This Friday, September 11th, the UK’s House of Commons will vote on an Assisted Dying Bill. This marks their first vote on voluntary euthanasia since 1997.
The aim of the bill is “to enable competent adults who are terminally ill to choose to be provided with medically supervised assistance to end their own life.” The bill would allow terminally ill adults to receive medical support in committing suicide, so long as they are deemed to have six months or less to live and are believed to be mentally competent. As campaigners for the bill explain, “any patient who requests assistance to die will need to be strictly assessed by two doctors each acting independently of the other and also a High Court judge.” Following this, “the dying patient would then have the choice to self-administer that medication at a time that was right for them.”
Although some time has passed since the House of Commons last considered the issue, the campaign for assisted dying has made repeated attempts to achieve its goal through other means. In both 2006 and 2009, similar legislation was put to the House of Lords and rejected. In 2010 and 2015, the Scottish Parliament also considered and rejected euthanasia proposals. Most recently, Lord Falconer proposed an almost identical Assisted Dying Bill in the House of Lords in June 2014, but time for debate ran out before the 2015 general election. Dr Kailash Chand, Deputy Chair of the British Medical Association, commented in 2014:
No change is not an option . . . Things are moving very fast: within two or three years we will definitely see a change in the law. Why are we trying to prolong unnecessary life? Today in the House of Lords we are seeing a battle between those who are seeking a constructive way forward and those who, rather than identifying appropriate safeguards, are seeking to place barriers in the way of dying people having control over their death. Whether the law should change seems to have been settled. It is about how the law changes.
Despite numerous complications—including difficulties in assessing who has six months left to live, what counts as mental incompetence, or what illnesses are categorized as terminal—a sense of necessity and inevitability surrounds the euthanasia debate.
A Principle of Change
What has brought about this sense of inevitable change for an issue previously defended against through a “universal declaration” of a “right to life”?
In a book published in 2009, the economics Nobel laureate Amartya Sen sharply criticized political theorist John Rawls’ widely influential theory of justice, arguing that it failed to live up to its promise of producing equality. As part of his criticism, Sen distinguished between helping people in terms of improving their capabilities, and helping people in terms of improving their choices. In 2013 I asked Sen at a public lecture if perhaps his concept of “capabilities” was actually being interpreted in the West as “autonomy,” which would explain its popularity. He replied that he certainly hadn’t meant it as autonomy. He compared the idea of choice for choice’s sake to choosing between luxuries such as tea and coffee; by contrast, he was interested in the basic necessities of the human person.
At first, the two positions sound very similar—surely what I can choose is also what I am capable of? The difference lies, however, in how the two positions value autonomy. To illustrate this, Sen gives the example of a disabled person, and asks the reader to evaluate the differences among these three situations:
Case 1: Person A is not helped by others, and she is thus unable to go out of her house.
Case 2: Person A is always helped by helpers arranged either by a social security system in operation in her locality (or, alternatively, by volunteers with goodwill), and she is, as a result, fully able to go out of her house whenever she wants and to move around freely.
Case 3: Person A has well-remunerated servants who obey—and have to obey—her commands, and she is fully able to go out of her house whenever she wants and to move around freely.
In terms of a person’s capabilities, Sen points out that the big difference is between case one and the other two. In case one, the person with disabilities is incapacitated by not receiving help and not being able to leave the house, whereas in both the other two cases she can move around freely.
However, for someone committed to autonomy rather than capability, cases one and two are actually the same. It is their difference from case three that is all-important. In other words, seen in terms of what one can do without being dependent on the goodwill of others, there is no difference between being unable to leave one’s house and being able to leave one’s house while reliant on either a social security system or friends and volunteers. For someone committed to autonomy, only case three satisfies: full choice by overcoming one’s disabilities through an absolutely unrestrained exercise of choice, independent of anyone else’s goodwill.
Our society’s movement toward case three as the minimum standard lies at the heart of the campaign for euthanasia. Those who provide palliative care may have entered the profession with intentions of loving accompaniment and charity. Now, they’re told that they are fostering a culture of dependence that runs directly contrary to society’s supreme ideal: autonomy.
For the golden age of volunteers—those who gave their lives in World War II and those who went on to rebuild Europe in the 1950s—a habit of charity means they will refuse to demand choice for choice’s sake. Faced with modern society’s prioritization of autonomy, they can only reply that they did not mean to be a burden, and that if the only health care is one where medical professionals must obey their autonomy, they humbly “choose” to revert to being without.
Our Society of Autonomy
The “golden age” of selfless denial is running out. Younger generations have taken up the demand for autonomy with alacrity. The basic argument is that choice should dictate our lives from beginning to end. At its core, it is an argument that resents discussion of the meaning of life, or even the meaning of pleasure and pain. This is consistent, because our general preference for choice over other goods requires that we avoid affirming through law goods that have an inherent dependence or social knowledge written-in, goods such as family condolence, deeper reflection on pain, or friendship as a guard against loneliness. All three depend upon others, and so are averse to absolute autonomy.
Our generation’s love for autonomy has not been built through frequently addressing end-of-life issues but through shying away from them. It is a product of our love for career. Career as the aim of life builds these discussions of efficient life termination as a question of autonomy, and it just so happens that it is also efficient for our economy.
And here there is an emerging difference between post-war baby-boomers and generations x, y, and z. Whereas baby-boomers were told simply to make an effort if they wanted to succeed, the economy asks generations x, y, and z for a complete commitment: not to give in to weaknesses such as family time, uncredited group activities, or children. Ours is a martyrdom for the economy, a black market trade for the dream career in exchange for family life. Ours is a feminism that openly admits its dysfunction and inability to achieve work-life balance, and we are led by “rebellious” musicians who find their meaning in whether they are being paid enough.
If we asked Karl Marx, he would say that our lives have become even more closely tied to the factors of production. He would not be wrong, because there is only one thing worse than the fake meritocracy of the twentieth century: the fully functioning meritocracy of the twenty-first. In a fake meritocracy, you can blame the authorities for keeping you down, as our parents did, but in a fully functioning meritocracy you can only blame yourself, as we do. We are the inventors of a truly individualized cult. We reject community-based religion as the zone of guilt trips and instead retreat into self-made sanctuaries where we pour our own stored-up guilt upon ourselves with the hope that it will make us study harder, make more careful life choices, and work with less rest.
Autonomy is the sunrise and sunset of our lives. It gives us the ability to do what we want, and the explanation for why what we do is good. Its enemy is dependence, not because the two are at war but because dependence provides a silent, robust alternative. If society accepted dependence, we would still be able to do what we want, and we would also have a better explanation for why what we do is good. Dependence is a threat to our love for autonomy because it is better, stronger, and speaks more deeply to our nature. Against this strength, it is futile for the lovers of autonomy to say their way is superior, so instead they say their way is inevitable. The irony is that their prophecy requires laws to be implemented.
A Society of Dependence
In 1951, Fulton J. Sheen wrote: “Where there is great love, people can put up with every manner of hardship, because of the quality of love that lifts them up from their environment.” This 1950s optimism seems strange to our ears; it is not that we think love has no effect, only that it seems unsustainable and inappropriate for long-term care. As divorce took center stage in the post-war period, our collective conception of love became more transitory, less assured. Autonomy is an easier fit because it shields against the fragility of love.
What we need to see, however, is that the individualism required by a society of autonomy doesn’t just shield against fragile love; it shuts down all loving, dependent connections. We are told that love ought to be impersonal. Yet the particularity of love is in its very essence; a perfectly impersonal form, consistent with a society of autonomy, is not love at all.
Our view on assisted dying comes down to whether we prioritize impersonal autonomy or particular dependence. A society of dependence is an acceptance, ultimately, of vulnerability, and runs against everything a society of autonomy wants to bring about. As Jorge Bergoglio, now Pope Francis, has explained, its vulnerability is a gradual discovery of the “existential margins” that give definition to the whole. Thus, when Leo Tolstoy sought to describe a father’s feelings for his newborn child, he wrote in Anna Karenina:
Smiling, hardly able to restrain his tears, Levin kissed his wife and went out of the dark room. What he felt towards this little creature was utterly unlike what he had expected. There was nothing cheerful and joyous in the feeling; on the contrary, it was a new torture of apprehension. It was the consciousness of a new sphere of liability to pain. And this sense was so painful at first, the apprehension lest this creature should suffer was so intense, that it prevented him from noticing the strange thrill of senseless joy and even pride that he had felt when the baby sneezed.
Or, as Augustine of Hippo put it, the only way to escape grief is to “prohibit or extinguish human affection” and “sever the ties of all human companionship.” To extinguish grief properly, we are being told we must extinguish the grieving.