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The duty to die?

By Brett Salkeld

05/25/2016

This is the third of a five-part series.

We live in a culture that makes an idol out of choice. In our basic and unquestioned public discourse choice per se, without any reference to the object of that choice, is seen as a basic good. Choice is understood as the sine qua non for authentic human freedom. Take away someone’s choice in any matter and you limit their freedom. This is seen as acceptable only when their choice might harm others.

It should not be surprising, then, that while the initial public arguments in favour of assisted suicide tended to hinge on eliminating unnecessary and extreme physical suffering, the discourse is quickly infused with the language of choice. “Who can presume,” we are asked, “to deny another person the right to choose to die?”

Indeed, children of one of Canada’s first assisted suicides told the media that, “Our father’s legacy comes down to one word: choice.”

We can leave aside, until our next instalment, the fact that a refusal to deny someone the right to choose assisted suicide includes a concomitant insistence that someone else actually kill them — and that our government is seriously countenancing not giving health care professionals any choice in that grave matter.

For our purpose in this piece, however, we need to look more carefully at the relationship between choice and freedom. Because while it is easy to imagine that more choice always equals more freedom, further reflection indicates that this is not always the case.

There are times when we find ourselves crippled by bad options, not freed. What does the choice to die look like to a mentally ill person? Or to the elderly?

Consider my grandparents. George and Esther White (names changed for privacy) are, by a certain kind of calculation, two very inconvenient people. They just celebrated their 70th wedding anniversary and took the opportunity to effectively say goodbye, realizing that there is little chance of them being together with all of their family at one time again in this life.

George and Esther are in their mid-90s. They each have a variety of health issues. One is nearly deaf, and the other virtually blind. They need help bathing. They have to choose between catheters and incontinence pads. Esther recently had a complete mastectomy. They are homebound in the assisted-living seniors’ community where they live.

Their daughter, my mom, goes in to see them several times a week. Though recently retired, my mother cannot take extended holidays. She would like to be able to travel to see her grandchildren, to spend a week or two helping her daughter and daughters-in-law with the burdens of being moms with young kids, but George and Esther can’t be left alone for that long.

George and Esther are blessed by the fact that they have lived until very recently in a time and a place where the question of their committing suicide may never be broached. They have not had to consider, on top of all of the other problems that come with aging and dying, whether or not they have some responsibility to hasten the process. The possibility that suicide is a “choice,” a legitimate option, was (and I pray still is) blissfully far from their radar screen.

They are free to live without counting the cost that their existence puts on their families and the health care system. The so-called “choice” to die would take away that freedom.

The French literary critic and anthropologist Rene Girard has said in an interview that: “The experience of death is going to get more and more painful, contrary to what many people believe. The forthcoming euthanasia will make it more rather than less painful because it will put the emphasis on personal decision in a way which was blissfully alien to the whole problem of dying in former times. It will make death even more subjectively intolerable, for people will feel responsible for their own deaths and morally obligated to rid their relatives of their unwanted presence. Euthanasia will further intensify all the problems its advocates think it will solve.”

On top of the physical suffering that accompanies dying, the legal availability and social acceptability of assisted suicide will add immense psychological duress. And it will add it for people who are already in an extremely vulnerable situation.

Even if legal safeguards are able to stand against the logic of choice, and we are able as a society to determine which people’s suffering legitimates suicide and which people’s suffering does not, all of which seems completely fanciful, there is simply no way legal safeguards can protect such inconvenient people as George and Esther from the psychological pressure that this “choice” introduces into the experience of dying.

Once someone could choose to die, there is no avoiding the question of whether they should choose to die.

And couples in their mid-90s with loving and stable families that they can still recognize and converse with are not the only inconvenient people in our society.

Any one of us should not have any trouble imagining someone of our acquaintance who would be under vastly more pressure than George and Esther. If you doubt me, consider the epidemic of elder abuse, or the kinds of fights even relatively stable families have over inheritances. If we imagine those considerations will play no role in the pressure exerted on certain inconvenient people, we are naive.

The same logic that extends the “right” to die from those close to death due to age or illness to those suffering people who are not terminal — a logic already insisted upon by the Supreme Court — will extend the pressure to die from the terminal to the severely disabled and the mentally ill and from there to anyone who might feel themselves to be a burden on society.

This pressure does not need to be overt to be real. Even if we can somehow mange to avoid health care practitioners and families ever bringing up assisted suicide with suffering individuals — which seems sheer fantasy when considered at the population level — individuals who know how much time, work, and resources their existence demands will not be able to avoid the question of their responsibility to society to cut their lives short.

We are now in a situation where our sick and elderly, our mentally ill and severely disabled are under automatic pressure. How we respond to this new situation is part of what will consider in part four.

Salkeld is archdiocesan theologian for the Archdiocese of Regina where he is responsible for the academic formation of diaconate candidates. He serves the CCCB on the national Roman Catholic - Evangelical Dialogue. Salkeld lives in Wilcox, Sask., with his wife, Flannery, and a growing family (numbers 5 and 6 are due this summer).