Those not familiar with the literal slow-motion suicide taking place in the Netherlands and Belgium would do well to read up on the harrowing tale in Rachel Aviv’s “The Death Treatment,” from the June 22, 2015, issue of The New Yorker. In both countries, patients can be euthanized even if they do not have a terminal illness, and the “legal but rare” predictions have not held up, as Aviv reports:
In the past five years, the number of euthanasia and assisted-suicide deaths in the Netherlands has doubled, and in Belgium it has increased by more than a hundred and fifty per cent. Although most of the Belgian patients had cancer, people have also been euthanized because they had autism, anorexia, borderline personality disorder, chronic-fatigue syndrome, partial paralysis, blindness coupled with deafness, and manic depression. In 2013, Wim Distelmans euthanized a forty-four-year-old transgender man, Nathan Verhelst, because Verhelst was devastated by the failure of his sex-change surgeries; he said that he felt like a monster when he looked in the mirror.
In 2014, Belgian doctors were euthanizing five people every day. In Belgium’s Flanders, 1 out of every 20 people dies by physician-assisted suicide. Unique cultural and historical factors, Aviv notes, contribute to Belgians’ apparent comfort with this practice. But it is not difficult to spot an overlap, in underlying philosophy, with the assisted-suicide arguments that succeeded in Oregon, Vermont, and Washington, the three American states with legal physician-assisted suicide.
Interestingly, Belgium’s situation — which, as of February 2014, permits the euthanasia of children of any age, with parental consent — has discomfited at least one person on the left: Elizabeth Stoker Bruenig of The New Republic, who suggested on Friday that the “rights-based ethical framework” underpinning legal euthanasia (the so-called “right to die”) “doesn’t seem capable of handling the full ethical weight of euthanasia”:
A rights-based ethical framework measures whether or not actions are acceptable by whether or not a person has a right to do them: If a person has a right to choose when to die, then when a child or healthy person elects to undergo assisted suicide, they have done nothing wrong. This would appear to be the Belgian analysis. But there is clearly a level of moral analysis missing from these cases, most notably because the valuation of human life itself precedes all rights. (If human life doesn’t matter, why are we obligated to respect human rights?) People have a right to live, but they have more than that as well. There is an inherent value to living that is difficult to describe in terms of rights.
And there is an inherent wrong in snuffing out life due to nothing more than impulse or unhappiness or spite, which is also difficult to formulate in terms of rights. It makes sense to avoid the lifelong imprisonment or execution of minors (or anyone, for that matter) in terms of rights because living life with some reasonable quality is an inherently valuable thing; on the other hand, it doesn’t seem to make so much sense to declare death the kind of right that life is, because death does not share the same inherent value as life, and because the death of a person has an impact on other persons that can’t be fully fleshed out in the language of rights.
There are several phrases here intended to separate Bruenig from the Belgians: “moral analysis,” “inherent value,” “inherent wrong.” But the distinctions are more rhetorical than substantive. Take a look back at the second paragraph. After seeming to suggest that life qua life is valuable, Bruenig admits that what is inherently valuable is not life as such, but “living life with some reasonable quality” (emphasis mine). That is a fundamentally different proposition, and it makes possible Bruenig’s weak conclusion: “Especially when it comes to assisted suicide, there must be another layer of moral reasoning, one that asks: Should this person’s life be ending?” (emphasis hers)
To her credit, Bruenig seems genuinely bothered by what is taking place in Belgium, and her essay attempts to return some modicum of moral gravity to the question of life and death is commendable. But her argument fails to offer an alternative. Consider the question with which Bruenig ends: What if, after all of her sober moral reasoning, the answer to the question is, Yes, the patient’s life should end? Then, presumably, the patient should — and can — die. In other words, he becomes possessed of a “right” to die. Thus for all her discomfort with a “rights-based ethical framework,” Bruenig eventually must default to precisely that; even if she would limit the acceptable occasions for assisted suicide, she must implicitly concede that a person can justifiably kill himself. She has merely provided herself, in the interim, the psychic comfort of having bolstered that conclusion with a case-by-case cost/benefit analysis. There is nothing here that would prevent Belgians from doing what they’re doing; they’d just need to exercise a bit more circumlocution before pulling the plug.
If Bruenig really wants to dispense with a rights-based framework for thinking through the question of assisted suicide, she would be best served by pursuing her initial, unqualified assertion: “There is an inherent value to living.” Period. If the fact of life merely, not its “quality,” is innately valuable, it follows that persons and governments should seek to extend protections of life as broadly as possible, and that in doing so any notion of a “right to die,” except in the most extreme cases (brain death, for example), would be effectively rejected. This would, furthermore, provide a firmer ground for rights-based reasoning on other matters, about which Bruenig expresses concern.
Bruenig, commendably, seems to be writing from a conscience bestirred. The question is whether she will pursue her discomfort to its end — or settle for palliative answers.
UPDATE: Ms. Bruenig writes to say that she is entirely opposed to euthanasia, something not clear from her original post. As a matter of logic, I believe the argument I have presented still holds. But given Ms. Bruenig’s actual position, it can now be read as an extension of her argument, not an attack on it. I hate to have inadvertently misrepresented Ms. Bruenig’s position, and, finding that we are of one mind on this terrible subject, this is one occasion on which I am happy to apologize.