Editorial: Assisted suicide - right to die or duty to die?

Recently, as I scanned the on-line version of the New York Times, a headline leapt out: 'Cuts in Home Care Put Elderly and Disabled at Risk'. It brought to mind similar debates closer to home about home help and bed numbers being slashed in Southland. The other evening I was chatting with an older woman, a casual acquaintance, who lives alone: "You know," she said, "I get the distinct feeling that as I am getting older I am becoming more and more invisible." Just days ago I talked with an elderly man in his eighties, a widower of three years who is struggling to come to terms with his increased level of dependency: "I feel that I am just a burden on my family," he said.

Where is this all coming from?

It is interesting that the debate about assisted suicide has arisen only in certain societies, namely affluent western societies. Why is that? It's a question that is rarely explored. I believe that the debate is a feature of those societies where certain assumptions prevail; where the dominant notion of personhood is individualistic and the dominant 'virtue' is the individual's right to make his or her own choices. This emphasis on autonomy and rights shapes us to see the world as belonging to those who are independent, strong and productive. Unfortunately, the price-tag that comes with this is that we struggle to deal with weakness and vulnerability. The sick and dying, the disabled and the elderly have, at best, a tenuous grasp on existence in such a world; they sit uncomfortably and precariously on the margins.

Those in favour of legalising assisted suicide argue that it is simply about recognising freedom of choice – the right of each person to make their own decisions. It is pointed out that those who do not wish to end their lives like this can still exercise their choice without interference. Why, then, should they impose their moral standards and beliefs on others, the argument goes. It seems a fair enough question ... but it's based on a misguided notion. We don't make our choices in isolation – we are affected by the underlying and mostly hidden assumptions of our society. So often we are unaware of the impact of these assumptions, even while they shape us; indeed, they are all the more powerful for being implicit as there is no reflection involved.

From this it follows that in a society in which the sick, dying, disabled and elderly are undervalued, the 'right' to die will all too quickly become a 'duty' to die. People who feel neglected, undervalued and invisible will understandably think they are a burden and will want to do the 'right' thing. While there will always be people wanting to exercise the choice to die at the hand of another no matter how much support they have, research suggests that their numbers are very small. As Madeleine Bunting notes (see her article in this issue), this needs to be weighed up against the 'cost' to society of much greater numbers of vulnerable people being exposed to the subtle and not so subtle forms of psychological coercion that flow from the underlying assumptions mentioned above.

Common sense and reflection tell us that the psychological pressures on those who are most vulnerable will only increase given the country's ageing population. Figures quoted in recent reports estimate that while we currently spend about 4% of our GDP on superannuation, that amount is expected to rise to 8% by 2030. At the same time, we know that healthcare spending will also continue to increase at a greater rate than our income growth. What is required more than ever is strong political leadership willing to address the financial and social challenges associated with ageing populations while ensuring a greater degree of protection for those most vulnerable.

The issue of assisted suicide cannot be debated as if it exists in a moral vacuum. We need to join the dots and make the connections between the debate about assisted suicide and all the interrelated issues. We need to think about assisted suicide within the bigger social, economic and political picture and more in terms of protecting the common good. Equally, as individuals and as a society, we need to recognise our complicity in fostering the perception held by many who are elderly and ill that they are a burden. At the same time we need to help them to accept the realities of greater dependence that accompany old-age and imminent death. We have the medical knowledge to deal with pain and other aspects of the dying process and the specialist care needed is available through the hospice movement.

In the interests of protecting the vulnerable members of our society, we should not legalise assisted suicide. We should instead deal with our deep seated fear of the dying process - this is where our real struggle for freedom lies rather than in the freedom to choose to demand that someone else end my life.

John Kleinsman
Director
The Nathaniel Centre
The New Zealand Catholic Bioethics Centre