National Post commentator makes up stuff about assisted dying

Andrew Coyne, well-known conservative part of Canada's commentariat, makes up stuff about assisted dying today. He deploys in his commentary pretty much every variety of slippery slope arguments that is known to humankind (they're usually all false, folks learn that in Logic101 classes). Bioethics students to the front. Whoever finds the most errors in Coyne's piece wins my last book :).  Inbox me with your findings.

This is in part what he writes:

"Udo Schuklenk, professor of bioethics at Queen’s University and chair of the Royal Society of Canada’s panel on “End of Life Decision Making,” recently published a paper advocating the euthanizing, with parents’ consent, of infants with severe deformities, a practice he likened to “post-natal abortion.” Eike-Henner Kluge, former director of ethics for the Canadian Medical Association, has made similar arguments for including the mentally incompetent among those eligible for euthanization. This is hardly a theoretical concern. In countries where assisted suicide/euthanasia has been legalized, it is increasingly the practice. Belgium, where euthanasia on the Quebec model has been legal since 2002, this year extended it to children, joining the Netherlands, where it has been lawful since the 1990s. In Switzerland it is permitted to euthanize the mentally ill. And the list continues to grow: prisoners serving life sentences are the latest addition. What begins in compassion, it seems, ends in eugenics."

Let me just note here that my contribution didn't once mention 'severe deformities', but hey.  I didn't even mention deformity by some other name as a relevant decision-making criterion. Making up stuff - steady as they write.

Coyne then claims that infanticide is increasingly the practice in countries where assisted suicide and/or euthanasia have been legalized. It turns that the published data cited in my paper show that the opposite is actually the case. Cases whereby the lives of newborns have been terminated whose continuing life-preserving treatment would have been futile have halved in the Netherlands (one of Coyne's straw men) since the mid 1990. Worth noting, virtually all of these life endings were not caused by acts of euthanasia, the act that excites Coyne so much. So, assisted dying does demonstrably not lead to a situation where infanticide is increasingly the practice, the opposite is the case actually.

Slippery slopes typically claim (as Coyne does) that as a result of the slippery slope more (rather than less) cases of something wrong occur. Coyne doesn't even engage the question of whether there might be good reason for why these newborns' lives were terminated by active means or by means of withholding life-preserving care. To him it's all bad. Nothing wrong with living life in a simple world unencumbered by facts. In this case, it's a world of make-belief, because these kinds of cases actually halved in number since the mid 1990.  Then Coyne moves seamlessly from infanticide to the mentally ill. Well, mental illness doesn't necessarily render you incompetent, legally or ethically.

Coyne's apocalyptic journey ends where it must end, in good ol eugenics. Case closed. Has he provided any evidence for this claim at least. Oops, no, that's where this rambling anti-euthanasia commentary abruptly ends.

Let me leave you with a bit more of Coyne's musings. He writes in the same piece, 'Advocates, impatient with such arbitrary distinctions as that between suicide and assisted suicide — of what use is the right to kill oneself, they ask, if you are physically incapable of carrying it out? — are nevertheless at pains to preserve the distinction between terminal illness and mere depression...' . I'm not a professional commentator, so let me just note with some bewilderment that I do indeed think that there's a different between what's commonly understood to be a terminal illness (say, late-stage cancer) and depression. They are simply different kinds of illnesses, one kills ya, the other one doesn't. Apparently, to a commentator on a roll it's all the same, kinda.

I'm always puzzled under what rocks major news organizations find these people. In the good old days they'd have had fact checkers at least that would have fixed (and re-written) Coyne's piece, today, they write and upload at manic speed. Oh well.

What should we do about severely impaired newborns?

My column from the Kingston Whig-Standard of May 10/11 2014

I was invited last week to be part of a panel discussing whether doctors should be permitted to actively end the lives of certain severely-impaired newborns with parental consent.

The host of the debate was a prestigious thoracic surgery society. The problem, simply put, is this: Every year a small number of fetuses are carried to term who have no reasonable chance of living a life worth living. They are so severely impaired that they will live a miserable, short life until they eventually expire. The good news is that, courtesy of prenatal screening, only few such births take place and the numbers are decreasing. We have some data from the Netherlands, where a few hundred out of about 200,000 newborns annually tend to fall into this category.

Well, the topic of our debate was a dicey one. We were given a scenario whereby the child’s prospect were sufficiently miserable that the attending doctors suggested to parents – among other options – the withdrawal of nutrition and hydration while providing palliative care to ensure the newborn does not suffer unnecessarily, as well as active euthanasia. The outcome of both scenarios: the death of the child. The jurisdiction where our case played out permitted the active ending of the newborn’s life.

One of the reasons for why we feel uneasy, to put it mildly, when we discuss what to do about severely impaired newborns, is, of course, that unlike adults in comparable circumstances the newborns do not have the capacity to make their own choices. In fact, the newborns’ developmental state is such that they don’t even have the capacity to desire continuing life. Would it make much sense to undertake significant surgery with the – unlikely but possible – result that the newborn might live a miserable life for another year or two before his impairment eventually catches up with him and kills him? Should we withdraw nutrition and hydration while providing palliative care so that he doesn’t suffer? Should we actively terminate his life to end his nightmare quickly and painlessly, as well as that of his parents? In our scenario the parents asked that their son’s life be ended quickly and painlessly. Should the doctors oblige them, was the question we were asked to address.

On the one hand we have – typically – religiously motivated opponents of euthanasia for severely impaired newborns. The distinguished theologian panel member who I debated argued that we should let nature takes its course, that we should provide clinical care not aimed at shortening the newborn’s life and that we should eventually let nature takes its course. The problem with the nature-takings-its-course argument is that we invented medicine to stop or delay nature from taking its brutal course. So, the letting nature take its course argument was a non-starter.

My opponent also argued that we should ask ourselves whether we would want to live in a society that terminated the lives of such vulnerable newborns. That’s a good question to ask as it forces us to think more carefully about the values that are at stake in such situations. If we merely go by the newborn’s quality of life and life prospects it seems indeed best to end the unfolding tragedy sooner rather than later, but probably a decision should be arrived at with parental consent as opposed to against the unfortunate parents. It turns out that one can reasonably answer the rhetorical question of whether one would want to live in a society that terminated the lives of certain severely impaired newborns if one held the view – as I do - that the newborn’s current and future quality of life is all that matters here. I could live in such a society where empathy for human suffering trumps religious conviction.

This view, in turn, requires us to rethink how we go about doing medicine, at least to some extent. It would require us to give up on what is called the sanctity-of-life doctrine in medicine and replace it with a quality-of-life ethic. There is no point in maintaining human life for the sake of it if that human life cannot enjoy a moment of its existence and is trapped in a never-ending cycle of immense pain and suffering. A quality-of-life ethics would not merely ask ‘do you exist’, but ‘do you have a life worth living?’, or ‘will you have a life worth living?’ We are not there yet, but significant changes in this direction are occurring in many countries.

My esteemed colleague also suggested that the infanticide proposition violated human dignity. It’s a strange thing this ‘human dignity’ rhetoric. If you were to ask yourself whether human dignity is important, you’d almost certainly say that it is. We all want to be treated with dignity. In my field, in medical ethics, you can find boatloads of declarations and guidelines having the dignity moniker included for good measure. Surprisingly though, when you look closer at it you will discover that this is about as question-begging a term as there ever was. It has actually no meaning in its own right. For Catholics human dignity means living by Catholic values, to Muslims it means living by Islamic values, to secular folks it could mean living by secular ethical values, and so on and so forth. Typically, when it comes to controversial ethical questions, human dignity is deployed to hide those actual values, mostly because they are likely to be more controversial than to just say ‘human dignity’. So, the long and short of it is, in the discussion about the severely impaired newborn, human dignity gives us neither action guidance nor action justification. A couple of years back, the judges on our Supreme Court, when looking at the euthanasia issue, also availed themselves, among other reasons, of the human dignity trope. It tells you something that both sides used it and neither side could show that their opponents just happened to use it wrongly. To the theologian I debated it was clear that euthanasia would violate human dignity because of his religious views on end-of-life matters. A secular ethics person could well conclude that human dignity was violated by not permitting euthanasia. So, we were non the wiser. Well, more to the point, we agreed to disagree.

What would your preferred policy on severely impaired newborns look like?

Udo Schuklenk teaches bioethics at Queen’s University. He tweets @schuklenk.

Infanticide Symposium in the Journal of Medical Ethics

To those interested in the continuing aftermath of the Journal of medical ethics decision to publish a paper endorsing infanticide, the current issue of the journal has a plethora of articles for and against the substance of said paper, as well as arguments on the question of whether the paper should ever have been published. It's a well-worth-reading collection of articles, including some of the best-known folks in bioethics and moral philosophy, among them (in alphabetical order) Tony Coady,  John Finnis, Robert George, John harris, Jeff MacMahan, Anita Silvers, Peter Singer, and a whole gaggle of other authors, yours truly included. Check it out, here. In case you are coming to this blog entry a bit late in the day, note that the link I've just displayed likely will lead you to what is then the current issue. Try to track the May 2013 issue of the journal on its website. My own paper, for what it is worth, reflects on the implications significant political pressures on bioethics journal editors have for the exercise of academic freedom. The piece is here.