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Choice devours itself--The quietus

Some readers may be familiar with P.D. James's dystopian future novel The Children of Men. It is a bit too dark and bitter for me to have been exactly fond of it, but it is undeniably powerful, and several aspects of it have stuck with me. One of these is the quietus. The quietus is euthanasia by the state, carried out on the willing or unwilling elderly. In the novel, the protagonist has a conversation with an old professor whose wife has dementia. The professor tells him a transparent lie to the effect that his wife (who isn't talking at all anymore) has been talking a lot about the quietus lately. Later, the protagonist stumbles upon the bit of seashore where the elderly are being drowned en masse and witnesses her murder.

And now, activists in the Netherlands are "investigating the feasibility" of a new suicide clinic at which they will kill, among others, people with dementia and Alzheimer's disease. They call this "assisting" people who "wish to die," but the open statement that the people "assisted" will have dementia and Alzheimer's raises the obvious question of how they can be taken to be giving rational, informed consent to their deaths.

I expect that my usual liberal time-wasters will come into the thread and tell me that people in the early stages of these problems can still give informed consent. To tell you the truth, I'm not really interested in what the liberal time-wasters among my commentators have to say. They'd find something to say no matter what, and I'm not minded to have my time wasted by them. (I would note that these are the same people who are furiously indignant at any suggestion that liberal doctrines could justify pedophilia, yet it seems like a more plausible case could be made for intelligent, rational "consent" by a healthy, normal ten-year-old child than by an elderly person with dementia.) I admit, moreover, that I am totally opposed to assisted suicide even for people with PhD's and all their faculties.

I am, however, interested in the "choice devours itself" phenomenon in which we start out by talking about choice and freedom--especially, as I often say, in the twin areas of sex and death--and end by justifying coercion, the use of deadly force against the vulnerable, and various other actions obviously entirely inconsistent with choice and freedom in these very realms. So, we started by talking about "rational suicide" and now are talking about "helping" people with dementia to die. If that doesn't creep you out, you have done something bad to your creep-o-meter.

Related: The phenomenon of murder-suicide for couples in which one member of the pair has Alzheimer's.

HT: Secondhand Smoke

Comments (21)

So, we started by talking about "rational suicide" and now are talking about "helping" people with dementia to die.

And then we begin talking about life-unworthy-of-life. Don't we realize the tremendous waste of effort and resources used to keep these things alive? For the good of the state and society, those who do nothing but consume food, medicine and other resources should be killed upon the demand of the state.

We've learned nothing from history.

I would note that these are the same people who are furiously indignant at any suggestion that liberal doctrines could justify pedophilia, yet it seems like a more plausible case could be made for intelligent, rational "consent" by a healthy, normal ten-year-old child than by an elderly person with dementia.

Well, as we've seen in the progression of liberal culture, it goes like this:

-The "Greatest Generation" gave us no fault divorce and started experimenting with loosening societal standards on sex and marriage.
-The Baby Boomers, expanded on their parents' behavior via free love culture.
-The Baby Boomers and Generation X saw the first hints of mainstream acceptance of homosexuality.
-Generation Y is blantantly accepting of homosexuality.
-Generation Z... will it be polygamy or will it be a general attitude that all sexual taboos are not to be judged except for the effects the inflict on others (like introducing new diseases)?

I admit, moreover, that I am totally opposed to assisted suicide even for people with PhD's and all their faculties.

Call me a cynic, but I think that if most PhDs and "public intellectuals" exercised this "right," the world would be much better off.

I mean, if Marx and Engels had slit their wrists in despair over the plight of the proles instead of writing their manifesto, can you really say that would have left us spiritually poorer?

I think it would be more accurate to say that license devours freedom. Laura Wood over at Thinking Housewife [http://www.thinkinghousewife.com/wp/] linked the other day to a fascinating page on the history of the marriage license [http://proliberty.com/observer/20040317.htm] that shed a great deal of light on the logic that led to same sex marriage. Marriage licenses began as licenses to mixed race couples to marry, despite state laws against miscegenation, which were commonplace in 1900. Their application rapidly metastasized to cover all marriages, and all states had marriage license laws in place by 1930 or so. The legal effect of the marriage license is that it binds the members of the marriage to a relationship with the state; the state effects the marriage, and it is through the license that the couple give the state rights over the marriage, its property, and its fruits – the children thereof.

Once the marriage license was in place, divorce became, like marriage, a matter for state adjudication, rather than church adjudication. This made the move to no-fault divorce quite easy. From no-fault divorce to same sex marriage is a baby step.

Forced euthanasia as a logical extension of legal suicide seems like a similar case.

What the state licenses, it implicitly assumes it has the right and the power to license. And when the state licenses an activity, there are logical consequences in other areas of law, which must all be changed accordingly. If x is licensed, then on the one hand unlicensed x is illicit, and on the other any practice that prevents x is also illicit, and license to engage in such practices must be revoked by the state. The state must in fact eventually criminalize activities that prevent x.

For what it's worth, I'd like to dispel the image of people with dementia sitting quietly by a window "regressing" and thinking fondly of their childhood or past loves-thank you Notebook-(that image we see in movies of accidentally seeing your partner and calling them "dad").

As a person that has supported people with dementia and dementia-like disorders, I'd like to at least give you an image of what people with dementia struggle with so that other people with not so "black and white reasoning" can make up their own minds.

I am going to give you the example of "Vicki". She will stand for many of the people that I have supported with dementia or dementia-like disorders.

Vicki spent the last 2 years of her life angry, to put it simply. Vicki screamed. When I say that she screamed, I mean that she screamed every single moment of her life that she was not asleep. Vicki did not have that wonderful, Hollywood depiction of Alzheimer's Disease that we have all come to know and love. She screamed that she hated everyone, she refused to eat (and based on our values of life- we cut her open, gave her a feeding tube and forced her to eat), she refused to get out of bed, hitting anyone that attempted to come near her (giving her bed sores the size of fists), and (did I mention?)she screamed until she lost her voice.

I am not saying that Euthanasia is okay. But, please, please when you talk about the issues understand what they are. Understand what the true face of dementia is. Understand what us folks down here on Earth are struggling with.

I am not saying that Euthanasia is okay.

Well then what are you trying to say?

Rachel,
Vicki screamed constantly, therefore ---- what? Do Vicki's screaming and rage change the morality of the issue at all? Is it in any way more moral to euthanize her in that condition than if she were perfectly quiet? In other words, I am missing the practical point of your comment. What exact difference does it make?

Besides the fact that "Vicki" only represents a portion of people with dementia, not all by a long shot . . . . so what? She clearly needs our loving care that much more, to help her remember somewhere down inside that love exists, and our own growth as we learn to keep loving her, remembering who she is and valuing all that she is, is invaluable to us and everyone around us.

Well then what are you trying to say?

I think she is trying to say that we need to be well aware of why people support euthanasia in these cases. It's because the condition is so terrible and intolerable that it seems like the lesser of the two evils. One might say that the pro-life side is almost counter-intuitive to most people in cases like these.

Regarding the case of "Vicki," it is understandable that a loved one might wish to stop the suffering on all sides with euthanasia. It is understandable that one might wish to end a bloody war by dropping nukes. It is understandble that, as in the Sister McBride case, one would want to save the life of a mother at the expense of an unknown/unseen child. It is understandble that one would wish for the happiness and fulfillment of a homosexual friend or family member by promoting same sex marriage.

But they're all morally wrong choices.

The thing about morality is, it goes against many of our emotions and intuitions about things. Principles can be like that, unfortunately. Much easier to be unprincipled and "flexible." But why insist on being right? Why not live with the fact that, yes, you chose the more understandable alternative, but it was an evil choice? It's hard to say it -- "I was wrong." Harder still to say "I did something evil." Christians have some ease with calling themselves sinners, but it's often tossed about without direct association to an immoral act.

This need to be always right is foundational: The forbidden fruit in Eden was from the tree of the knowledge of good and evil. We know better. Turning sin and evil upside down is at the core of our fallen nature. We want to reorder the cosmos without God at its center. If we make morality conform to our intuitions and desires, what use is it? Give up the pretense of moral language, as Alasdair McIntyre points out.

Being a postmodern means never having to say "I was wrong."

I could not better Beth Impson's comment, here. Clearly, some type of sedation is appropriate for Vicki to prevent her harming herself and those around her. Killing her is entirely another matter and obviously gravely immoral. Gratuitous insults against people who say that it is immoral to murder Vicki--that they are not "down here on earth" and the like--are out of place.

She will stand for many of the people that I have supported with dementia or dementia-like disorders.
Understand what us folks down here on Earth are struggling with

I don't know if Rachel works in health care, but I assume so from the context of these statements. Do you ever notice how prevalent this attitude is among health care workers? They pretend to possess some special knowledge or experience that gives them greater moral insight -- call it the "medical charism" if you like. Sorry, I've had more than my fair share of "down to Earth" experiences, too, and very often they involve coming into friction with supposedly compassionate health care workers. I don't mean to tar all of them, but I've run into plenty of doctors and nurses with the moral insight of a toad. Maybe that's what happens after years of seeing people as something to pharmacologically control on your way to a paycheck.

"Vicki screamed constantly, therefore ---- what?"

Therefore we should probably reflect on what we would choose in sundry dire circumstances and fill out our advance directives accordingly. I assume that if Vicki had indicated no feeding tube no way in hers that Rachel and her colleagues would have respected her wishes.

"The Dutch pressure group Right to Die NL (NVVE) is investigating the feasibility of setting up a clinic for suicide and euthanasia. It would help people who sincerely wish to die and have nowhere else to turn."

I'm confused. I thought, from what I have read here and at SHS, that euthanasia was already an accomplished fact in the Netherlands.

"I am, however, interested in the "choice devours itself" phenomenon in which we start out by talking about choice and freedom--especially, as I often say, in the twin areas of sex and death--and end by justifying coercion,.."

If I indicate no feeding tube (or antibiotics or whatever) under certain circumstances, how would the insertion of such a tube, against my express wishes, not be coercion?

For that matter, if I choose to feed the Turkey Vultures who have been patiently circling and waiting all these years how is that anything but my business?

Euthanasia most certainly is a fact in the Netherlands, but people with dementia, Alzheimer's, and people who consider their lives "complete" (those are the three groups mentioned in the article) apparently do not have easy access to it. Legality is always a rather vague question in these areas in the Netherlands, as what is illegal on the books can be a far cry from what is illegal de facto. Judges acted as one-man nullification crews for a long time over infanticide before the Groningen Protocol was put into place. The goal of this group is to construct a clinic where these three groups of people can come (or be brought) and be made dead, which isn't apparently an easily accessible service right now for those particular groups. (Those who merely consider their lives "complete" are presumably physically healthy, which is no doubt part of the reason for doctors' hesitations about killing them.)

I have no intention of engaging in an argument with you over feeding tubes, Al.

I notice that as usual you are disinclined to express even the mildest of problems with what is recounted in the main post: the intention actively to kill people who, quite plausibly, cannot be giving rational and informed consent to their own deaths, specifically, people suffering from dementia. So much for "choice" and "freedom." But I suppose if I talked about finding ways to bump off Grandma who has Alzheimer's you would say that I must be either a liar or a dupe of liars. Evidence is wasted on you, even the outright statement of the intentions of this pro-death "pressure group."

This, of course, is why I have no interest, as I said in the main post, in wasting my time in this thread with time-wasting liberal commentators.

Numbers work best for me:

1. I am not a health care professional. I am a social worker in a home where six people live who require assistance in daily living. But I do understand the view expressed by j. christian. I have met many bad nurses and doctors that don't see people as people. This experience put me in contact with many health care professionals who described people with dementia as "the screamers". (And yes aggression and agitation towards the end of the life of someone with dementia is common. Vicki's struggles were not rare.)

2. What was I trying to say? I was trying to share a story about an experience I had and how that experience made me feel differently about euthanasia.

3. Drugs are not always the answer. Vicki, due to health reasons, was not a good candidate for psychotropic medications that would have "calmed" her down.

The moral debate? I'm not up on the literature. Sorry to disappoint. I just thought that people who maybe have not come into contact with people with dementia would be interested in why some argue that it would be more humane to not let them suffer.

One last note: I was not arguing that Vicki's family or I should have had a say in her dying. I am still doing my thoughts on how if I were to be diagnosed with dementia tomorrow would I add (if it were legal) "please let me go peacefully when I get to a point where I am angry all of the time". I don't know.

"please let me go peacefully when I get to a point where I am angry all of the time".

That's what I thought you were trying to say. How do we do that? Let you go "peacefully", I mean.

Phrases like "not let them suffer" and "let me go peacefully" are, of course, euphemisms for active killing, since people in that situation aren't just dying on their own. That's why this group wants to set up the clinic. Because the people they want to kill have "nowhere else to turn."

"That's what I thought you were trying to say. How do we do that? Let you go "peacefully", I mean."

Below is some of the standard wording of a California Advance Directive for health care. A person checking box (b) suffers Vicki's fate. That is their right and, as I have indicated previously, I oppose euthanasia but consider each person's decision as to their death to be their own business. I, of course, have checked box (a) and included further instructions in 2.2 restricting care in certain events.

I presume that William and Lydia would check box (a). I respect that and it is their right and would argue that point even if i just don't get it. I assume (b) to be the default in the absence of an AD.

My question is a simple one. You all have rights in my world. Do folks like moi have any rights in yours?

"(2.1) END-OF-LIFE DECISIONS: I direct my health care providers and others involved in my care to provide, withhold, or withdraw treatment in accordance with the choice I have marked below:

a) Choice Not To Prolong I do not want my life to be prolonged if the likely risks and burdens of treatment would outweigh the expected benefits, or if I become unconscious and, to a realistic degree of medical certainty, I will not regain consciousness, or if I have an incurable and irreversible condition that will result in my death ina relatively short time.Or

b) Choice To Prolong I want my life to be prolonged as long as possible within the limits of generally accepted medical treatment standards.
PS-X-MHS-842 (Rev. 2-04) Page 2 of 4 MPS/PMD
_________________________________________________
(2.2) OTHER WISHES: If you have different or more specific instructions other than those marked above,such as: what you consider a reasonable quality of life, treatments you would consider burdensome or unacceptable, write them here."

Just to clarify. I don't get all exercised over posts in SSM because they usually lack nuance. There are six billion + people in the world. Some believe Elvis lives and that OJ is innocent. I have a friend, an otherwise good person who votes Republican and believes in the Illuminati. The Oregon shrink was a nut ball, not a trend. I know nothing of Dutch politics, know no Dutch personally, and don't speak or read the language. Is this a serious proposal or an irrelevant outlier? I don't know and have no way to figure it out with any certainty and likely neither do any of you or Westley, for that matter.

Do folks like moi have any rights in yours?

You talk about rights as though it were a choice between a Big Mac and a Quarter Pounder. I'm okay, you're okay.

Being out of one's mind is not a terminal condition nor is it punishable by death. Sane Al cannot leave an AD telling me not to feed him should he become insane and refuse to eat. You have a right not to be murdered, and I have a moral obligation not to do the murdering.

On the subject of choice in the case of dementia patients in nursing homes, an article by Evelyn Tenenbaum of Albany Law School:

TO BE OR TO EXIST: Standards for Deciding Whether Dementia Patients in Nursing Homes Should Engage in Intimach, Sex and Adultery

http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1470316

j. christian says:

But they're all morally wrong choices.

The thing about morality is, it goes against many of our emotions and intuitions about things. Principles can be like that, unfortunately. Much easier to be unprincipled and "flexible." But why insist on being right? Why not live with the fact that, yes, you chose the more understandable alternative, but it was an evil choice? It's hard to say it -- "I was wrong." Harder still to say "I did something evil." Christians have some ease with calling themselves sinners, but it's often tossed about without direct association to an immoral act.

I suspect your problem is that modern society uses suffering to define good and evil rather than morals.

For example, if God demanded that I kill my son, it might well be immoral to refuse, but it would be unethical to kill my child. I suspect that vast majority of people in modern society (even those claiming to be Christian) would claim that, where I to kill him as instructed, I would have done evil. In fact, even if God changed his mind at the last minute, most would *still* consider me evil for having been fully prepared to kill my son at God's demand.

We have become a society that bases our notions of good and evil on the personal outcomes (is there more or less suffering?) rather than on adherence to a set of moral tenets. Interestingly enough, I would say our major challenge is dealing with a religion where adherence to their moral principles is far more important than any suffering their actions cause, namely militant Islam.

There, we are indeed dealing with a group of people who place their morality far above the suffering and pain their actions cause. Notice how our leaders and media call them cowards rather than pointing out that they died in order to remain true to their morality, a feature almost absent in modern Christians.

In other words, *true* adherence to any principled morality is an impossibly scary thing for modern society to accept. How do you handle the man who, if their moral principles happen in some particular situation to demand your destruction, will not be swayed by simple human compassion or even self-preservation?

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