I disagree in whole or in part with most of the articles published in Public Discourse. Yet, read it I do. Admittedly, I started reading it when my daughter became its managing editor. I continue to read it and other media that are often at odds with my liberal and humanist sensibilities precisely because they offer thoughtful views that differ from my own. For, as a wise friend once told me, it is impossible to improve the world without exposing ourselves to the viewpoints of those who think differently than we do.
And that is precisely why I write this review of Assisted Suicide: The Liberal, Humanist Case Against Legalization, by Kevin Yuill, for Public Discourse while being fully aware that the viewpoint of most PD readers is decidedly conservative and often religious. This book is neither—and that’s one reason why it is important.
In the fight to prevent the legalization of assisted suicide, religiously informed reasons for opposing the practice may not persuade the average undecided American. If you want to reach these people, who face a deluge of “compassionate” arguments in favor of “death with dignity,” you need clear, compelling reasons that undercut the supposed wisdom and humanity of assisted suicide.
This book provides those reasons with both quantity and quality.
Yuill does an excellent job explaining how those promoting assisted suicide have been able to get the general public to discount conservative arguments against the practice. As previous Public Discourse articles have noted, one key tactic has been changing terminology surrounding the practice and thereby shifting both explicit definitions and implicit, unconscious perceptions.
Until the 1970’s, for example, the movement used the term “euthanasia.” After the ethnic cleansing of World War II, that term’s public support went into a steady decline. So, the people and organizations that had been advocating euthanasia stopped using that term and substituted “assisted suicide” instead. Its sister term, “physician-assisted suicide,” further sanitizes the act by transferring responsibility to a clinician, at least semantically. As I will discuss in a moment, the danger of this diffusion of moral responsibility forms the core of Yuill’s strongest argument against euthanasia.
More recently, a new term has been judged more palatable to the public: “assisted dying.” This shift is significant. As Yuill points out, suicide is legal, but it is also widely considered immoral. Yuill quotes G.K. Chesterton, who wrote in Orthodoxy:
Not only is suicide a sin, it is the sin. It is the ultimate and absolute evil, the refusal to take an interest in existence; the refusal to take the oath of loyalty to life. The man who kills a man, kills a man. The man who kills himself, kills all men; as far as he is concerned he wipes out the world… There is a meaning in burying the suicide apart. The man’s crime is different from other crimes – for it makes even crimes impossible.
The new term, “assisted dying,” avoids bringing up such painful and morally problematic associations. Pro-euthanasia activists attempt to deflect attention from the moral implications of suicide by injecting a different set of moral concerns into the debate. They couch their arguments in terms of “rights,” arguing that if people have a right to life, then they also have a right to death “on their own terms,” including when and how to die. They talk about intractable pain, about the desire not to be a burden on others, and about the dehumanization that sometimes comes at the end of life from conditions such as dementia. In general, they paint “death with dignity” as an altruistic, even heroic, choice to lessen the strain one places on one’s family and friends.
Does the Slippery Slope Argument Work?
Yuill details the history of the euthanasia debate, gathering and scrutinizing the experiential evidence that has resulted from its legalization in various countries and states. This is a great service to those who have long been arguing against assisted suicide based on the “slippery slope” argument. He argues that the dire situation predicted by slippery slope arguments
is demonstrably not an immediate practical problem. Set out as such, it can be demonstrated to be false using the material made available in the excellent Oregon Death with Dignity (DWDA) Reports. In Oregon, at least, there is no sign of increasing deaths or any good evidence that anyone has been euthanized against his or her will. Just as with the sanctity of life, there is a real basis to the slippery slope argument but it deals with intangibles rather than practical issues. Allowing assisted suicide might very well lead to a more casual perspective towards killing but it is difficult to marshal evidence to prove this . . .
Yuill concludes that it seems unlikely that the passage of an assisted suicide law would lead to a large number of deaths, nor of the lax application of the standards the laws set, nor of unwilling participants becoming ensnared in the assisted suicide machinery. He quotes Raymond Tallis, who notes: “Contrary to expectation, those patients who receive assistance in dying tend to be ‘feisty,’ self-assertive characters from higher social classes, not the cowed, complicit, vulnerable, frail individual that opponents to liberalization worry about.” He continues, “there is little to support the worries expressed in the New York Task Force’s 1994 report. Proponents can simply point to the evidence showing that the number of assisted suicides is fairly stable, that there is very little evidence of coercion or that the practice is becoming widespread.”
It is precisely because this position and supporting evidence are at odds with most conservative examinations of the subject that Yuill urges moving the slippery slope argument to a secondary role when PAS is debated. As Yuill puts it, this argument
contains a conservative core based on unforeseen risks, something that holds little appeal to mainly liberal proponents and, it seems, the majority of people in the UK, Canada, Australia, New Zealand and the United States.
Relying on the slippery slope argument will only lead to a battle of dueling statistics. In Yuill’s view, PAS opponents can righteously employ such arguments and continue to fail, or they can prevent PAS legislation from passing by making more compelling philosophical and moral arguments.
In addition to questioning the statistics upon which they are based, Yuill observes that slippery slope arguments often depend on “what if” scenarios, in which euthanasia opponents tell horror stories that—even when true—may lack clear documentation and hard evidence of abuse. In these contexts, euthanasia proponents can often come off as the rational, calm, and caring ones. They counter negative storytelling by painting scenes of unspeakable suffering that is eased by compassionate “care.” In the end, this leads to approval of legislation as long as it seems to contain rigorous safeguards against abuse.
Yet Yuill does see one valid and useful aspect of slippery-slope arguments: They can be used to emphasize the danger euthanasia poses not to individuals, but to groups, such as the disabled. Here, he says, opponents should concentrate on the message that PAS legislation sends rather than its effects in specific cases. As an example, he cites laws such as Oregon’s, which stipulate that an applicant be in the last six months of life. While that clause might be intended to protect the individual, it ultimately devalues the end of life and those whose condition is compromised. It says to such people—and to society at large—that some lives are worth more than others.
Liberal, Humanist Reasons to Oppose Assisted Suicide
If Yuill does not believe that its legalization would lead to widespread abuse of the practice, why does he, as a liberal humanist, oppose assisted suicide? There are a few reasons. Chief among them is that it involves the government in that most intimate of life’s processes: death. By creating a mechanism where an official panel is empowered to grant an assisted suicide request, what has been shared only with health care providers and chosen intimates—including a person’s physical, emotional, and mental health history—becomes fodder for a bureaucracy that is probably far from private and not accountable to the requestor.
Legalizing physician-assisted suicide removes moral responsibility for what is usually an immoral act from the person committing suicide. The process spreads out and weakens this responsibility, transferring culpability to a faceless government bureaucracy that depends in turn on various health professionals who are asked to make a pronouncement about the fitness of the patient for the requested service. The fact that they are merely carrying out orders from above tends to absolve those who physically assist the suicide from any remaining moral responsibility.
Yuill’s argument converges with those commonly made by conservatives when it comes to the devaluation of certain human lives. Since legislation usually stipulates that the patient seeking assistance in committing suicide must be near the end of life, or that the usefulness of his or her life is at an end, Yuill argues that such laws devalue all lives that are nearing their end. Old and feeble? Demented? Heavily dependent on others for physical support? Then what good are you to yourself, to those who love you, to humanity? Why shouldn’t society support your decision to “take one for the team” by ending your life?
Yuill also points out that government has an additional, economic motive for supporting assisted suicide: It saves tax dollars. Many last-ditch treatments are very expensive and tend to have diminishing chances for success. By encouraging, or at least enabling, individuals to be assisted in ending their lives prematurely, public and private insurances can expand their efforts to control costs through the delay and denial of more expensive treatments in favor of PAS. Might that cloud the judgments of legislators and their choice of whom to empower to decide assisted suicide requests in favor of those who would help save money? Now that PAS is being legalized in more and more states, and “end-of-life counseling” is an allowable charge for Medicare, the specter of Sarah Palin’s “death panels” seems to be edging into the realm of reality.
Challenging but Rewarding
On these topics and more, Yuill’s book is closely reasoned, finely documented, and backed by convincing evidence. To be sure, this is not light reading. The book’s dense prose is both emotionally and intellectually taxing—but it’s worth the read nonetheless. I especially recommend the excellent eleven-page Foreword by Brendan O’Neill. It succinctly summarizes Yuill’s work and the main arguments presented in the book.
Those who are invested in the fight against legalization may want to keep Assisted Suicide: The Liberal, Humanist Case Against Legalization handy as a reference. For those who wish to delve more deeply into the problems and practices of assisted suicide—and especially for those who want to play an active role in resisting the rise of a reinvented euthanasia movement—this book is likely to remain a “go to” source for many years, providing a helpful way forward for conservatives and liberals who wish to work together to fight against the dehumanizing effects of euthanasia on our society.
Wayne Miller is a retired librarian and library director. His thirty-five year career spanned medical, school, public, and university libraries. He lives on a farm north of the Adirondack Mountains of New York, where he and his wife, a physician specializing in geriatrics, raised their five children. He recently ran for public office as a Democrat.