Saturday, June 8, 2019

Whose Life Is It, Anyway?

We want people to have autonomy and ease their suffering as much as possible. But that doesn’t mean we just allow people to kill themselves. Mental illness is difficult to combat, but giving up on a 17-year-old should never be normal or acceptable.
This teen’s death wasn’t euthanasia — but it was still deeply wrong
Given that the 17-year-old in question lived in the Netherlands, the question of just who Ms. Markowicz is referring to when she says "we" is an important one.While there is a generally-accepted right for people to refuse life-saving treatment in many jurisdictions in the United States, in practice, it's a very tenuous thing. As this case and commentary article from 2008 demonstrates, medial providers can come up with a number of rationales for overriding a patient's expressed wishes. The Netherlands, on the other hand, appears to be somewhat more firmly in the "patient autonomy" camp.

In the United States, it's unlikely that someone like Noa Pothoven would have been allowed to refuse all foods and fluids without being subjected to force-feeding. It's probable that someone would have sought out someone with the standing to legally challenge the decision to respect her wishes (presuming that they didn't have standing themselves) and gone to court to force action to keep her alive. So if by "we," Ms. Markowicz meant the United States, either its authorities or the public as a whole, the case could be made that "we" already don't "just allow people to kill themselves."

But if someone in the United States wants to include the authorities and/or the public of the Netherlands in "we," then it becomes a much broader net being cast, anywhere from advanced First/Second World nations to all of humanity. And that raises the question of what legitimate authority can demand that multiple nations adhere to a single standard in this regard, and back it up. The United Nations could certainly request that all member-states refuse to honor a person's wishes in a case like Ms. Pothoven's, but they have no viable enforcement mechanism. And while there are other nations that may take exception, as an official matter, to the Netherlands' stance on this, it's difficult to imagine troops being landed in the event that the Netherlands simply says: "That's nice."

Of course, I'm not really engaging with the logical considerations of making the determination that in the case of mentally ill/traumatized 17-year-olds, hope must be maintained by someone, and the youth in question must have their options limited only to those that reflect that hope. That is not only a difficult question, but a personal one, that touches on the determination of when, if ever, does a person acquire sufficient ownership of their life that they may choose to dispose of it.

Presuming that a person, for whatever reason, does not have sufficient ownership of their own life, determining where that ownership actually lies is more difficult than a blanket statement that "'giving up on' a 17-year-old should never be normal or acceptable." (And this statement is of dubious utility itself. It's one thing to allow someone to kill themselves because you, too, have given up. It's quite another to allow them to do so because theirs is the only choice that matters.) This question is important, mainly because once someone is given that level of authority over others, they tend to use that authority for their own ends, rather than those of the persons who they are intended to protect. And this is not necessarily out of malice or corrupt intent; it's not difficult for someone to see their interests as being those of the persons they are protecting.

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