the quote in brackets but the Talmud is not (strictly speaking) theology. Great post Kim, obliged, Daniel.

roger flyer said...

How is the Talmud not theology?!

Anonymous said...

Hi Ben, I appreciate your response.

Tyler: Nice you agree with Kim so strongly. I do too most of the time. I don't have a cell phone and never will have one. The 'truth' is never simple.


Anonymous said...

@ Roger Flyer: yes, maybe (parts) could be considered theology, I was thinking about those portions of the Gemara (say, Tract Sanhedrin Horioth--Macoth) that deal with questions like: 'what were the windows of Noah's arc made of,' or the hierarchy of dogs, cats, and mice, or determining the amt. of damages paid to a father whose daughter has been sexually abused by the counting of her pubic hairs. I reckon all those kinds of issues that are dealing with our relationships with one another, are hinged on our relationship to G-d, and could be considered 'theology.' Sounds like an issue for the blog 'An und fur sich' to sort out. Anyway one more story from the talmud may be appropriate. In another case, the great Talmudic authority Rabbi Yehudah Ha Nasi lay dying in his house, while his adoring students prayed outside for his recovery. Those unceasing prayers kept Yehuda alive, but he was in great and increasing pain. A devoted young woman attending him went up on the roof and threw down a large clay pot that shattered loudly, momentarily causing the praying students to stop their prayers. In that moment of silence Yehuda died. The Talmud praises the action of the young women even though she indirectly hastened Yehudah’s death. obliged, Daniel Imburgia

mw said...

A bioethical question that hasn't been raised yet: Does our societal ability to keep people alive obligate us to do so--to the point where if the person wants to begin considering a "premature" death, we enforce the higher will of medical capacity rather than even giving consideration to their own desires? The concept of "premature" death itself is shaped by scientific advancement and life expectancy studies. In a sense, society is also chained by choice: the choice that comes with the power to decide to sustain a life. Why is having a default 'yes' setting for society's chained choice preferred to society defaulting to the individual's equally chained choice?

Tyler Wittman said...


2 + 2 = 4

You really should get a cell phone :)

roger flyer said...

and we are but clay pots, my piece of theology spun on the wheel of the Talmud lesson.

Anonymous said...


that's not 'truth' and no. I don't want one and I don't need one. And never ever will have one. I'd rather die. :-)

Actually the euthenasia question is a no win situation. Those unloved enough who could potentially be persuaded to end their lives against their will must be protected but at the same time those of us who know if our quality of life sinks beneath a point we can tolerate should be allowed the freedom to end it.


melissa f-b said...

My major concern with Kim's letter is that it doesn't take into account the gendered nature of the euthanasia question. The primary feminist quip with euthanasia is that women attempt suicide more often and, if given the proper tools, the rate of female (now assisted) suicide would sky-rocket. Unlike men, women are less likely to see ending their lives as an assertion of control or choice. They want to die because they fear being a burden on their families. A nice quote from Susan Wolf: “women as caretakers; women as affected by long-scripted cultural roles of sacrifice and suicide; women as prone to defer to the paternalism of their physicians, who are most often men.” THAT is a whole different kettle of fish.

Lilian Calles Barger said...

Autonomy is a western and modern myth. No human being is solely for themselves. We live in a continual dialogue between ourselves and the world around us. All our actions, desires, and thoughts are always mediated by what we have been given. Language is the fundamental basis for our thinking. You change the meaning of words and you change human experience. I think how we talk about suicide is changing and therefore changing the social terms of carrying it out.

Beth said...

The conclusion of this letter reminds me of an essay I read recently by Rene Girard on eating disorders and mimetic desire. Girard also talks about the illusion of choice in light of the social conditioning of human nature. He also does a good job illustrating how religion is not the problem for girls with eating disorders, but rather a society that claims that they are completely free to make their own choices without obligation to anybody else (the manifestation of the post-Nietzshce will-to-power nihilism). You could draw similar conclusions as Girard regarding euthanasia and PAS.

Halden said...

Melissa, that is an absolutely indispensible point.

Josh said...

"Those unloved enough who could potentially be persuaded to end their lives against their will must be protected but at the same time those of us who know if our quality of life sinks beneath a point we can tolerate should be allowed the freedom to end it."

Steph, I think I agree with this comment--that people "should be allowed the freedom to end [their life]." However, I am not convinced Christians should exercise this freedom.

Anonymous said...

When precisely did any society - unconditionally - affirm the value of a life? Let's remember that Saul chose to die by the hand of a brother and rob his and thus God's enemies of their boast of victory, of course David slew the git for touching the Lord's anointed which just goes to show ethics'll be the death of you. Phil

Tyler Wittman said...


"that's not 'truth' and no."

You sound like an empiricist! I can understand the aversion to cellular phones, we're probably all getting cancer as we yap on and on and on about all sorts of things that can wait.

Nevertheless, I don't understand the aversion to addition. None of us can escape the challenge of mathematics on our ethical deliberations. But this is a whole other discussion and it would be a great divergence from what everyone seems to be talking about.

The question I would like to hear thoughts on is, How does assisted suicide glorify God and love others with Christlikeness? I know this takes the brackets off of theology...

Fat said...

How short the trip from I have become a burden on others and my life has lost it's dignity to YOU have become a burden and your life has lost it's dignity will be once the journey down the slippery slope to compulsory euthenasia (while satisfying certain socially acceptable criteria of course) has commenced.

The cost of care outstrips the desire for society to pay and suddenly our aging population is no longer a problem.

kim fabricius said...

I've been away. Thanks for all the comments, not least Ben's explanatory gloss. Of course, pace St. E., the idea of "bracketing" the theology is, substantively, an idiotic one. I did it as a desperate strategic move in the context of British journalism (not US journalism), which is universally hostile to religious interventions in the public square (there are religious "slots" in UK broadsheets, but that only proves my point - and witness the ignorant outcry against Rowan Williams' nuanced lecture on sharia law) - as I was saying, my letter (or rather postcard! - the first two paragraphs were omitted) was a desperate strategic move to shoe-horn in a polemic, however intellectually bastardised, against the cult of the autonomous individual that sets the parameters of public discourse in the UK and, unsurprisingly, bewitches contemporay social ethics and law. I would only add - again, pace St. E. - that even the God who is above me encounters me in socially mediated ways, not least in the church, its people and its offices.

steph said...


I never understand that superfluous redundant 'of'. It's an american addition that doesn't make sense. Your assumptions for my aversion to dinky phones are false. And there's more than one sort of 'truth' and your equation is irrelevant. Why should assisted suicide have anything to do with God? Love and compassion for the person wishing to be assisted is enough.


saint egregious said...

'I hear your pain', Kim, about the ways the media limit the range of discourse. And we're certainly in agreement that God is met in the church. But I think of how 'God' has encountered gay and lesbian persons in the church for centuries,how this 'God' has been socially mediated to them, and again I thank God (and Karl Barth for teaching me of this non-'religious' God) for her willingness to sidestep even the holiest of social mediations. God has plucked many a soul up from the mire of our social mediations. Praise be, the church continues to bear witness to this remarkable God, even in its very betrayals. Thats why I rejoice in my office as priest of the one holy catholic and apostolic...

Dorothy Inman said...

Very interesting discussion. I have never thought of it that way, but I have to say even the way I view myself sometimes can be influenced by the world around me...even if I would like to deny it. What Kim is stating is that while we may think that someone who is critically ill or who would "qualify" for assisted suicide is really ... Read More influenced by the world they live in and even by their own philosophy on life---if you believe it is possible for a human being because of their age or medical/mental state to not be valuable or worth something then you are going to lean more towards affirming these practices, however if you take on the Biblical view that every person is valuable and loved because they are made in God's image then assisted suicide (just like un-assisted suicide) is never an option.

I would have to agree that Tyler's comments hit the nail on the head, "We are surrounded by a culture obsessed with the young and tired of the old; a culture hungry to remove both the minute they become an inconvenience. That this choice is even being debated tells it all.

HOWEVER at the same time I have never had a relative or friend who was terminally ill and have never experienced the pain of watching their pain as they struggle to exist with every breath. So, I can understand the sympathies of wanting to end someone's suffering, but again it goes back to what your worldview is. From a Biblical standpoint there ... More is a whole other view of suffering that I will not get into here and if you think that killing yourself or having someone kill you is the answer to suffering-no matter how severe or terrible-then your worldview does not support the examples we have seen and read about in the Bible. (and I have a medical condition where it's victims are four times more likely to commit suicide than the normal population) Bottom line if your worldview supports this practice they are stating it is just that: a worldview and it is influenced by things outside of yourself. To say that it is not seems naive.

steph said...

Tyler: have you ever had anyone close to you whose last years were spent in gradually increasing agony with loss of mobility and control of bodily functions, whose will to live declined as he became more desperate to die and end the agony despite your unconditional love and efforts to care for him all of his days. Did you cling to his life, force him to live, unable to cope with the thought of his death? When at last he did die a horrible death, did you feel guilty that you made him live when he had wanted to die? Was that about loving him with 'Christlikeness' and glorifying God?!

Tyler Wittman said...

steph: no, no, no, and no.

Fat said...

Some further thought. (this debate is ongoing on another quite secular forum as well after this Australian News item http://www.abc.net.au/news/stories/2009/08/14/2656334.htm?section=justin )

I believe in the sanctity of life - and, strange though it may seem, I also believe in the right to die with dignity.

Where I am at odds is with a 'system' where if all the boxes are correctly ticked (including the fact that only a sane person can decide on suicide but a profoundly damaged person cannot) then the state can sanction their death. That isn't dignified - it's downright degrading and treats a person as a mathmatical formula or at best a subject for debate among a selected comittee.

The state and the courts do not have that right. This man may believe his life isn't worth a moment more while others in an even worse state will struggle and fight to live and when it is time to go they still fight on - I have seen both sides close up and it makes me angry that it should be taken from those entrusted with the wellbeing of the patient and given to unknown and unknowing people comparing quality to a set of parameters.

Yes there may come a time when it is right to go and I would trust that Doctors, nurses , relatives, palliative care people would be able to assist with pain relief when that time comes without the intervention of a set of numbers (easily manipulated numbers - we do not know what the future brings but we can bet that eventually cost will be a factor.

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