Inadequate healthcare doesn't justify banning assisted dying

Respecting choice in a non-ideal system

Photo by Maxim Hopman

Some people argue that structural factors make assisted dying ethical untenable. In the United Kingdom, which is currently debating legalizing assisted dying, some have argued that the quality of palliative care provided by the National Health Service, which critics say is sometimes insufficient, means that people will choose assisted dying because of inadequate care.

Meanwhile, in Australia, where assisted dying is already legal, an eighty-six-year-old man named Cyril Tooze recently had an assisted death after waiting almost a year for home care services. He was clear that the long wait was a driving factor in his decision. “I don’t want to live my life laying in a bed waiting for something to happen,” he said.

Cases such as Tooze’s prompt people to call for MAID bans or, in the U.K.’s case, for members of parliament to vote against the proposed legislation. One common form this argument takes is that people in Tooze’s situation aren’t really choosing freely. He was pressured into choosing an assisted death, and, if he didn’t need to wait so long for home care, he wouldn’t have chosen death, which shows that he chose to have an assisted death for reasons to do with the healthcare system, not his disease.

It’s hard to argue with Tooze’s point that the wait times are too long. “We don’t deserve that in such a country as Australia,” he said about the months he has been stuck in a hospital bed instead of receiving home care. The same is true in the U.K., Canada, and elsewhere. The rent is too damn high, the lines are too long, and the support is too low.

But it doesn’t follow that Tooze’s choice shouldn’t have been allowed. To see this, consider a situation where a person’s decision was undoubtedly influenced by circumstance:

You and your friend Clarisse decide to take a vacation. Randomly, you are kidnapped. Weeks go by and you and Clarisse are treated badly by the kidnappers, who make credible threats that they’re going to kill you both. It’s at this point that Clarisse, who is well prepared for every trip, reveals that she has two doses of cyanide in her pocket. After much contemplation, she decides that she wants to take a dose, thereby ending her life before the kidnappers do. You talk at length about her decision and believe that she has thought it through. Her hands are tied, so she can’t take the pill by herself, but, fortunately, if you move just so, you can reach into her pocket, remove the pill, then place it on her tongue, at which point, she can choose to spit it out or swallow it.

When Clarisse reveals the existence of the pills and asks for your help in getting one out of her pocket, suppose you say the following: “I’m sorry, but I can’t help you. You’re only here because of the kidnappers, and, if it weren’t for them, you wouldn’t want to take the cyanide, so you aren’t deciding freely. However, I’m happy to revisit this discussion if we’re released.”

I’m of the mind that this kind of response would be mistaken. Clarisse’s situation is the result of injustice, but her reasoning isn’t mistaken: she has accurately assessed the situation and made a reasonable decision in light of the evidence.

I think what’s going on is that people reason too quickly from “an injustice is influencing a person’s decision” to “therefore she shouldn’t be allowed to make that decision”. But this doesn’t follow. It’s true that, in a better world, the kidnapping wouldn’t have happened, but that’s not the world we’re in.

Here’s another way to think about it. Suppose that when Clarisse reveals the existence of the cyanide, you reveal the existence of a gun you carry that, somehow, the kidnappers failed to notice. Then, instead of getting the cyanide for Clarisse, you could simply shoot the kidnappers. Problem solved. However, since that isn’t the situation, helping her get the drug from her pocket is ethical.

If it’s ethical to help a person end her life because she has been kidnapped and is going to be killed—a choice she wouldn’t have made if not for the kidnapping—then this shows that it’s a mistake to reason from ‘an unjust circumstance is the cause of a decision’ to ‘therefore, it’s wrong to allow the person to make the decision.’ Tooze’s situation was bad. He shouldn’t have had to wait so long for home care. But that problem wasn’t going to be addressed in a timeframe that was acceptable to Tooze, so his assisted death was ethical.

As I’ve said a whole bunch, bans aren’t better. Stopping Tooze from having an assisted death wouldn’t have magically given him access to home care. Instead, it would have kept him in a situation he autonomously deemed insufficiently good to keep on living.