Control

I was puttering around on Slate, when I came across an old Human Nature column from 2005. In it, William Saletan recounts a meeting of the President's Council on Bioethics concerning "legalized assisted suicide and euthanasia in Oregon and the Netherlands." It's the kind of interesting and thought-generating column that I so enjoyed reading back in the day.

If you're interested, you can read the column yourself, so I'm not going to bore you with an attempt to recapitulate the substance of it here. But one of the very interesting points that Mr. Saletan deals with is that of autonomy and control. Seeing parallels in the abortion debate, he warns against "deny[ing] autonomy in the name of protecting it," - blocking a person's attempts to make certain choices, under the idea that no-one would ever freely make THAT choice. (Not mentioned is the next step, in which people cast certain choices as indicative of some sort of threat to autonomy - in other words, the very fact that you have made a certain choice indicates coercion or mental distress or defect, and therefore, your autonomy must be suspended until you have been returned to "right thinking.")

During the column, Mr. Saletan brings up three ways that people have used or advocated to steer people clear of wanting to end their own lives. One) Stalling. Hospitals simply ignore laws that require compliance with a patient's wish to be taken off artificial respiration, until such time as the need for same has passed. Two) Moralizing. One of the council members favors an approach that tells patients "that while it's natural to wish for death, they ought not act on that wish." Three) Improved (and improved information about, and access to) palliative care. "Once you show that suffering can be relieved without killing, almost nobody chooses killing." When the Netherlands began to improve hospice and palliative care, the suicide rate dropped.

Bit if it's true that "No suicide prevention measure for the elderly would be more effective than good end-of-life care," as one council member put it, what's the best way of promoting good end-of-life care? Perhaps paradoxically, my first thought is the broader legalization of assisted suicide. Of the three ways discussed to prevent the suicides of the grievously injured and gravely ill, one of them costs money and requires specially trained people to be effective. If you can simply stall people or base laws on moral strictures that prevent suicide, where is the incentive to improve the palliative care infrastructure?

But, alas, the real world proves me wrong. Legalized abortion has done little to get staunch pro-life activists on board with initiatives for better prevention of unwanted pregnancies. People who feel that you have no right to something often have a hard time accepting the idea that desirable alternatives to that something should be advanced. Look at the case of the Bush and then Obama administrations dealing with North Korea and/or Iran - in neither case does the administration want to make it worth Pyongyang's or Tehran's while to go along; instead they both insist that the governments are acting illegitimately and seem to fear a future pattern of blackmail.

One of the council members cited an Oregon study that found that patients who seek assisted suicide when it is illegal have "an inordinate need for control." But I doubt that they're the only ones. Stalling and moralizing both seek to exercise control over the patient. Perhaps the issue of control needs to take a back seat, leaving more room for people to have options.