19 November 2009

from Lawrence, Pub Philosophy Group, Sunday meeting: Do we have a right to assisted suicide? + NEWS

Essay + Exhibition by Alfonso and Maths Tertulia by Miguel

Dear friends,

This Sunday we are discussing: Do we have a right to assisted suicide?

In my essay, which turned out to be rather long, I tried to identify the real philosophical issues and not to do a rehash of stale arguments.

In the meantime Alfonso and Miguel would like to share these messages with you:

From Alfonso:
Amigo Lawrence:
Te intento enviar el catálogo de la exposición en Cuenca, el día 26 de Noviembre, en la sala Pilares, calle Hermanos Valdés 12, inauguración a las seis de la tarde.
Un abrazo

I have uploaded the photos on to the blog and the link is this;

From Miguel:
Estimados tertulianos,

Por razones de trabajo, Roberto Álvarez Chust se ha visto obligado a aplazar la conferencia prevista. El programa queda modificado como se adjunta.

Aprovecho para enviaros este enlace, que muchos encontraréis de interés: http://gaussianos.com/

Saludos y hasta el próximo Martes,


PROGRAMA DE LA TERTULIA DE MATEMÁTICAS del próximo Martes 24 de Noviembre

Proyección de "The Genius of the East" (en inglés), la segunda parte del documental "The Story of Maths".



I have also posted this on the blog:

see you Sunday


+++++++++MEETING DETAILS+++++++++
SUNDAY 6.00pm – 8.30pm at Molly Malone's Pub, probably downstairs----
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-metro: Bilbao : buses: 21, 149, 147

Tertulia with Ignacio and friends: Every Thursday, from 19:30 to 21h, at Moore’s Irish Pub, c/ Barceló 1 (metro Tribunal).

Let me put it this way: we know that the answer to this question has to be yes, what is extremely difficult is the philosophy that will get us there. Of course, by assisted suicide we are referring to those cases were we cannot halt the acute pain of some disease or when the quality of life is non existent because of some debilitating disease.

Indeed one of the biggest hurdles we face is to establish that this is a legitimate problem in applied philosophy. At face value this seems an issue that involves the medical profession, the law, politics and many would certainly want to include religion. Each faction claiming to have a major shareholding in the issue that they think they ought to have the last word. However, I would go so far as to say that assisted suicide is only a philosophical issue, pure and simple. It is not an overtly medical issue nor a legal issue, and certainly not a political or religious issue. But this is not to say that these disciplines do not have a role to play, on the contrary these disciplines will be the front line disciplines in the issue of assisted suicide; (however I doubt that religion can play a constructive role in the issue). What needs to be established, though, is the scope and the purpose of their participation.

Firstly, suicide and assisted suicide are emotionally charged issues and a big challenge to our mind set. The very same mind set that serves as a battle ground for those who have or think they have a controlling shareholding in our intellect and morality. This faction-play tend to result in looking after the interests of vested ideologies. Their main objectives being to fit the facts to a particular ideology at the expense of those who are actually suffering. However, conflict resolution can neither be resolved by conflict nor by absolute dominance. So basically, the discussion has to take place on neutral ground. A ground where ideologies have equal status and facts dominate the discussion.

And secondly, analytical philosophy is both a neutral ground for the debate and also has no extrinsic power or authority on others. This means that analytical philosophy can only question, analyze, investigation, clarify, interpret, but what it cannot do is adjudicate and impose.

Therefore, if we have the right to assisted suicide, this is not because it is a conclusion that suites philosophy, but because it is the conclusion we arrive at after careful deliberation. If anything is done it would have to be done by consensus.

A pressing philosophical issue is the language employed in the debate. The word suicide has gathered a an array of meanings and implications that can only muddy the situation. Suicide as a mental illness, product of depression, despair, freedom fighting or terrorism, honour restoration, peer copy cat and so on. And the context of the language makes the word look positive or negative. In western society the meaning is definitely negative.

However, what is clear is that suicide involves two personal faculties: a personal intention and a personal act both involving the idea of free will. With assisted suicide the context would be pain or quality of life. Therefore, as far as assisted suicide as a semantic term is concerned is both an oxymoron and a contradiction. The action is not done alone by the suicidor, the intention is influenced in a distressful setting and the stigma disregards the physical state of the individual.

Assisted implies, directly or indirectly, accomplice. Which itself has a very loaded meaning. We might also interpret assisted as helping, which most want it to mean, but this only reduces the sting since the meaning of helping depends on what we are helping with. Basically the term “assisted suicide” is itself so emotionally charged that it does not even come close to being a neutral term let alone an objective one.

In effect the term assisted suicide helps those who argue against this form of humane death. Maybe humane death might satisfy both the neutrality and objectivity criteria; this term might even apply to euthanasia and mercy killing (killing is the objection here).

Consider the neutrality of the term apoptosis [from Greek: a falling away, from apo- + ptōsis a falling (www.thefreedictionary.com)] which includes the meaning: A natural process of self-destruction in certain cells (www.thefreedictionary.com) and Apoptosis is also called programmed cell death or cell suicide. (www.medterms.com). Scientific terminology, although sometimes, archaic, tends to avoid the emotional implications is part of the semantic content for ordinary words. This brings me to a relevant question: do we need to have a common language to engage in the debate? Or will it be possible to communicate with each other using the discourse of our discipline?

An equally challenging issue is the following question: does a right imply a duty on someone else? And does a right mean that we must exercise our right whatever the costs and implications?

Instinctively we cannot infer a duty unless there was some intentional or implied relationship. While an intentional relationship requires us to consider the issue of free intention, an implied relationship is fraught with philosophical difficulties and actual dangers.

If a duty is imposed then can we seriously speak of this being a legitimate duty? I submit that for a duty to be legitimate it must be done within a rational and reasonable framework. Is imposing something on others reasonable and rational, and if it is would it make it moral? This only, however, gives us legitimacy but legitimacy does not necessarily lead to a reasonable or rational obligation. The obligation might not even be feasible.

Consider these two situations. We have a right to receive goods in working order when I go to a shop. This implies a duty on the shop owner to supply us with working goods. But what do we make of this situation, a society that cooperates gives its member the right to enjoy the benefits of that cooperation. Do we have a duty to cooperate? Never mind such questions as, will we cheat instead?

The idea of explicit or implied duty on someone due to a right we have is complicated. The closest we come to an implied duty is the "duty to rescue". This is also an informal name to a legal issue of whether we have a legal duty or obligation to rescue or offer help to someone injured or in distress. Many legal jurisdictions on continental Europe impose such a legal duty but then go on to give a huge list of exceptions which give the impression that this is quite a messy set of laws. In English and most US states with common law jurisdiction do not impose such an obligation on strangers (i.e. those people were there is no relationship established by legal precedent or law). However, common law does establish a duty to care if we do decide to help. Thus under common law the situation seems to be that if you decide to offer help you have to perform to a standard of what is reasonable. Thus if you give first aid make sure that you know what you are doing. (See Wikipedia “duty to rescue” for a brief introduction on the topic)

I personally think that at face value the imposition of a duty to rescue creates too much of an unnecessary burden on the common citizen. In my opinion such actions should be up to the individual but the state should have the obligation to teach its citizen on how to help. And certainly not by using such inefficient methods as exams.

Incidentally the imposition of a duty to rescue also indirectly introduces a language issue. In a way what the law is doing is to introduce a legal duty by using common language, you have a duty to help someone in need, but what that duty means and how to interpret the meaning via any acts done or not done depends on legal language. I submit that a reasonable person can make a reasonable calculation whether to risk crossing the railway lines to help someone, but I doubt whether a reasonable person can calculate what voltage that particular line might have to provide a defence in law. Of course, such questions are best answered by lawyers, but matters of language and issues of rationality are not the sole domain of lawyers.

The reason why the issue of duty matters is that when a person requests assisted suicide, and we have all come to the conclusion that this is the best course of action for this person, then the least we can do is to respect that decision. And respect here means fulfilment by all concerned and not just the medical staff.

In a way a right to suicide is absolute because it’s the most singular decision a rational person can make. As a consequence maybe there is no room for conscientious objection to assisting in an assisted suicide unlike say war or abortion. It fallows therefore that if we have a right to assisted suicide then we have to respect that right. But we must also be clear about the rights and duties concerned. Especially duties others would have.

Of course some jurisdictions already offer the right to assisted suicide Switzerland is one example. But the issue for us is not whether we have a right to assisted suicide today where ever we happen to live. But rather whether we, as humanity, have a universal right to assisted suicide. Maybe in the same way that we have a universal right to life.

Therefore, what kind of right are we talking about? I can identify three fundamental types of rights which might begin to help us understand the issue and these are : biological right, moral right and legal right.

What is a biological right and why and how does it involve our subject?

It is unfortunate that Western philosophy and social thinking has refused to consider the human being as first and foremost a biological system. And contrary to the yelling and gnashing of teeth by those who refuse to consider the biological person, and calling this approach reductionism, I would claim that the starting point for us is precisely the biological being.

By biological I do not mean natural rights. The kind of nature that past philosophers discussed for example on the issue of the social contract. By biological I mean precisely that: cells, genes, bacteria, digestion systems, pain nerves, eyes, etc

Of course I have no intention of writing a grand opus on assisted suicide, what this means is that I’ll probably be asking more question than I will attempt to answer. And one of those questions is this: is there a precedent at the cell level of suicide and assisted suicide?

What does cell biology have to do with our debate? The answer is simple, if it happens at the micro level, it will probably be reflected at the macro level. And in a way this can be proved a priori. For example the principles of information theory apply at both the micro level (removing information noise from digital devises) and the macro level (language). But we can also see this possibility in real life: having inherited genes for blue eyes, we can see their manifestation of blue eyes in people. Genes belong to the micro world, but blue eyes belong to the macro world: the world you and I inhabit. Don’t forget that the issue whether there is a causal connection between the micro and macro worlds is about quantum mechanics, but cell and genes are on this side of the fence even if they are close to the quantum world.

I think that the foregoing is useful enough to suggest that at the biological level there is enough evidence to suggest that suicide is a precedent at the micro level.

Consider the situation described in an article called: Why bacteria commit suicide (published in Science Centric, 3 December 2008 http://www.sciencecentric.com). “Some bacteria are suicidal' - producing toxic chemicals that kill them as well as closely related individuals. …. Despite killing its own creator the suicidal' poison provides an overall survival advantage, by preventing other bacteria of the same, or similar, species from invading the population.”

Or consider this headline from Nature: Kamikaze bacteria illustrate evolution of co-operation
Suicidal Salmonella sacrifice themselves to allow their clones to get a foothold in the gut.
James Morgan (Nature, 20 August 2008 http://www.nature.com/news/2008/080820/full/news.2008.1056.html : paid for article)

Of course, establishing the precedent of suicide in cells and bacteria does not necessarily mean that we have this faculty of suicide in us. But this is an empirical question and the fact that some people do commit suicide points at this faculty.

Also, doesn’t a biological feature in us come under the rubric of human rights? If we have cells and neurons that form a brain doesn’t this mean that we have a right to the functions of the brain? I agree with you that these are strange questions, but they are strange maybe because we are not used to asking them very often. If we have a right to free speech isn’t this because we have a biological system that can produce speech in the first place?

Likewise, if we inherited a biological system that triggered suicide doesn’t this imply that we have a right to activate that system when the need arises?

And to establish this biological right, we can argue that suicide, and by implication, assisted suicide, makes evolutionary sense under the conditions of our context.

In a nomadic hunter gatherer society it would have made altruistic and cooperative sense to exist (as with bacteria) the group if a person was not able to keep up with the group or put the group in danger.

The issue, I am inclined to hypothesize, is that the dilemma would have been whether the individual opted out (suicide) or was excluded (duty to die) from the group. There would have been no doubt about the outcome nor the motivation, what had to be decided was the when and the how. I am therefore convinced that assisted suicide would have been a reasonable evolutionary strategy for nomadic groups. But like all evolutionary strategies it would have made sense under these conditions: 1) the strategy conferred a benefit to the group and the suicidor (no pain, freedom to genetic relatives; 2) there was no way to alleviate or neutralize the pain or distress; 3) it was a strategy of the last resort since it would be a faulty strategy to allow suicide at the least mishap.

Not only is there a causal link between biology and the human being, but by default there is a causal link between biology and the moral being. Suicide in our context is no less altruistic and cooperative than sacrificing ones life style and welfare for the benefit of the family especially in small groups.

Having neutralized the question: is assisted suicide wrong? we are left with the question: what kind of morality and moral rights are we now involved with?

Ironically, the kind of moral rights we are left with are more complex than what is traditionally involved and have nothing to do with death: but rather all to do with life itself.

I have already established that there is strong evidence to suggest a biological right and although I have not discussed nor intend to discuss the issue there are also hints of a duty to die. In the moral world of rational beings there are clear cut rights with assisted suicide and clear cut duties which the rest of the community has. If suicide directly or indirectly benefits the community then we instinctively feel that there ought to be some duty involved.

But before I continue I want to address the main objection some people put forward against assisted suicide and that is we do not have a right to take a life. I quite agree, for example the legal profession will never sufficiently qualify to oversee capital punishment, because the profession will never be able to satisfactorily be able to answer the question: is the legal methodology beyond reasonable doubt? The standards to take a life are high but they have to be beyond reproach for the overseers. The issue is not that someone does not deserve to die for a capital crime (they may or may not) but that the legal method is not without reasonable doubt not more and no less than the scientific method. But this does not mean, as some self appointed moralist tend to do, that just because the scientific method is probabilistic than the scientific method does not work. It just means that our certainty will never be a priori. But this is the nature of the world and our capacity to knowledge.

Even taking one’s life is really not acceptable, but again this is not because there is some moral law written in the sky or in stone that says thou shall not kill thyself, but simply because no one should be put in a situation that they feel they have to take their life away. So I hear you ask, how can you square the binding right to assisted suicide and that life should not be taken away.

The anomaly arises because we assume that the statement “thou shall not take a life” or the question, “is taking a life morally wrong?”• are valid moral questions. If they are valid they are only naïve moral questions. The real moral question is what duty do we have to support and maintain life? And precisely, what ought we to do the assist those keep their life when they feel suicidal?

But “what shall we do……?” does not mean offer a pill or an analgesic, maintain the twitching and the uncontrollable spasms or jerking. What I mean is, how can we use our intelligence and resources to develop our understanding of the human body and to develop techniques that would take away the need for some to consider the very singularity question: should I commit suicide?

Therefore, the morality that involves our issue and by implication our moral rights, are based on two empirical questions:

1) Are we making all the resources we now have available to this person to alleviate their predicament? (e.g. Have they got access to the latest medicine?)

2) Are we using all our resources to develop techniques and understanding of the human body to prevent or to manage devastating diseases? (e.g. Are we investing in the right drugs?)

Moreover, the moral issue is not really about life per se but about the quality of life. We are not really interested in keeping a mass of biological matter twitching and jerking uncontrollably, but rather to keep a human being alive with dignity and purpose.

In a small group, such as a group of hunter gatherers, someone who opts out of the group because they are not fit enough to help the group are doing more than just reducing the number of the group. But rather they are releasing the group to purse their lives without hindrance or use of resources. In any language that means they giving give back to the group their quality of life.

So the first moral right a suicidor has is to receive all possible help and access to resources to mitigate against the perils they are facing now. And because, at least in theory, a suicidor can be a help to the group, we have by implication a duty towards such a person. And indeed in many societies this kind of help is already made available in some countries (palliative care).

Our right to end our life is insignificant compared to our right for life. When it comes to life there are two important utilitarian principle: the longer our life the better and the more quality of life the best possible option. There is also one categorical imperative: everyone has a right to longer life and a quality life.

Having just argued that legal systems do not have a moral jurisdiction over capital punishment, what is the scope of a legal system in the issue of assisted suicide? In real life, as I have already mentioned, some countries allow assisted suicide with a stringent screening process and some others try to offer a semblance of clarification to a rather muddy legal situation. (e.g. (England) DPP publishes interim policy on prosecuting assisted suicide, 23(09(2009 Crown Prosecution Service, http:((www.cps.gov.uk(news(press_releases(144_09(). Many countries, however, still prohibit assisted suicide outright.

The DPP document and I am sure similar policy and legal statements from other jurisdictions offer extremely comprehensive details on the issues and the dangers at stake. Of course, like such documents these can never deal will all possible cases, not because of a failure on the part of those who prepare such documents, but rather because such documents are about human beings. Uncertainty is part of the nature of human beings. I am even convinced that in the not too distant future most jurisdictions would have some form of assisted suicide. This situation would not, I submit, solve our right to assisted suicide, but the opposite, it will compound our problems about the topic.

But despite these issues, of a rather theoretical nature, I am sure most would agree that a legal system is a good platform to oversee assisted suicide. Incidentally, if you are still wondering, capital punishment is about taking someone else’s life, suicide is about taking our own life (and we are not discussing euthanasia).

If you remember when I was discussing suicide and hunter gatherers the issue was whether to opt for suicide or to be excluded from the group which basically means, a duty to die. It is one thing to be give a right, so to speak, to do something and another to be imposed with a duty to do the same thing. And although the issue of duty to die is one of the most important aspects in the debate, it also merits its own independent consideration especially when there are equally important issues directly involving assisted suicide. A duty to die raises import legal and political challenges which need not be discussed now since we are concerned with a right to suicide.

Policies such as those of the DPP focus on the protection of the individual, and quite rightly so, and of course such policies do not say that the “victim” cannot commit suicide because there is no such law (at least in England). But what is interesting for us is what is left out.

The public prosecutor does not mention things such as the “victim” receiving the best medical treatment or the best palliative care possible? Such documents do not concern themselves whether our resources are used to the best benefit for the sick and dying. But as I have argued these are the real moral issues in a discussion on the right to assisted suicide. Basically, can we prevent the need for suicide? And do we have a duty to work towards preventing that need?

Who is to protect the “victim” so to speak, from abuse of resources, irrelevant research, inefficient and even negligent distribution of resources that could be employed to help people who are suffering? And then of course there is the big picture, who is going to protect people in third world countries who are at this moment being abused and blackmailed by being recruited to clinical trials in exchange for basic medical care? Or maybe protection against crazy interpretations of informed consent that makes the whole medical profession practice defensive medicine as opposed to treating and researching human ailments. Of course, I’ll be the first to shout blue murder if I knew that information from blood samples I have to give during medical check ups is used against me or people like me to withhold medical treatment in the future. However, I would be equally disgusted if I knew that my blood samples were not used to further medical knowledge because someone somewhere might interpret the law in a way that was not intended to make a quick buck.

It seems to me that the easiest part of the debate is the actual dying; anyway nature will always follow its course. Of course, I do not pretend to have identified all the questions in the debate nor teased out the issues of such questions. But it seems to me that it is clear that a right to assisted suicide is no right at all unless and until we have been given the right to life. Dying without first having access to the best of life is but a death sentence.

Take care


from Lawrence, Pub Philosophy Group, Sunday meeting: Do we have a right to assisted suicide? + NEWS

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