By Dr Wong Wee Nam
“You will not mistake my meaning or suppose that I depreciate one of the great humane studies if I say that we cannot learn law by learning law. If it is to be anything more than just a technique it is to be so much more than itself; a part of history, a part of economics and sociology, a part of ethics and a philosophy of life.”
– Lord Radcliffe, The Law and Its Compass
Writing in a recent issue of the Singapore Academy of Law Journal, National University of Singapore law professor Stanley Yeo and DPP Toh Puay San had proposed that a terminally-ill patient be legally allowed to kill himself with the assistance of his doctor.
They even crafted a piece of draft legislation on this.
The article could have been just a piece of academic musing or it could have been a controversial kite flown to test the winds of public opinion. Whatever it is, a piece of legislation such as this would be an ill-conceived one.
Unlike strict liability, eg, traffic laws, where no moral issues are involved and hence do not need an input from society, the question of euthanasia and physician-assisted suicide is a very complex one. This is not just a medical problem but a moral and ethico-legal problem that has far-reaching effects on the moral fabric of society. Thus the question is: how much feedback have the authors received from the community before they penned the article?
Yes, law sometimes needs to be changed, but it needs to take into consideration human values and societal mores. Lord Simonds in Shaw v Director of Public Prosecutions said, “The law must be related to the changing standards of life, not yielding to every shifting impulse of the popular will but having regard to fundamental assessments of human values and the purposes of society.”
He also said that the moral welfare of the State must also be conserved and protected: “In the sphere of criminal law I entertain no doubt that there remains in the courts of law a residual power to enforce the supreme and fundamental purpose of the law, to conserve not only the safety and order but also the moral welfare of the State and that it is their duty to guard it against attack which may be more insidious because they are novel and unprepared for.”
Thus any law on euthanasia without consultation with the community must end up as a flimsy piece of work.
What is Euthanasia?
We all live in a civilised society where there is general moral prohibition against killing.
Unfortunately there are now some people who find that active euthanasia and physician-assisted suicide is an attractive proposition. This is because medical interventions have, in many cases, made dying very unpleasant. People who have experienced the dying of an aged parent, relative or friend under such circumstances would naturally want death to come quickly and painlessly. It appears to be more compassionate that way.
However, active euthanasia and physician-assisted suicide is not compassionate killing. It is just a way of reducing demands on the compassion of the care-givers.
It is actually nothing more than a perverse way of managing suffering. We are merely trying to solve the problem of suffering by knocking out the sufferer.
The danger of active euthanasia and physician-assisted suicide is that once we accept killing, it just becomes a little easier the second time, and each time thereafter, until it becomes routine and mechanical, totally devoid of compassion.
The Slippery Slope
What then comes next? We will then start using pain, disability, suffering and, worse still, age and economic status to assess the worth of a human life and as reasons for the doctor to end his patient’s life. I hope this is not what Prof Yeo and DPP Toh have in mind when they said, “The rapidly ageing population calls for much more to be done than just the provision of advance medical directives and improved palliative care by the Government.”
Imagine how you would feel when you are old, poor, disabled, sick and an economic burden to have a doctor telling you to get off his uncaring face!
Once human lives become a commodity to be disposed off when it becomes too expensive to maintain, the rot of materialism will set in and the caring ethos of medicine will disappear.
In such circumstances, how are we to safeguard against tendencies to take the easy way out and the possibility of subtle coercion to put pressure on the patient to die?
The real danger of such physician-assisted suicide legislation is that it is the thin edge of the wedge towards a society in which the aged, the handicapped, the mentally deficient and the chronic sick will be faced with a duty to die so that they will not be a burden to society.
Is Assisted Suicide Morally Right?
It is obvious that allowing terminally-ill patients to end their suffering by killing themselves is morally wrong. Even the authors of the report appear to think so. Otherwise why would they want the suicide to be physician-assisted instead of allowing anyone else to do it?
This is because assisted suicide is not a morally correct thing to do and thus the suicide must be medicalised to make it morally right. Making suicide a medical condition and turning it into a medical problem would assuage the guilt of the loved ones. Without medicalisation anyone else would loathe to take on the role of the executioner knowing that it is morally not the right thing to do.
Even then this will not make euthanasia any more psychologically comforting. Ask anyone who has put a pet dog to sleep.
Impact on Medicine
The most humanitarian function of medicine is the relief of suffering and helping patients cope with their physical disabilities.
Active euthanasia and physician-assisted suicide, therefore, runs counter to the traditions of medicine and to the training, inclinations and intuitions of doctors and nurses who care for dying patients. Allowing active euthanasia and physician-assisted suicide will give the doctor the taint of an executioner. It will relieve the community of its obligation to provide good care.
If our doctors start to be pre-occupied with whether a case should be killed or not, then they have stopped doctoring. Instead of being dispensers of care our doctors will become dispensers of death.
Impact on Society
A community needs its aged and dependent, its sick and its dying because they show us the virtues of humility, courage, and patience — just as much as the community needs the virtues of justice and love shown by doctors, nurses and families, and they can only do so with the presence of the aged, sick and dying.
Thus the ability to invoke love, devotion, sacrifice and care is one contribution of the handicapped, sick and dying to the humanity. (To understand this better, readers should read “Soft Sift in an hourglass” by Dr Rosalie Shaw)
Once we have active euthanasia and physician-assisted suicide, human lives would be in danger of becoming commodities to be disposed off when they becomes too expensive to maintain. Would the lives of the terminally ill, the senile, the permanently unconscious, the retarded, the incurable, the chronic sick and even the aged then have any value?
Care of the Terminally-Ill
The challenge in the care of the terminally-ill is not to assist them to die but to make euthanasia unnecessary. It is to find ways to improve the comfort and quality of life for them and not hurrying to dispatch them on their way.
Hospices, for example, by alleviating patients’ pain and comforting them, allow the dying to live as fully and painlessly as possible until death. They also help to relieve the burden on the caregivers and help them to cope.
The palliative care that they provide has made it less common for patients to ask for euthanasia and physician-assisted suicide.
Though there are still many conflicts to resolve and a wide range of issues to be addressed, there is no need to end life prematurely and to try to control death.
The Meaning of Dying
Dying used to be an occasion. Death was a significant part of life. In the past, it was a public ceremony showing the living how to die with dignity. The dying person is surrounded by his loved ones and not isolated in a ward attached to machines and have tubes inserted into all his orifices.
Euthanasia and physician-assisted suicide seems to allow a merciful end to suffering and dying, but what it actually does is to increasingly isolate the rest of us from death’s significance to life. It will make us more likely to abandon the aged and the dying in order to make life easier for us. In the end, it will make us poorer as human beings.
We must, therefore, be careful not to allow the momentum of the right-to-die call to push us over the slippery slope so that the call for the right to die may eventually become a demand for the duty to die.
Conclusion
It was reported that the two authors had also argued that “it is realistic to assert that even with their prohibition, acts of PAS are being conducted in secret.”
In April 2009, Health Minister Khaw Boon Wan made it very clear that “euthanasia, which means helping the patient to commit suicide, is not what Ministry of Health (MOH) is promoting” and that MOH is actually “promoting palliative care for the terminally ill so that they, and their family members, will be able to cope with terminal illness with the least pain and being cared for in the most appropriate setting, which usually means the home they live in.”
With such a clear stand from the Minister, it is hard to believe our doctors can be so reckless as to conduct acts of PAS in secret. Maybe the authors know something that the Minister and the medical fraternity do not?
I always believe that law must have a human face. Thirty-five years ago, when I was studying law, I came across these words of Walter Scott, a lawyer himself, from his novel Guy Mannering and they have stayed with me: “A lawyer without history or literature is a mechanic, a mere working mason; if he possesses some knowledge of these, he may venture to call himself an architect.”
Materialism and selfishness have eroded our soul and made us a less caring society; let us not add on to it by allowing the killing of the dying.
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References
1. Lord Lloyd of Hampstead Introduction to Jurisprudence
2. L. A. Hart Concept of Law
3. Daniel Callahan Setting Limits – the medical goal in an ageing society
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Spiegel,
(1) Separation of Church and State is not the same as Isolation of Church from State. Also, it works both ways: The State is not supposed to intervene in the affairs of the Church. The affairs of the Church include the promotion and exercise of religious conscience.
(2) No problem: Take DCT as an implementation of Divine Intuitionism i.e. the religious conscience I was talking about.
But anyway, my point was that it is already part of the debate, whether you like it or not, or whether you approve of it or not. Trying to exclude it is enforcing your atheistic prejudice (which even the BBC is not fully innocent of). [And of course, I am validated in assuming you have that kind of prejudice since your handle is the name of an anti-religious German newspaper.]
(3) Hmm … you were the one who were saying opponents are “monolithic”, they frame things in terms of “zero-sum”, just two examples to boot. And you are still trying to claim that you did not caricaturise/stereotype opponents in any way? Carol, likewise, thinking that opponents have an “imaginary image of death”.
I didn’t claim to be representative of everyone on my side, but you made that assumption early on. And now, you are trying to turn the tables on me. How really smart.
(4) Below that is also said that only 20% of the physicians were willing to give lethal medication. And of course there is still Diginitas and the French woman.
(5) Because their position is an a postierori position from several millenia of experience. This does not imply that it is correct, just that it is logical.
Similarly, by talking about “ceding moral grounds” or “weaknesses of the proponent’s argument”, I am not dismissing their conclusions out of hand; to do so would be the ad Logicam (Appeal to Logic) Fallacy. Any illogic in their arguments does not necessarily prove the falsity of their conclusion. And I have not been as rash as to claim that.
(6) Naturally, that is a methodological starting point for taking any position – pro or anti – in an argument. I see no inconsistency there.
(7) “safeguards” are a form of “qualifications”. By invoking any safeguards in any situation, you are implicitly conceding that there is a section of that situation which does not adhere to your defense, and thus requires a sort of fence.
As my argument goes, since the topic of this debate is morality, all qualifications thus become ultimately moral qualifications. Thus, the proponents (descriptively) cede moral ground to the opponents. But the moral ground need not be so significant as to totally derail the relative morality of each position, if the proponent’s side is really very strong enough.
(8-9) Enlighten me: what is the difference between “bad” and “immoral” when used under conventional circumstances?
(10) That is the self-defence argument. And self-defence is only valid if there are compelling reasons to do so. Police can be charged for manslaughter otherwise. Soldiers are (theoretically) bound by the Geneva Conventions, which stipulate war crimes i.e. homicides done by soldiers for non-defensive purposes.
But even the self-defence argument does not make the killing in self-defence morally acceptable. What it makes acceptable is the ignorance of the immorality of the killing, that is to say “closing one eye”.
I fail to see how the Self-Defence argument can be applied to the Euthanasia debate, where the physician’s life is not at stake. I am sure that we can at least agree that the pro-camp is not arguing that the doctor needs to euthanise a patient to save the doctor’s life. (In fact, Euthanasia does not even save anybody’s life in the first place, so the question is moot to begin with).
(11) Yes, yes , yes, I agree with your analysis of the proponents’ position here. But the moment you start talking about “the next logical step”, you are making a question-begging assumption. You say “in some circumstances euthanasia can be moral”. You need to qualify this statement and prove that there is nothing inherently immoral about Euthanasia itself in the first place.
(12) Your argument on “totalising” beliefs incorporates a cognitive bias against the opponent’s side. Sure, the opponent’s beliefs are totalising, but so are the proponent’s. The proponent’s views are totalising on the opponent, because they aim to edge out the opponent’s views. The proponent creates an ideological straitjacket for the opponent to live in, just as much as the opponent does.
(14) Still with the cognitive bias. Why is there this normative restriction on the doctor? Also, why is the choice only “not to give palliative care”?
Your argument ignores the fact that Dignitas is willing to dole death to anyone who comes to their door, and it is the exemplar of the pro-side. Dignitas practically says, “As long as you can pay us 90 Euro, we will kill you. No questions asked.” Dignitas would consider the safeguards as “red tape”. (remember the French woman.)
Spiegel (last post),
So it was Dr Kerkovian then; whatever, doesn’t change my main argument here. And anyway, she was the one who was condescending first of all; Just giving her a taste of her own medicine.
Spiegel,
(17) The dichotomy is also problematic, because it implies that pro-life people have a less than favourable attitude towards choice, although you fail to see that because of your cognitive bias.
(18) This pretends naively that the only agents at work here are the physician and the patient.
In the larger scheme of things, we have the hospital, the government and the pharmaceutical industry (“Big Pharma”).
If the hospital forces the physician to act against his/her own conscience, then the physician has no free choice.
Given that Dignitas is the ideal for the pro-camp (you can dispute that if you wish), after successfully establishing the policy with safeguards, the pro-camp – or at least the more potent radicals (like Carol) – will seek to erase the safeguards one-by-one; after all, nothing triumphs individual choice.
Because Big Pharma controls biomedical research, they might (and probably would) choose to divert research from research into palliative care to research in euthanasia equipment. And so, anyone on the opponent’s side would have an unfair, involuntary disadvantage due to economics. Corporations with a heart? You wish.
What’s wrong with being pro-choice? My life and body is my own, and my existence brings about no responsibility except to those whom I have close relationships with in my life. If I communicate to them the boundaries within which lies my desire to have a peaceful end to my life (i.e. the extent of an illness), why do I not have the choice to end it as I deem fit? No higher power holds my body/soul/whatnot hostage. I am my own person.
Fear-mongering is distasteful. For you to assume that Big Pharma corporations, who already hold the knives to our throats apparently, will leap into research for euthanasia equipment (what the what?) is distasteful and factually untrue. I’d say that the research in actual medicine are what brings, and will continue to bring, the ridiculous amount money and power to the Big Pharma corps as we can see from their annual revenue statements. They search for Blockbusters drugs (big money-makers) that creates dependence on the part of patients who are alive, not dead.
Arix (@UK),
“So it was Dr Kerkovian then; whatever, doesn’t change my main argument here. And anyway, she was the one who was condescending first of all; Just giving her a taste of her own medicine.”
Yes, two wrongs make a right.
“(17) The dichotomy is also problematic, because it implies that pro-life people have a less than favourable attitude towards choice, although you fail to see that because of your cognitive bias.”
My point is that such labels are misnomers. The pro-life/pro-choice dichotomy as a label however is more damaging to the pro-choice side. The pro-life label is less so, since the position does proscribe a specific choice.
“Because Big Pharma controls biomedical research, they might (and probably would) choose to divert research from research into palliative care to research in euthanasia equipment. And so, anyone on the opponent’s side would have an unfair, involuntary disadvantage due to economics. Corporations with a heart? You wish.”
Pharmaceuticals go where the money is. But to make such a forecast is to jump several steps ahead. You make the unproven assumption that by legalising euthanasia, there will be a significant increase in the number of people who end up taking this option, enough to make it a lucrative specialty for a pharma company to invest in. And then for your worse-case scenario to work, this new money-making venture must be more lucrative than the palliative care market – so as to displace it.
Using the Oregon example – “The US state of Oregon legalised physician assisted suicide in 1998. During the first three years only around 2 people a month used this to end their lives.” From 1998 to 2009, only 460 people have committed PAS – making an average of 3.2 a month. To be exact, in Oregon’s case it is stated specifically that it is PAS (the patient is the one who must administer the lethal agent, the physician is barred from doing it). The statistics are available here – http://www.oregon.gov/DHS/ph/pas/docs/yr12-tbl-1.pdf
According to the US Census, Oregon in 2000 had about 742,565 people aged 55 and above. Lacking directly comparable year-to-year data, I shall make a very rough comparison here. In 12yrs of the Death with Dignity Act in Oregon, only 314 people aged 55 and above committed PAS – an average of 26.2 a year. By this very rough comparison (using 742,565 as a base figure, a number which should rise year on year since 2000), this means 0.0035% of Oregon’s elderly aged 55 and above committed PAS – a rather insignificant proportion from the perspective of a money-minded big pharma firm, considering the number of people receiving palliative care would logically be larger than those who choose PAS (for a bit more detail, 404 of the 460 were known to have enrolled for hospice care, or 88.2%).
Furthermore, from a rather macabre analysis utilising your logic, big pharma should logically desire a greater number of people choosing palliative care – that’s where the money is. You don’t make money if your patients die. Providing palliative care resources and equipment is far more lucrative than developing PAS and euthanasia drugs.
Therefore, I don’t think your worse-case scenario scare tactic holds much water.
Ryvyan,
(1) Your analysis is not wrong, but it is self-centred, or, if you prefer a technical term, ego-centric. You have no responsibility regarding your body and so on to others; that is correct. But the relationship isn’t symmetric. They have a responsibility towards you (and others).
I won’t make any comment about the “higher power keeping your soul hostage” bit, except to note that it is a strawman from an atheistic prejudice.
(2) Corporations make the most money selling to corporations. Hospitals, not people at pharmacies, determine the bulk of Big Pharma’s demand; they are the “Corporate” customers of Big Pharma.
Spiegel,
(1) Don’t get your point here.
(2) I agree, and disagree. I agree that these political labels are misnomers, but I disagree that “pro-choice” hurts more than “pro-life”. “pro-life” has now been equated with “anti-choice”, with a number of pro-choicers on internet forums actually claiming that “pro-lifers” want to remove women’s right to vote, which is totally off-the-boat.
And specifically in the Euthanasia debate, pro-choicers – including you – have distorted the “pro-life” position into a “life-at-any-cost” choice. The pro-life position is more accurately the “let’s bring a person’s life to its end naturally” position.
(3) Corporations’ greatest customers are other corporations. Big Pharma’s largest customers are hospitals and clinics, not individuals. So if hospitals and clinics are compelled by law to provide euthanasia equipment, then they will demand euthanasia equipment, and Big Pharma will supply to meet that demand.
(4) The patient administers the “medication” (more accurately, poison), but it is the doctor who provides it. The market is the relation between buyers and sellers, not between users and creators.
(5) That is assuming that every elderly in Oregon died from a terminal illness. Many people still do die of natural causes, you know.
Anyhow, what matters to a Big Pharma is how much of their product gets sold. Less than 1 million people might actually go for euthanasia, but hospitals might buy stocks for 10 million, just-in-case. So Big Pharma will sell stocks for 10 million.
(6) Au Contraire. It is much better for a company to sell more of a good than less. A company that sells a consistent stream of one-use items will survive much longer than a company that sells multi-use items. That is why even companies which sell multi-use items come up with frequent “upgrades” for their products.
Pharmaceuticals are a very lucrative industry because most pharmaceuticals are one-use. Big Pharma relies on the fact that once you are convinced of the effiacy of one medicine for a particular disease, you will be willing to get that medicine for that particular disease. Incidentally, “disease” has a very wide definition; Viagra is considered a pharmaceutical as well. This is also why Durex sells disposable condoms and why there has been a proliferation of cold medication in recent years. (There is a huge controversy over why Big Pharma is wasting time and resources producing unnecessary flu medicines while it is not devoting an equal amount to solving the AIDs Crisis in Africa.)
The marginal cost of creating pills and syrup is very small, although the fixed cost of R&D for their formulas is very huge.
Life-support systems used by palliative care, conversely, incur a high marginal cost of production due to their intricacy as individual pieces of equipment. (I can use a single vat to fill several bottles of syrup, or “freeze” several “cylinders” of pills, but not to create several smaller vats.)
Because the marginal cost of producing one-use euthanasia equipment is lower than the marginal cost of producing multiple-use palliative care equipment, economic sense dictates the production of euthanasia equipment/syrups/pills.
And political sense tells the Big Pharma that they can get away by sounding pro-choice, which would become the politically-correct position.
Arix (@UK),
“And specifically in the Euthanasia debate, pro-choicers – including you – have distorted the “pro-life” position into a “life-at-any-cost” choice. The pro-life position is more accurately the “let’s bring a person’s life to its end naturally” position.”
- The pro-life position is to “choose life over artificially-induced death everytime”. From the proponents perspective, it is at any cost since they believe that there are circumstances where no one can ameliorate the pain suffered by a terminally-ill patient. If this premiss is accepted, this is not a distortion. It becomes true. But the opponents position is to dismiss this premiss, as you have, and to claim that no pain cannot be ameliorated satisfactorily as long as we try, as you have asserted.
“Corporations’ greatest customers are other corporations. Big Pharma’s largest customers are hospitals and clinics, not individuals. So if hospitals and clinics are compelled by law to provide euthanasia equipment, then they will demand euthanasia equipment, and Big Pharma will supply to meet that demand.”
- You still have not proven that euthanasia demand will exceed palliative care demand. It is still an assumption plucked from the air.
“The patient administers the “medication” (more accurately, poison), but it is the doctor who provides it. The market is the relation between buyers and sellers, not between users and creators.
- I have no idea what you are on about here. I was just clarifying that in Oregon it is PAS and not euthanasia. And also, it is not accurate to say it is poison. Anything in overdose is poison – so is that Paracetamol you take for headaches. The drug used is an oral dose of barbiturate, which is a depressant used in general anesthesia – go look it up.
“That is assuming that every elderly in Oregon died from a terminal illness. Many people still do die of natural causes, you know.”
- Which is why I say it’s a very rough comparison. In any case, 0.0035% of Oregon’s elderly population at any one time including its healthy elderly is still a miniscule percentage.
And the fact remains that number of people receiving palliative care will be much larger – in the available stats up to 2007 and later in 2009, there are more people who received a PAS prescription than those who actually administered the drug to die, and some will die of their terminal illness before they decide to take the PAS drug anyway (30 died in 2009 from their underlying disease, after being prescribed).
For your scenario to have a chance at coming true, the euthanasia option must necessarily become just as popular, if not more, than the palliative care option – which makes no sense, since that reverses the chronology of the process of contracting terminal illness. And since where euthanasia/PAS is legal, it is designed as a last resort – it is not easy to get a prescription as there are many criteria to meet and rules to follow – the number of people who take this option, expressed as proportion of population or absolute numbers, is always going to be smaller than that who take up palliative care. And 88.2% those who do take up PAS in Oregon are in fact on palliative care in the first place before they decide to pursue PAS.
Assuming the illogical, that euthanasia does become something everyone chooses when they contract a terminal illness, and that they are legally allowed to do it without having to prove the intractable-ness of their pain and condition – so that they can just die without having to take up palliative care, it still doesn’t make sense for a big pharma firm to invest in PAS/euthanasia drugs, as you will see later – the basic idea is, there are already plenty of them.
“Anyhow, what matters to a Big Pharma is how much of their product gets sold. Less than 1 million people might actually go for euthanasia, but hospitals might buy stocks for 10 million, just-in-case. So Big Pharma will sell stocks for 10 million.”
- This is point where you demonstrate you have no idea what you are talking about. Your argument can also be applied to palliative care medication and equipment. Since that group will still be larger both in absolute numbers and proportion of population, that’s still where the money is.
Also, the amount of stocks bought up is dependent on the perceived potential demand – while you pluck random numbers from the sky, I have provided you with concrete data from Oregon, which show a very small market potential for investment. And as I will explain below, it’s not even the small market size that is a problem. It is the drug itself – it is not profitable.
“Because the marginal cost of producing one-use euthanasia equipment is lower than the marginal cost of producing multiple-use palliative care equipment, economic sense dictates the production of euthanasia equipment/syrups/pills.”
- How do you know that? Do you run a pharmaceutical firm manufacturing palliative care equipment and medication and euthanasia/PAS drugs?
Firms don’t even have to develop dedicated euthanasia/PAS drugs – it’s all there already. In Oregon, the PAS prescription is almost always an oral dosage of barbiturate – a depressant already used for various medical applications. And it works with the issuing of an overdose. And i.e. there is no other equipment to speak of.
This isn’t rocket science. Existing drugs already do the job as required, and there is nothing fancy and new here – i.e. it is bad for big pharma, since a pharma firm no longer can get a patent on the drug that would make it worth its financial while to invest R&D in it. And if you know the pharma industry, you will recognise the significance of securing a patent on your inventions. Firms that produce such drugs with a PAS/euthanasia application will continue to do so, just because they have other medicinal applications as well. From their point of view, it’s not a new frontier, it’s not new ground. It’s what they already do. Since the patent for such drugs will already either have been taken or even expired, there is no financially compelling opportunity to exploit. No firm will sink money to fund new PAS/euthanasia drug research because a) existing drugs do the job, b) to sink money on a drug that may or may not produce a better performance than existing drugs, when the market is miniscule and doesn’t promise significant returns on investment, is not something big pharma would do (new drugs take about a decade to develop).
On the other hand, palliative care is still a significant field of research – just google “palliative care research” and you get hits from various countries and organisations. Since it is a growing problem due to aging populations across the developed world, there is a strong market impetus to continue to develop and patent equipment and medication.
Sure, some of it will be govt-funded research, but Big Pharma don’t care where their income comes from – if it comes from govt-funding, they will take it. Gilead Sciences, the pharma firm with the patent on Tamiflu, doesn’t care if it’s govts who buys from them, in fact they love it – govts are the largest buyers of Tamiflu.
And finally, yes it is as you say “It is much better for a company to sell more of a good than less.” The real market is palliative care. And palliative care is NOT all about multi-use equipment. Single-use medication is also a significant outlay for patients on palliative care, as is training for hospice workers specialising in palliative care.
“And political sense tells the Big Pharma that they can get away by sounding pro-choice, which would become the politically-correct position.”
- Now you are undermining your own position, by conceding that it will become a politically correct position? That’s really weird. Half this debate is about public perception on PAS and euthanasia as well.
Gosh, this is a really long debate. :S
Spiegel,
(1) That is the same distortion I was mentioning. The “pro-life” position is to choose “naturally-executed death over artificially-induced death at any time” not “life over artificially-induced death at any time”. That is why “pro-life” in the euthanasia debate is even more of a misnomer than “pro-life” in the abortion debate (In fact, many pro-choice people tend to oversimplify Roe vs. Wade.) So, to clarify (yet again):-
“Pro-life”: Let them release/express all their pain and then die peacefully.
“Pro-choice”: Let’s kill them while they are feeling pain, so that they will die peacefully.
Feel free to reason differently, but from my perspective the pro-choice opinion seems to be a non-sequitur.
(2) That’s later on.
(3) PAS = Euthanasia. (Duh.) Whether or not the doctor administers the “medication” that causes the patient to die (e.g. at Dignitas), or the patient administers the “medication” (e.g. under Oregon Law), it is still the doctor who is providing the medication, i.e. acting as the ultimate administrator of the “medication”.
(4) But we are concerned about people with terminal illnesses, and people who are ill in general. Including the healthy people in your population count is a dishonest way to downplay statistics. It is the same as the government including foreigners’ pay in local income statistics, to make it seem like Singaporeans are richer than they actually are. Statistical Manipulation; Intellectual dishonesty.
(5) It is designed as a last resort now, but following the usual way that liberals (e.g. Dignitas) work, it won’t be in 30-40 years time, perhaps less. Organizations like Dignitas see Oregon Legislation as the “first step”, just like the LGBT movement sees the attainment of same-sex marriage as the “first step”. (And some people still wonder why the “religious right” “invents” the Gay Agenda; sigh.)
Your “always” is un-substantiated Wishful Thinking.
(6) Yes, I know about drug patents. But just like what they do with flu medication and condoms, they can do the same to anti-depressants. Think Barbiturate, and Barbiturate (Easy-Death) or Barbiturate (Kill-it-Yourself) or Barbiturate (Coffin-Relief).
The profitability exists precisely because all they need is re-branding, and no costly R&D. Do you really think all the kinds of Panadol are that different? It is a literal money-tree for Big Pharma. They have the added social-capital of being able to justify these warped provisions as part of their “civic duty”.
Profits = Revenue – Costs. R&D is a form of costs. It is really not rocket science, as you say.
And why there is a controversy is quite much because it is very easy for Big Pharma to obtain drug patents; they are practically patent-trolls nowadays.
(7) Palliative-Care Research is still a major field because Euthanasia is mostly illegal.
(8) You don’t see hospices being renovated each time a patient passes away, do you?
(9) No, I am not undermining my own position. I am saying that the moment euthanasia is written into law, it will attain a politically-correct status that it previously did not have. Undeniably, Appeal to Law is a logical fallacy, but most people are not as keen to notice that.
Arix (@UK),
“Pro-choice”: Let’s kill them while they are feeling pain, so that they will die peacefully.”
No. Firstly, it is the patient who must want to end his or her own life (patient agency is still key, even considering all practical external influences – in fact that’s what distinguishes it from homicide, although some opponents will fudge that, like you have). There is nothing non-sequitur about this position – in some cases, prolonging life in a way that harms the patient physically and mentally is not allowing a patient to die peacefully.
There is an interesting interview that touches on this with a German doctor who works in palliative care, as posted on another article on TOC – http://www.spiegel.de/international/zeitgeist/0,1518,685426,00.html
“PAS = Euthanasia. (Duh.) “
It isn’t “duh” under Oregon law. Oregon makes the distinction – PAS is specifically in the case where patient administers his or her own life-ending drug. Euthanasia is defined as the physician committing the physical act of administering death.
Arix (@UK),
“Yes, I know about drug patents. But just like what they do with flu medication and condoms, they can do the same to anti-depressants.”
Barbiturate is a depressant, not an anti-depressant.
“It is designed as a last resort now, but following the usual way that liberals (e.g. Dignitas) work, it won’t be in 30-40 years time, perhaps less. ”
I think the phrase “slippery slope” means nothing to you. Slippery slope arguments are weak, unsubstantiated speculation, nothing more.
“Organizations like Dignitas see Oregon Legislation as the “first step”, just like the LGBT movement sees the attainment of same-sex marriage as the “first step”.”
Of course they are first steps. How do you achieve your goal without making any initial progress? Regardless of their goals, everyone must take a first step, no? Can’t take the last step before the first, no? Republicans will say repealing healthcare reform is a first step to a better healthcare system, no? Because most people subscribe to a linear chronology of progress, no?
Do you believe in this fanciful right-wing concoction known as the gay agenda?
As for euthanasia/PAS medication:
Your fears are that big pharma a) “might (and probably would) choose to divert research from research into palliative care to research in euthanasia equipment” and b) “economic sense dictates the production of euthanasia equipment/syrups/pills” over palliative equipment and medication.
a) Existing drugs used for euthanasia are generic drugs. It is also safe to say no firm will invest money to develop a radically new euthanasia drug – so that it can patent it to maximise profitability – for reasons I have already state previously; it costs too much, takes too long, for little returns.
The only thing that might make sense to research into is new formulations of a generic drug, which it can patent. Once again, there is the problem – to do such research is to increase costs on a poor promise of returns – again no compelling reason for a firm to break ranks from the rest of the industry. The existing product works after all.
Generic drugs remain profitable for a firm because of low production costs, true. But pharma already profits off these drugs due to their current non-euthanasia medical applications – the frequency of their use in euthanasia/PAS is miniscule in comparison, even negligible. For a firm producing these drugs to decide to want to do further research and differentiate its product range, there would have be demonstrable and significant growth in the proportion of euthanasia applications in comparison to its primary uses – a rather unlikely proposition. Otherwise, there isn’t a good reason for a firm to want to develop a new formulation for such a specialist application.
Where there is a differentiation – based on present knowledge – is the method rather than the drug. The Dutch use lethal injection in a process that utilises two different drugs, which are also used in the US for capital punishment and are in all likelihood generic drugs as well. Dutch protocol cites intravenous administration as the most reliable and rapid method to carry out euthanasia. Perhaps this would become more utilised if governments did not restrict the method.
In both the case of Oregon and the Netherlands, the types of euthanasia drugs that can be used are dictated by the government – there is little sense in making differentiated products unless the government removes such restrictions.
If there is competition involved, it would be between the drugs and methods, rather than an opportunity to differentiate an existing drug by coming up with new formulations.
b) For palliative care market to be displaced, the euthanasia market would have to be much more profitable than the palliative care market.
The palliative care market is growing. Thanks to the aging populations in developed economies. The number of people needing palliative care, expressed both in absolute numbers and as a percentage of the overall population will grow alongside this process. More hospices will be needed, more staff need to be trained, more equipment and medication need to be produced – i.e. to say there is a market here, and it’s looming large.
The euthanasia market can’t become bigger than the palliative care market. People are not going to (and they are not going to be allowed to) choose euthanasia outright over palliative care. Rather, they will most probably already be on palliative care, before they decide to pursue the euthanasia option. If euthanasia is going to be offered, it is going to be the last resort – and this is the case where it is legalised. How can a last resort option be more frequently taken up than palliative care, which is the initial, and in most cases, default option that is taken?
“And why there is a controversy is quite much because it is very easy for Big Pharma to obtain drug patents; they are practically patent-trolls nowadays.”
Just because the legal process is “easy” doesn’t mean the development process is cheap and profitable.
“Palliative-Care Research is still a major field because Euthanasia is mostly illegal.”
How do you know it will be displaced if euthanasia made legal? You still haven’t addressed the fundamental problems in your premiss – that legalising euthanasia will necessarily lead to a growth of euthanasia patients significant enough to diminish the profitability of the palliative care market. You have not proven this, and indeed you can’t. You can only speculate with slippery slope arguments.
“You don’t see hospices being renovated each time a patient passes away, do you?”
No, because this is a ridiculous strawman. The real issue is aging population in developed economies. As I’ve already mentioned above – the number of people needing palliative care, expressed both in absolute numbers and as a percentage of the overall population will grow alongside this process. More hospices will be needed, more staff need to be trained, more equipment and medication need to be produced.
Spiegel (6 Apr),
The question is : why does the patient want to end his/her own life? And is this expression cognitive or non-cognitive?
I am not fudging any issue. Ultimately, it is still the physician/doctor who gives the patient the medication, and this fact stays whether or not the patient uses the medication. The distinction between PAS and euthanasia is a synthetic one.
And oh yeah, I guessed that you would b linking to your favourite newspaper at some time…
Spiegel (7 Apr),
(1) Fine, amend it then. The main argument doesn’t change.
(2) Slippery-slope arguments are valid if a causal link can be proven, and in this case the causal link is the liberal attitude that seeks to demolish constraints. And evidence is in how the LGBT movement has worked.
(3) Yep, first steps are essential to reach the goal. And that begs the question: “What is the goal?”
(4) I thought the same as you, that it was a fanciful invention of the “religious right”, until I happened to chance upon the Gay Liberation Manifesto; now, which Manifesto has no agenda? The GLM is available here:-
http://www.fordham.edu/halsall/pwh/glf-london.html
You can judge for yourself.
(6-8) Governments change, and especially frequently in democratic countries.
(9) But euthanasia is a substitute for palliative care, and a cheaper one at that. That is what you are missing out. It happened that Dr Wong wrote his article because MOH talked about healthcare costs; but it is equally possible for hospitals to care about costs too, and so implement euthanasia over palliative care. And as I said before, Hospitals are the large corporate customers of Big Pharma, so their demand will determine Big Pharma’s production.
What prevents that now is the safeguards which you and other proponents use to validate euthanasia law. But while a sizeable amount of people want euthanasia law with safeguards, there are some (e.g. Dignitas) who think that those safeguards are too onerous, and want to reduce them. And these groups will do so, after euthanasia law is globally-standardized.
We see that in the abortion debate. Most people accept that late-term abortions are wrong, except in unique medical circumstances, but there is still a minority that shrilly argues otherwise. And this minority becomes active on policy debates for healthcare reform.
We also see that in the LGBT movement. First, they called for decriminalization of gay sex. There is a strong argument for that, so fine. After they did that, they then called for legalization of same-sex marriage. Conservatives protested, but the liberals said, “we need to accept them and that their defects are natural variations”. So fine, legalization of same-sex marriage passed. And then, they asked for the constitutionalization of so-called “homophobia”, whose definition is so vague as to be laughable (ref Journal of Applied Philosophy, 2002, Issue 16, Vol. 3, p202), and naturally becomes a weapon against their critics. And if you look at the GLM, you read a rant against “compulsive monogamy”, a requirement to reshape society according to what they think is best, and so on and so forth. Going along all that, you see why the “religious right” and even the moderates are up in arms.
There is a Chinese saying, “de chun jin ci”: Get a metre, ask for a mile”. And that is exactly what the radical abortionists and the LGBT movement have done. That’s not a slippery slope; that is history. Since the people pushing for euthanasia to be legalized have the same general attitude, mapping the results isn’t a slippery slope at all.
Arix (@UK),
“(4) I thought the same as you, that it was a fanciful invention of the “religious right”, until I happened to chance upon the Gay Liberation Manifesto; now, which Manifesto has no agenda?”
Dear sir, should I go dig up all the constitutions and agendas of the various right-wing militia, tea party groups, religious zealots, conservative think-tanks etc. and present them to you as if they represent a cohesive, singular, monolithic movement, with a unified singular agenda?
How you can so readily accept such material as proof is beyond comprehension.
Even where there is an agenda, must an agenda necessarily be bad? Gandhi had an agenda for Indian nationalism, Martin Luther King had an agenda for civil rights, Nelson Mandela had an anti-apartheid agenda, the list could go on.
“Governments change, and especially frequently in democratic countries.”
So? That doesn’t mean the euthanasia standards and methods will radically fluctuate with the change of governments.
“Yep, first steps are essential to reach the goal. And that begs the question: “What is the goal?”
“There is a Chinese saying, “de chun jin ci”: Get a metre, ask for a mile”. And that is exactly what the radical abortionists and the LGBT movement have done.”
These two statements are linked, so I’ll deal with them together. The goal for the LGBT movt is equality. The religious right rejects this as a premiss outright – in their minds, there can be no equality to speak of in the first place for those that they consider an abomination. The threat is perceived from a narrow religious-based framework – once again, religion cannot be allowed to dictate secular public policy. You appear to accept the idea that just because a threat is perceived, it is real.
I can’t see anything wrong with the LGBT movt seeking equality and ending discrimination. You could apply the same argument to the civil rights movement and the feminist movement – but no you wouldn’t, because that’s “racist” or “misogynistic”.
Finally, “de chun jin ci” – a heavy negative, normative connotation. How is this connotation justifiable without an assumption that the people are pushing an agenda you reject? How is this any valid an argument for you than it is for the other side? Surely it applies both ways – the left can just as easily throw such epithets the other way? Does it reflect on the relative merits of their political positions? Hardly.
“That’s not a slippery slope; that is history”
That is the history as written from the right-wing perspective. On the other side, this history is that of social progress.
“But euthanasia is a substitute for palliative care, and a cheaper one at that. That is what you are missing out.”
Dearie me, don’t you read other people’s arguments at all? I have argued that euthanasia is NOT a substitute, because it will not be allowed to be a substitute – that’s why it cannot displace palliative care. Euthanasia where legalised is instituted as a last resort. In the legal frameworks which allow it, it doesn’t replace palliative care, it is one possible option for someone who would already be receiving palliative care by the nature of their condition.
Instead, you conveniently ignore this problem and continue to build a grand argument tying tenuous knots with unsubstantiated slippery slopes.
Spiegel,
I don’t wish this conversation to turn into a mudslinging match, so please restrain your left-wing invective. Let’s reason like proper Centrists.
(1) You quite well argued that they were, at least for the Euthanasia debate.
(2) That wasn’t the point of this paragraph. The point was simply to show that there is an Agenda. The judgement comes later.
(3) Yes, the religious right, but not the religious moderates. I presented three steps to show that I was in favour of the first, accepting of the second, and only throw doubt on the third.
Oh yes, that tripe again to do with religion and “secular” public policy. *Sigh* A truly secular public policy should not be Atheist either, no?
Anyhow, put aside your liberal blinkers, and objectively evaluate whether the “religious right” does have any valid points. At least, from the GLM, they do. Since history aligns well with the GLM, and Gay Pride rather matches the “Gay is the Way” slogan in the GLM, the onus is on the liberal to show the ways in which the LGBT movement (and not just LGBTs in general) have deviated from the GLM, or why they will not seek to complete the mandate of the GLM, which goes further than both the civil-rights and the feminist movement.
The civil-rights movement focused on re-integrating racial minorities into society two-way, so that each racial group gets to learn something from other racial groups. It was not for the purpose of promoting a counter-imperialism.
The feminist movement sought to end domestic oppression and the oppression of domesticity. Some radical feminists eventually forgot the first, but most feminists still remember it. But even the radical feminists were striving for moral and socio-economic equality.
The GLM, conversely, clearly perceives the LGBT people as being superior to non-LGBTs. And that is where the LGBT movement differs from both the civil-rights movement and the feminist movement. Even Dr King’s family is divided over the issue whether Dr King himself would have endorsed gay rights. Many African-Americans regard it an affront to compare the LGBT movement with the civil-rights movement. And as the AWARE saga demonstrated, even feminists are not of one mind when it comes to LGBT issues.
Note: I did not argue that the “religious right” is totally correct, just that they have some valid observations.
(4) I do not see anything wrong with mere equality either. But enforcing your own moral system on others while not allowing them to do the same, that just sounds hypocritical. You would agree, if you didn’t have liberal blinkers on.
(5) Well, the left wouldn’t have a justification to throw this particular epithet, because it is quite clear, historically, that it is the “religious right” who have been forced to concede ground to the anti-religious left.
Since you are the one who rails against “totalising” agendas, I don’t see why you shouldn’t rail against the “totalising” agenda of the GLM (and it’s quite explicit too). Just to be fair, no? Or perhaps, you have a cognitive bias towards liberalism.
(6) I stated historical fact, fact which the right and the left then interpret in their own ways, the right as “moral degradation” and the left as “social progress”. I was merely trying to explain how the right came to their position, not giving full endorsement of it.
Incidentally though, without liberal blinkers on, how can you tell whether the left-wing interpretation of “progress” is more valid than the right-wing interpretation of “decadence”? I ask this as a Centrist. I would argue that you need to fuse talking points together from both sides to find a proper solution that will remove (instead of suppress) the LGBT people’s societal alienation and respect the “religious right’s” social concerns (instead of haphazardly dismissing them as “bigots”). This animus between LGBT and “religious right” is turning the LGBT into a pawn for the culturally-destructive New Atheism, which is not good ofr any society in the long term.
Your comment merely betrays left-wing arrogance.
Anyhow, this is off-topic. Let’s return to the topic at hand.
(7) I read. In fact, I read and reply paragraph-by-paragraph. What do you think the numbers in my post are for? For show? No, they are used to indicate which paragraph the particular section is referring to. So , (7) here means “paragraph 7″ of your original post.
I know, I got your argument, and I disagree with it. I know what it is currently; I am arguing that it will not stay that way beyond the near future. Incidentally, need I stress to you that the French lady was not receiving palliative care by the nature of her condition? So apparently, your “one possible option” thesis doesn’t apply to Switzerland and Belgium.
In case you didn’t realize, I mentioned the Abortionists and the LGBT movement in order to justify my claim of the liberal attitude. I linked this to Dignitas and the French lady (whom you always seem to forget) and hence argue, that unlike what you choose to claim behind your liberal blinkers, my slippery slope is not “unsubstantiated”.
But because you are so concerned with bashing religious opinion, you failed to see my argument at all.
And I repeat: I am arguing from a respectable Centrist position, not a right-wing (or left-wing) position.
A Secular Policy = An Atheist Policy?????
Ok.. I’m tickled.
wui,
You obviously didn’t get my point. My point is that a Secular Policy is not equivalent to an Atheist Policy. So Atheists should not be cloaking Pro-Atheistic, Anti-Religious policies under the bandwagon of Secular Policies.
Arix (@UK),
***“I don’t wish this conversation to turn into a mudslinging match, so please restrain your left-wing invective. Let’s reason like proper Centrists.”
— The irony.
***“Anyhow, put aside your liberal blinkers, and objectively evaluate whether the “religious right” does have any valid points. At least, from the GLM, they do. “
— The GLM is a manifesto produced by the GLF in the 1970s, a group that doesn’t even exist anymore! Why? Because it split into numerous splinter groups – due to ideological differences. Get this, ideological differences!
You say that the liberals must prove that current LGBT movements are not trying to fulfill the motives of the GLM. Seriously? Why can’t you judge each LGBT group’s aims and methods on their own merits? Why must they be lumped into a cohesive whole? Why do you consider the GLM the absolutely representative manifesto?
Are you going to go back to Michael Foot’s 1983 election manifesto to make a point about New Labour and Gordon Brown, about how Tony Blair and the third way is really the disguised path to old Socialism? Are you going to go back to The Communist Manifesto to critique the present day Chinese Communist Party, the Nepal Maoists, the Cuban government?
***“Note: I did not argue that the “religious right” is totally correct, just that they have some valid observations.”
— Valid only because of a preposterous premiss that an entire equality movement can be defined in a single document penned by a single group within that movement.
***“Incidentally though, without liberal blinkers on, how can you tell whether the left-wing interpretation of “progress” is more valid than the right-wing interpretation of “decadence”?”
— You make a point citing the right-wing perspective, so I present you the opposite. I did not say it is more valid. The point is, you are basing your argument of a slippery slope on the right-wing perception of a liberal track record of pushing a socially damaging agenda to its extreme. If your position is truly centrist, rather than the disguise you are pulling, then you would not make this argument. You are the one who privileged one perspective over the other with no good justification, and used it to make an argument. Oh, the irony.
If you want to make a centrist argument about how you think euthanasia proponents will come to enact the kind of damaging euthanasia legislation that you think they desire, then you should appeal to empirical evidence without selective borrowing of partisan rhetoric – i.e. demonstrate that proponents desire legislation that will make euthanasia not a last resort but a direct substitute for palliative care, but not by borrowing a right-wing narrative of liberal social destruction. Not by predicting what Dignitas would want in 30-40 years time on a projection based on a right-wing narrative.
***“But enforcing your own moral system on others while not allowing them to do the same, that just sounds hypocritical. You would agree, if you didn’t have liberal blinkers on.”
— How am I the one enforcing my own moral system on others? A secular policy is precisely designed to allow the different belief systems and moralities to co-exist. I’m not saying religious people can’t live by their rules and follow their own moral compass. I’m saying everyone has their own moral compass, and policy should not bar people from following that, as long as they don’t infringe on someone else’s ability to do the same. Banning euthanasia outright infringes on the ability of certain groups of people to follow their own moral compass. You are reversing the polarity of the situation.
***“My point is that a Secular Policy is not equivalent to an Atheist Policy”
— Of course it isn’t. An atheistic public policy would preclude religious space in society. But that is not what I was arguing for. Secular policy would be one where the faith and non-faith belief systems would not be allowed to impose itself on society. In which case, religious precepts cannot be accepted as a basis for policy formulation – it does however have to considered to ensure policy does not infringe on the religious groups right to practice their faith.
Also, what French woman? For all your references to “Dignitas and the French woman”, I’ve gone back to the previous page of comments to find this example, I can’t seem to find it. Where is it?
***”In case you didn’t realize, I mentioned the Abortionists and the LGBT movement in order to justify my claim of the liberal attitude. I linked this to Dignitas and the French lady (whom you always seem to forget) and hence argue, that unlike what you choose to claim behind your liberal blinkers, my slippery slope is not “unsubstantiated”. But because you are so concerned with bashing religious opinion, you failed to see my argument at all. And I repeat: I am arguing from a respectable Centrist position, not a right-wing (or left-wing) position.”
— Oh no, I do realise what you are doing exactly – it is a hypocritical gesture. You mention those movements to justify a claim about the liberal attitude, yes – by borrowing the right-wing narrative. See, the right-wing people say the left are like that, and it seems reasonable – therefore, the left-wing are like that. And if left-wing people are like that, this will happen if we let them legalise euthanasia! But oh no, I’m centrist, so don’t blame me, I merely stated the truth!
Three words on that – ‘poisoning the well’. The only thing this line of argument demonstrates is how the right-wing perceives and represents the left-wing. But you use that, turn into objective observation of fact and then use it predict future attitudes, demands and goals of the left-wing and euthanasia proponents, and from there predict the consequences. Assumptions built upon assumptions built upon assumptions.
Arix,
hmm.. ok. Sorry for that misunderstanding.
I do not think atheists cloak pro-atheistic, anti-religious policies under the bandwagon of Secular Policies though.
Anyway, that would be another subject, discussion and I do not wish the digress from the main topic here.