Preventing Teen Suicide? An Unethical Intervention in Autonomy?

Tagging this view onto my previous arguments about Physician Assisted Suicide, I think it’s also important to think about the permissibility of interfering with attempted suicide cases, even though they’re hairy.

I anticipate this topic potentially going to a dark place pretty quickly, especially as my view has to weigh in on teen suicide and similar delicate matters. While I don’t want to offend anyone, I do think it’s an important to address and discuss.

In my previous post, I brought up a potential condition as having a physical component necessary for AE/PE, or at least sufficient age for informed consent. I’m not convinced this is a necessary condition.

I might (or rather, ONE might) argue that suicide of any kind is permissible, regardless of age or suffering threshold, because there’s no reason to interfere in the autonomy of individuals who may wish to take their life. I find this potentially convincing provided it does the necessary work.

I don’t mean to say that we ought to be OKAY with people killing themselves, certainly we should still take measures to raise awareness about teen suicide and the necessary ways to get and offer help to teens in need, but do we really have any right to interfere with someone who wishes to take their own life? Or are our intuitions, which tell us that we ought to stop people from killing themselves, only based in selfish concerns about the loss of a peer/friend/family member/colleague/whatever?

If so, should we really be basing an ethical principle fundamentally concerned with interfering in the bodily autonomy of others (granted this is sts permissible) on grounds related to OUR best interests? This seems quintessentially conflicted to me. Any view that wishes to take issue with a permissive view of suicide HAS to deal only with the best interest of the subject, not those around them (provided no dependents).


Ethical Obligations to Assist Euthanasia

Here’s some more follow-up thinking on Physician Assisted Suicide.

In this post, I will argue that provided sufficient conditions, any individual has a right (a claim on the assistance of others) to euthanasia of any kind. I do not believe this claim on others is restricted to passive euthanasia, in which the subject is merely allowed to die via a foreseen consequence of actions (or non-actions), but includes active euthanasia, in which the subject may ask for the assistance of and thereby obligate others to take action to end his/her life.

While I believe the intend/foresee distinction is a valid one, it will not enter into my post, as I believe both intentional and foreseen killing/euthanasia is permissible. Note I also will not take the time to outline the sufficient conditions for a right to die. While important, this can be argued elsewhere and I do not have the space.

Furthermore, I would argue that because the right to die can obligate others to actively assist in euthanizing, refusing to take part in an active process and force the subject into a situation in which they must await death as a foreseen consequence is unnecessarily cruel.

First, negative argument intended to dismantle objections:
One might argue that a right to death is far too demanding. Granting a claim on the assistance of others seems to unfairly obligate a third party to do something they don’t wish to partake in, violating their autonomy. My response is two-fold.

1. Demanding-ness is Meaningless. While the objector may have a valid concern that such a right is in fact demanding, I fail to see why such demands hamper the strength of my argument. For example, granted Kiddie Pool which was part of one of my recent posts (Walking by kid drowning, low risk to save him, you are obligated to save him), it seems that our intuitions sometimes think that it’s okay for a moral principle to place demands on others. Provided no/minimal risk, as in the case in both Kiddie Pool and active euthanasia, there is a duty to assist people in need, so we ought to think we’re obligated to assist the suffering person seeking assisted euthanasia.

2. This Isn’t About You. A naysayer might object, “Sure, but there’s a difference between Kiddie Pool and AE (active euthanasia)! I don’t have anything against the act of pulling a kid out of a pool, that’s a good action, but killing someone!? I can’t do that!” Let me refer this objection back to the title of this argument. This Isn’t About You. The action itself, be it a killing or letting die, is permissible granted the informed consent of the subject, regardless of whatever feelings you have about the act of killing. Any feelings you may have about the emotional damage you may or may not suffer (The brutalizing of the killer argument?) by assisting in a death are massively outweighed by the subject’s suffering. In short, I’m ambivalent to concerns you have about getting your hands dirty when someone is so miserable they want to die.

Looking at The Elizabeth Bouvia case (explained in more detail later), “Judge John H. Hews … [decided] allowing her to starve herself to death in the hospital would ‘have a profound effect’ on the staff, other patients, and other handicapped people.” This is a miserable reason to assert that someone continue to suffer. The argument, in effect, asserts that the autonomy and wellbeing of Bouvia is less important than the well-being of the people around her, who might be negatively affected. Give me a break. Better yet, give the suffering woman a break.

Now, positive argument in favor of active euthanasia:

Passive Euthanasia Defeats the Purpose. The point of euthanasia is to end/shorten suffering. Does passive euthanasia do this? Our response is mixed. Yes, it does end suffering, but it does not shorten it (case in point Elizabeth Bouvia, who eventually decides she can’t starve herself to death because the side effects would be too costly and actually worsen her suffering, despite her wishes to die). Passive euthanasia (often, in comparison to active) prolongs the very suffering euthanasia seeks to end, seemingly only for the reasons addressed in This Isn’t About You. While the intend/foresee distinction does have significant moral weight, if the very goal of euthanasia is to end/shorten suffering and This Isn’t About You is granted, it seems that PE (passive euthanasia) fails to achieve its goals. It should therefore be rejected in favor of AE.

I think it is important to lay out necessary/sufficient conditions upon which we think that a claim on others for AE is granted, but won’t argue for them here. What’s included is not meant to be an exhaustive list, merely some preliminary ideas that might guide the creation of necessary/sufficient conditions. Such conditions might include:
1. Subject’s inability to perform euthanasia themselves.
2. Physical and emotional suffering, where emotional suffering alone is sts insufficient for AE (physical suffering that does not cause emotional suffering seems unlikely to create a situation in which the subject would ask for AE).
2a. Emotional suffering may be sufficient for AE, should it be great enough, and the subject is of an age where they can make an informed decision (Perhaps above 21? 25? 30?) This quells worries about teen suicide.
3. The lack of dependents – a parent that is still able to provide for his/her children cannot ask for AE (if the parent is no longer providing, perhaps this condition is not necessary)

Provided such conditions are fulfilled, we ought to think AE is preferable to PE, and subjects have a right to demand AE from others.

Right to die? Why not? Physician Assisted Suicide

Long time no post! I’ve decided to get some material on here simply by migrating material from my Biomedical ethics class onto here. I believe it’s appropriate, as it is meant to foster discussion, although it is unlike many of the topics I’ve discussed before.

Without further ado, argument for a position on Physician Assisted Suicide.

A right to die is a very demanding sounding right that the vast majority of people are frequently opposed to. A “right to die” has implicit positive claims on others, that if it is impossible for me to facilitate my own death, I can obligate another to assist in it, should I so desire.

Often times defenders of euthanasia take support weaker rights that don’t put a claim on the assistance of others. I don’t see the need to do so. Here are two cases.

Kiddie Pool: X is walking by his neighbors house when he spots their young child face down in the kiddie pool. The water is shallow, and there is no risk to X, (in terms of his safety, or legal risk) should he choose to assist the child by pulling him out of the pool.

Child in Pain: Bente Hindriks has Hallopeau-Siemens, a rare syndrome that results in a loose external skin layer that peels off easily, causing extreme pain as well as the potential for infection among other things. Hindriks’ parents and doctor have no way of curing the syndrome, but only the option of continuing her suffering until she dies naturally between ages 3-10, or taking measures to euthanize.

Now, I imagine that short Jimmy, the vast majority of people’s intuition about Kiddie Pool is that there is a moral obligation to assist. What is our reason in thinking so? Perhaps there is an obligation because there is no risk of damage to the agent, while an assistance can be given to the child. I’d argue that the same is the case with Child in Pain.

In Child in Pain, an assistance can be given to Hindriks by ending her life and thereby her extreme suffering, knowing that there is no way to ease the suffering should her life continue. Because there is no way to ease the suffering, we should be inclined to say that working to continue her life does not count as an assistance to her, as it does little other than prolong her suffering.

One might object that saving a life and ending a life are dis-analogous types of assistance. I’m inclined to agree. Regardless of this, I think it’s plain to see that between the two choices, keeping Hendriks alive as long as possible or ending her life and her suffering, the latter is the kinder option. Because one is significantly kinder (we might even say the other is cruel), AND there’s no risk to the agent (provided we correctly model our legal system after our ethical system, so that it isn’t legally impermissible to act this way because it’s ethically permissible to act this way) we ought to think that the parents/doctors are obligated to assist in Hindriks death.

Why else might we think that this is wrong?

Perhaps someone might object that the agent does in fact assume a risk by assisting in the death, some form of psychological scarring and/or memories of killing an infant that will cause them harm should they choose to assist.

Even if I grant this (which I won’t), I don’t believe the two harms are even remotely comparable. Scarring memories from killing a child (that likely would want to die, but I won’t visit this issue) and their associated psychological distress is NOT comparable to the physical agony that Hendriks would be forced to endure for years should the doctors choose not to act. Choosing not to act, even if the choice is grounded in risk analysis, would be selfish, as the risk associated is not comparable to the harm that currently exists.

In some cases, at least, we can say that patients unable to do so themselves have a right to the assistance of others for their death.