Assisted Dying is Suicide
Another moral fiction
In my last article, I introduced the concept of moral fiction. A moral fiction is a false claim that people believe is true or treat as true to serve some end. Moral fictions are analogous to legal fictions, though legal fictions are usually recognized as fictions when they’re used. For instance, lawyers and judges know that corporations aren’t really persons, but they’re treated as persons by the law because it’s useful (e.g., it means corporations can be sued).
In contrast, moral fictions aren’t usually recognized as fictions. We treat them as true and claim that they’re true. In the last article, I argued that the withdrawal of life sustaining treatment, such as removing a ventilator, is killing, despite many people—ethicists, healthcare providers, and judges—claiming that such withdrawals merely let such patients die of their underlying illness.
To the question, “Isn’t removing this ventilator killing, and isn’t killing wrong?” proponents of the moral fiction will say, “This isn’t killing, so don’t worry.” But the correct answer is “This is killing, but sometimes killing is permissible, and this is such a case.”
Some people avoid this moral fiction. In a 2012 article on the B.C. Supreme Court case that would become Carter v. Canada—the Supreme Court case that struck down the prohibition on assisted dying—Globe and Mail columnist André Picard correctly says that doctors were already killing patients pre-Carter:
The reality, too, is that there are plenty of physician-assisted deaths already. There is “withdrawing of potentially life-sustaining treatment”—also crudely called “unplugging a patient”—when patients with no hope of recovery are mercifully removed from respirators that are keeping them alive artificially.
Here, I want to discuss the moral fiction that assisted dying isn’t suicide. The form is the same as the previous fiction. To the question, “Isn’t assisted dying a form of suicide, and isn’t suicide bad [wrong, irrational, or tragic]?” proponents of the moral fiction will say “This isn’t suicide, so don’t worry.” The correct answer is “This is suicide, but sometimes suicide is okay [or acceptable, rational, or fortunate].”
This is partly a definitional point. For centuries, ‘suicide’ has meant ‘deliberately killing oneself’. People have also debated the rationality and morality of suicide for centuries. Some, such as the Catholic Church, have consistently argued that it’s always wrong. Others argue that it’s wrong sometimes. This isn’t theological advice, but my favourite example of this approach is John Donne’s Biathanatos from 1608, which was the first book-length discussion of suicide in English. In it, Donne argues that Christ died by suicide through martyrdom. And still others argue that suicide is always appropriate. David Hume says that “I believe that no man ever threw away life while it was worth keeping.” (This also isn’t my view.)
Unless you redefine suicide as ‘the tragic or irrational killing of oneself’, suicide just means killing oneself.
I’m also making an ethical point. Until the past fifteen or so years, it wasn’t the case that ‘suicide’ was reserved for ‘bad or wrongful self-killing’ while another term—e.g., assisted dying—was used for justified self-killing. This redefinition likely helped increase support for assisted dying, but it did it at the expense of non-medical suicide, which is not always tragic, and which continues to be heavily stigmatized.
Consider the Ngram of the term ‘assisted suicide’:
It reached its peak in 1998, the year after Oregon began allowing people to “end their lives through the voluntary self-administration of lethal medications” (i.e., die by suicide). After that, the term began its decline, being replaced by ‘assisted dying’, ‘physician-assisted death’, and, in Canada, ‘medical assistance in dying’. As with ‘assisted suicide’, the term ‘euthanasia’ reached its peak in 1998.
This happened because proponents of assisted dying began arguing that assisted dying isn’t suicide. It was an astute marketing move. When people think of suicide, they have a strong negative reaction. It usually isn’t the sort of thing they would want for themselves or their loved ones. Therefore, it’s easier to redefine suicide more narrowly so that assisted dying doesn’t meet the definition.
An article called “Why Medically Assisted Dying Is not Suicide” says that calling assisted dying ‘suicide’ “stigmatizes people who are suffering intolerably from a devastating medical condition and want the option of a peaceful death.” This is surely true, and one way of avoiding the stigma of suicide is to employ the moral fiction by using redefinition.
In the Globe article I mentioned above, Picard goes for redefinition:
Suicide is an act of self-harm that is almost always a byproduct of mental illness like schizophrenia or severe depression. This is in no way comparable to hastening death via a methodical, sober process with a number of legal safeguards.
The problem with redefinition is that it does nothing to address the stigma of suicide. In other words, while calling assisted dying ‘suicide’ stigmatizes some people, redefinition puts the stigma onto others who also don’t deserve it.
The better way is to confront it directly. Some suicides are tragic, but others are not. Dying by suicide, even without the legitimacy that formal assisted dying provides, doesn’t mean that the person made a mistake or was acting irrationally. Just as killing is sometimes murder and other times ethical, suicide is sometimes tragic and sometimes justified, appropriate, methodical, and sober. People take their lives for different reasons. Some of them are unfortunate and regrettable, others are fortunate and justified. None of them deserve stigma.
So what to do? When a term begins its life with negative connotations, it’s sometimes adopted positively. I’m not sure if there’s a different term in linguistics for this concept, but I call these ‘adopted phrases’ and have been collecting them for years. Here are some examples: americano, big bang, minimalism, Methodist, meritocracy, Obamacare, and queer. One approach is to advocate for the neutralization of ‘suicide’. We should think about suicide the way we think about news, with both good and bad forms.
Of course, the point of a moral fiction is that it has value. All things considered, it might not have been a mistake to separate suicide from assisted dying. But, minimally, we should name the moral fiction when it arises. “Isn’t this suicide, and isn’t suicide always bad?” It depends.