UK lawmakers recently approved assisted suicide for those suffering with a terminal illness and given only six months to live. In considering medically assisted killing, O. Carter Snead provides valuable insight in his award-winning book What It Means to Be Human: The Case for the Body in Public Bioethics.
What does it mean to be human? Snead rejects views that fail to adequately appreciate embodied human existence. René Descartes reduced each of us to “a thinking thing.” John Locke thought of a person as “a thinking intelligent Being.” Jean-Paul Sartre’s existentialism gives rise to expressive individualism in which I am who I am choosing to be. In all such views, the “real me” is not a flesh-and-blood embodied individual. Rather, I am reduced to a rational mind and an autonomous will.
But, in fact, human beings are embodied, vulnerable, and interconnected. We cannot be reduced to our activity of reasoning or of choosing. As a newborn, I existed before I had rational thoughts. If I become cognitively impaired, I will continue to exist, albeit injured and temporarily or permanently unable to think. A single blood clot or a microscopic virus can force the strongest human being in the world to the door of death. We are embodied, so we are all vulnerable.
Snead calls attention to our embodied vulnerability as human beings in order to think through what a truly just and human response to suffering and dying ought to be. “As living bodies in time, we are vulnerable, dependent, and subject to natural limits, including injury, illness, senescence, and death. Thus, in order to survive, let alone thrive, we need to realize our potential, we need to care for one another. We need robust and expansive networks of uncalculated giving and graceful receiving populated by people who make the good of others their own good, without demand for or expectation of recompense.” We are, as Alasdair MacIntyre put it, dependent rational animals. So, we need the virtues of generosity, hospitality, and merciful love.
The systematic neglect, especially of the infirm elderly, makes them particularly vulnerable to manipulation and coercion.
But the law permitting medically assisted killing presupposes a different view of the human person, the view of expressive individualism in which we are independent, autonomous, and atomized individuals. As Snead puts it, “The law ignores the embodied reality of the profound vulnerability and dependence of the person suffering under the yoke of debilitating cognitive impairment and instead projects onto him a false image of an intact mind and will. At a time when a person is most fragile and dependent on the care of others for basic needs, the law elevates freedom and self-determination as its animating goods.” The law permitting assisted suicide abstracts from the vulnerability of those suffering at the end of life.
The law allowing killing is also arbitrary. If autonomy justifies assisted death, why should those with greater autonomy (the clear headed not suffering and facing death within months) be denied assisted death? If alleviation of suffering justifies assisted death, then why not allow those who will suffer for more than six months to have assisted death? The law determines who lives and who dies, who gets killed and who gets care, based on arbitrary stipulations.
Laws allowing medically assisted killing fail to protect the most vulnerable in their time of greatest need. As Snead points out, “The anthropology of expressive individualism fails to account for the diminished agency at the margins of life for an embodied being in time, overstates the possibility of autonomy in this setting, and underestimates the risks of systematic neglect, fraud, abuse, mistake, and coercion in a legal regime that allows assisted suicide.”
The systematic neglect, especially of the infirm elderly, makes them particularly vulnerable to manipulation and coercion. Insurance companies weighing the costs of caring against the costs of killing have financial incentives to prioritize cheap suicide over expensive medical treatment. When money talks, few are deaf. Snead notes, “In 2018, 54 percent of patients who obtained [suicide] prescriptions reported they were seeking to end their lives because they perceived themselves as a burden to family and friends, the highest percentage recorded since 1998.” In such cases, the so-called “right to die” becomes the “duty to die” as the healthy and hearty pressure the vulnerable to kill themselves: “Grandma, you wouldn’t believe how expensive Johnny’s college tuition will be. . .”
Legalizing killing the vulnerable also harms the vulnerable who do not kill themselves. If Grandma doesn’t kill herself to free up resources for Johnny’s tuition, will she feel guilty? The more assisted killing is used, the less the demand for proper pain relief for the suffering. Why provide options for attentive hospice care, if killing is cheaper and at the ready?
The impoverished, aged, ostracized, and afflicted need our care the most. They deserve better than death. We need to do better in caring for the vulnerable. As British politician Danny Kruger said, “I am very aware of the terrible plight of people begging us for this new law—I think we can do better for them. . . True dignity consists of being cared for to the end.”
