Saturday, October 27, 2007

Lives not worth living and voluntary euthanasia

Most of the voluntary euthanasia crowd argue that we should permit competent folks who are suffering from a terminal illness, and who consider their lives not worth living access to death with dignity if they so wish. Death with dignity here is meant to include access to voluntary euthanasia and/or physician assisted suicide. The main reasons have both to do with the idea that we should respect competent people's choices particularly when it comes to how they wish to end their lives, and also with the view that there is little point in sticking around when you suffer from a terminal illness, and there is no prospect that you'd be able to enjoy your life sufficiently again that you yourself consider it worth living. So, it's not about a Nazi declaring your life not worth living, but that you yourself say that you wish to die, because you yourself do not consider your life worth living any longer.

I find this argument by and large persuasive, but it strikes me as mostly strategically motivated. Opponents of voluntary euthanasia have long been arguing that accepting this argument, and translating it into policy would lead us down a slippery slope to non-voluntary euthanasia (say folks get killed a) against their express wishes [there doesn't seem to be any evidence whatsoever to support this claim, at least with regard to countries that have since legalised voluntary euthanasia], and b] that incompetent folks get killed). The latter point is quite dicey obviously. If you've someone who meets the other criteria (terminal illness, overwhelming impact on that patient's quality of life), and you know that competent people under such circumstances often (but not always!) demand voluntary euthanasia or physician assisted suicide, how are you to go about someone unable to express an autonomous choice?

Anyway, my main question today is somewhat different, but also somewhat related to the incompetent patient. As you may or may not know, very many people suffer from clinical depressions. It's truly a debilitating disease that renders the quality of life not worth living for many of those affected. Some of the anti-depressants that are on the market work for some of those affected, but for many patients these drugs do not work, or do not work reliably over time, or do not work sufficiently well to permit them to enjoy their lives again. It goes without saying that depressive people have suicidal thoughts that are usually caused by their depression.

But, here is the question: If a given depressive patient has tried and tested the available anti- depressants over reasonable periods of time, and they fail to do the trick for her, would it be unethical if a doctor complied with her request for an overdose of some drug cocktail or other that would permit her to end her life? If the legitimacy of decisions on voluntary euthanasia or physician assisted suicide rests on a patient's evaluation of her experienced quality of life over time, who are we to say that a depressed patient 'because she is depressed' should not be respected in her wish to end her life?

My view would be that we should acknowledge that depression might be the major factor triggering her demand to die with dignity, but equally that unless we're able to do something successfully (in her judgment, not our's) about her depressions, we should respect her choice. At the end of the day, whether or not we consider our lives worth living should be the decisive factor with regard to society respecting patients' end-of-life decision making. The question surely is not whether their condition is terminal but whether there is a reasonable likelihood that the condition that renders their life not worth living (in their judgment!) can be fixed in the foreseeable future. If the answer to this question is 'no', or 'most likely not', it does not matter whether the condition we are concerned about is of a terminal nature. It does not help a great deal to go on about depressed people being not competent to evaluate exactly how they feel about their lives. The fact of the matter is that they know perfectly well how it is to live with depressions, they understand that it is their depression that stuffs up their lives, but also that nothing that they tried worked to bring their lives back to reasonably livable normality. To use that experience to declare them incompetent to make choices about ending their lives seems absurd to me.

Am I missing something?


  1. Yes you are forgetting that depression colors one's perspective. Depressed people often have an unrealistical, inaccurate, pessimistic negative view of things that is part of the effect of depression and which can often be treated successfully with psychological therapies such as cognitive-behavioral therapy. There are a number of successful psychological therapies for depression that need to be tried as well as the anti-depressants. The drug companies and physicians will make you think they won't work but research shows that they do. If a number of them fail only then does it become an ethical situation, especially if the therapists concur that the lifestyle situation is hopeless. We have to ensure, however, that the patient's perspective on hopelessness is accurate, as hopelessness is part of the effect of depression.

  2. I disagree with Bruce. Living with depression can be hell, and in the case presented, the depression was untreatable. Should the patient wish to end his or her life, so be it. It would be a kindness on the part of the physician to assist in so doing, if assistance was requested. I do not think that the argument that alternative therapies "might" work is a valid one, as it goes into another ethical argument: how many hoops does a patient need to jump through before he or she can throw in the towel? And who decides?

  3. Hello well the euthanasia is not a easy decision to make cause its somebody life but sometimes is better that way.


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