Thursday, January 30, 2014

Autonomy, Compassion, and Physician-Assisted Dying

Mercier, Sumner, and Weinstock on "physician-assisted dying":

Those who advocate for the legal option of medical aid in dying have been quite consistent in calling upon these two principles, autonomy and compassion, in support of their efforts.

It should now be obvious why the opponents’ equation of physician-assisted dying with murder is mistaken. No one, of course, doubts that murder is wrong. But its wrongness is due to two important factors: the harm it does to the victim and its violation of the victim’s autonomy. Neither of these factors applies to physician-assisted dying.

What really should be obvious is how much this begs the question; practically all opponents of the process involved hold that it in fact does harm the victim and/or in fact violates the victim's autonomy. We see this even more obviously when they go on to explain. First, for autonomy:

Murder substitutes the will of the perpetrator for that of the victim. Physician-assisted dying respects the free will of the patient.

But no serious analysis of murder as wrong on autonomy grounds takes it to be wrong for such an absurdly vague reason as that it "substitutes the will of the perpetrator for that of the victim," a description so thoroughly useless that it can apply to virtual identity theft in Second Life. And respect for "the free will of the patient" in no way affects the analysis for whether one should actively cooperate with it or not; one cannot simply leap from one to the other as if they were the same. Much of the confusion here is due to the author's conflation of autonomy and freedom of choice -- the two on certain conceptions overlap but are not the same -- but even setting this aside, the analysis given is absurdly simplistic.

And on harm:

Murder harms its victims by depriving them of further life which would be of value to them. But patients elect medical aid in dying when the only future they can foresee promises nothing but additional suffering.

That the terms are being deliberately rigged to get the 'right' answer is even more obvious here, since most people would hold that the harm to a victim comes by depriving them of further life -- no additional weasel clause. If someone clearly and obviously did not value further life and someone came up and killed them without asking their consent, there would be no room to argue that it didn't count as murder because further life wasn't of value to them; the bare fact of taking their life would be regarded as harming them. What is more, it isn't clear why anyone would assume that 'harm' can be connected so tightly to valuing of one's life. Everyone recognizes that people die because of biological harms; this doesn't magically go away if the person in question is suffering from severe prolonged depression. Everyone recognizes that people can be harmed in ways of which they are not aware, or, indeed, in ways that they don't think they are being harmed, by means of things that they do not at that point value. (For instance, the experience of looking back and seeing that one was harmed by being deprived of something of value that at the time one was simply not in a position to value is not an uncommon experience.) When they first raised the issue of harm, the authors said that the principle involved was "compassion for our fellow citizens". Does compassion suddenly vanish if people don't value further life, so that no harms against them are recognized at all? Because to hold not that the harm is outweighed but that there is no harm to raise the issue of compassion is, at the most generous assessment, a clear case of trying to rig the definitions to get one's pet result. (This doesn't even get into the obviously illegitimate slide from talking about "further life which would be of value to the patient" to "further life of which the patient can foresee no value".)

Mercier and Weinstock I don't really know, but that Sumner, who can generally be expected to give an argument with some effort in it, would put his name to such ridiculously amateurish and question-begging reasoning just baffles me. This is not serious philosophical argument; it is sophistical advocacy pretending to give reasons.

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