The Value of Autonomy

The Value of Autonomy June 9, 2011

I’ve been following this debate between Ross Douthat and Kevin Drum about the morality of assisted suicide. In his latest post, Douthat made a telling, though apparently unintentional, statement:

The slippery slope that I discussed in the column doesn’t amount to much if you don’t disapprove at all of people deciding to take their own lives. Absent that disapproval (and an accompanying, even-stronger disapproval of the people who assist them), you won’t be bothered by… people taking lethal prescriptions in Oregon because they’re worried about “losing autonomy” or “being a burden” (both of which are more frequently cited reasons for choosing assisted suicide under Oregon’s law than are concerns about physical pain)…

Douthat takes it entirely for granted that the fear of losing autonomy is an insufficient justification for desiring to commit suicide. But why should we believe this?

Not all suffering is purely physical. For a person who’s severely disabled, such as with a disease like ALS, to the point of requiring 24-hour nursing care – the point of being unable to speak, to get dressed, to eat, to use the bathroom, even to sit up or roll over in bed without assistance – I would fully understand if that person decided their life had become intolerable and requested help to end it. In fact, it doesn’t surprise me at all that people who commit assisted suicide cite loss of autonomy more than pain. Pain can be controlled with drugs, but loss of independence and dignity can’t be controlled; and for many people, those things might well be worse than pain.

It’s also true that some people who seek assisted suicide aren’t “terminally” ill, in the sense that they can be kept alive indefinitely with life-support technology. But there’s no reason why the only allowable justification for suicide should be a disease that’s inevitably lethal. If the disease itself doesn’t kill, but so alters the sufferer’s life as to completely preclude future happiness, why shouldn’t people be permitted to decide for themselves that they no longer wish to endure it?

Take the case of Edward and Joan Downes, which I wrote about in 2009. Joan Downes had terminal pancreatic cancer; her husband Edward was going blind and deaf, but unlike her, wasn’t at imminent risk of death. Nevertheless, he decided that he didn’t want to go on living without the woman who had been his love, his caretaker and his constant companion of over fifty years, and the two of them elected to commit suicide together so that they could die in each other’s arms. (My eyes still sting a bit when I type that.) That was a poignantly beautiful, even heroic, death, and I hope, when my time comes, that I have one anywhere near as good. If this is the kind of conclusion that Douthat would prefer to see outlawed – if he would take away people’s right to write an end to their own stories like the one Edward and Joan Downes did – then his view is cruel and senseless sadism.

Or take Terry Pratchett, who’s been diagnosed with early-onset Alzheimer’s disease. Alzheimer’s itself doesn’t kill, but the end stages aren’t pretty: mood swings, delusions, incontinence and paranoia, ultimately progressing to the complete loss of memory and even the capability for speech. Pratchett has announced his intention to end his life on his own terms, if necessary, when the time is right rather than suffer all this. But in Douthat’s criteria, this would be outlawed, and people with Alzheimer’s would be required to live as long as possible, regardless of the emotional pain and humiliation caused by loss of identity, regardless of the suffering inflicted on their family by watching a loved one’s mind slowly disintegrate. (This, I presume, falls under the heading of “not wanting to be a burden” which, again, Douthat scoffingly dismisses as an illegitimate reason to commit suicide.)

To decide these cases and others, the only real question that needs to be asked is this: Who owns our lives? The humanist view is that we are the owners of our own lives, and we are entitled to end them when we choose. If a person is suffering from mental illness that deranges their reason and gives them an irrational desire to die, we should prevent that, just as we’d (hopefully) prevent a person in the throes of mental illness from taking any other rash and irreversible action. But if a person of sound mind genuinely desires to exit life, we have no moral grounds to stop them, nor to criminalize the actions of those who compassionately help them on the way.

For Douthat and those like him, however, their moral system is built on the basis that a being called God exists, that they know what this being wants, and that they’re authorized to act on his behalf. In the name of these beliefs, they would force people to remain alive, force them to endure all the agonies of incurable illness, force them to endure all the humiliations of a disintegrating self, for no gain and no purpose. You couldn’t ask for a better proof that religious morality is fundamentally anti-human in its outlook and its spirit.

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