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Choice Devours Itself: Murder affirmed in the Netherlands

Readers may or may not remember the story I posted about 2 1/2 years ago concerning the Dutch doctor who told family members to hold down an elderly woman so that she (the doctor) could administer a lethal injection. The doctor had secretly drugged the woman in her coffee, but she woke up and put up a fight for her life, so they held her down and killed her anyway.

There was an itty bit of tut-tutting surrounding this, and the Dutch called for a trial, not (mind you) so that justice would be done for this open act of forcible murder, but so that the court could exonerate the doctor, thus paving the way for more such acts. Yep, really. They said so in scarcely coded language at the time.

Well, that all went just as predicted.

You see, the woman had previously said that she would want a lethal injection "when it was time." Then she developed worse and worse dementia and continued not to feel that it "was time." But she was going downhill, so the doctor, and presumably the family, decided that the previous version of the woman would have thought that this was "time," so they decided to bump her off. To follow her wishes. (Got that?)

And that's exactly what the court declared.

Judges said the doctor acted lawfully as not carrying out the process would have undermined the patient’s wish.

Um, what? She fought the doctor. How was lethally injecting her carrying our her wish? Oh, not that wish. The other wish. The wish she had before, see? When we presume she was rational. Then if she decides later she wants to live when she's no longer deemed to be mentally all there, that wish doesn't count. So we hold her down and lethally inject her. To carry out her wish. Makes sense, right, right?

When I wrote about this earlier, an alert reader (Sean K.) pointed out the double standard concerning sex: If a woman consents to sex and then changes her mind before the act is fully consummated, everyone says that "no means no" and everything has to stop. Apparently that doesn't apply to death, though. Death is sacred. You have to carry death through if the person saying, "No" is no longer mentally competent.

One wonders if that could apply to sex, too. Suppose that a woman developing dementia says that she wants her husband or lover to go on having sex with her even after she's no longer mentally competent. And then later when she's no longer mentally competent, she fights against it. And suppose he holds her down. Does it not count as rape because she consented when she was mentally competent and now that's just "carrying out her wish"? The later wish doesn't count, right, because she's not mentally competent now? Maybe the poor man, like the doctor, is obligated to hold her down and have sex with her in order not to "undermine her wish." My head is starting to spin.

Getting back to the actual case, one of the creepiest things about all of this is the way a BBC story discusses it. For several paragraphs the BBC makes it sound like the doctor committed some procedural error by "failing to verify consent." Failing to verify consent? What? That's all it is, folks.

You have to read on for quite a while until you get to what really happened, which the author still tries to word in a passive way: "When the day came to end the woman's life, a sedative was put in her coffee and she lost consciousness. But the woman then woke up and had to be held down by her daughter and husband while the process was finished."

The day just came, you see. How did the day "come"? Because the doctor decided to give her a lethal injection. Then the passive verb, "a sedative was put in her coffee." By someone. Who knows who did that? Then she "had to be held down." Why did she have to be held down? Why not just stop killing her? Oh, y'know, because reasons. She just "had to be." She had to be held down "while the process was finished." Passive verb again. "The process." What process? The process of killing her! The story makes it sound like, having given her a sedative, the doctor had begun some inexorable process which now had to "be finished." This of course, is untrue. They could have simply stopped, not killed her, not given her the lethal injection, and left her to sleep off the sedative. In fact, the story doesn't even mention a lethal injection.

This is Newspeak indeed, and terrifying.

What I think is true is that there are many people, perhaps most people, who have advocated assisted suicide, "death with dignity," etc., in the name of choice and who have all along been willing to accept this situation. That is to say, while talking about choice and safeguards and so forth, I now would guess that many if not most assisted-suicide advocates would always have endorsed what this doctor did. I realize it's just one data point, but in evidence of this conclusion I want to link here to a discussion of euthanasia between Douglas Murray and Sam Leith in The Spectator. Leith goes on and on about choice and freedom, just like every assisted suicide advocate does. That's what it's all about--my freedom to do what I want with my body. But look what happens when Douglas Murray brings up the possibility of murdering people who don't want to die:

Douglas: It’s not unwise to make these things harder than they need to be, rather than easier. I once spoke to a euthanasia doctor about his terminally ill patients. Many suffer from degenerative illnesses which mean that they cannot sign the form to die when they are at their worst. They sign it in advance which is not dissimilar to what’s being suggested here. I asked this doctor, how can you be sure further down the line that you are definitely killing — or however one wants to euphemise that…

Sam: Euphemise, euthanise.

Douglas: …that you are killing them and they want to die? And he said, I can’t be sure. I asked, do you think you have ever euthanised somebody who didn’t actually want to die and he said yes, I’m certain of it. I’m sure we both know of elderly relatives and friends who are at the end of their lives. Quite often they will say ‘I don’t want to get to X stage’ and they are absolutely certain they will never get to X stage and if they ever got near X stage they would be flying off to Switzerland. But then they get to X stage and the stage beyond and they still want to live.

Sam: These are hard cases. There is a considerable philosophical discussion here, about how much your present self can bind your future self.

Douglas: Can you imagine lying in a bed, not wanting to die, but knowing that you will because you once signed a form, which the state is now enforcing? That’s the other thing about it, the sheer bureaucratic awfulness of it, the form filling, the euphemising that will go on, when we’re talking about whether or not people should die.

Murray is human and horrified. Leith is bloodless and blasé. At the risk of psychologizing, I think it's fair to say that Leith doesn't really care. He's not really upset. After all his talk-talk about freedom and choice, he is not moved in the slightest at Murray's picture of a person lying in bed, not wanting to die, and knowing that he's going to be killed against his will because he signed a paper long ago. Leith may be, at most, a trifle uncomfortable. But to him the whole thing (which is not merely a hypothetical possibility) is just a philosophical puzzle. Ah, well, there is a considerable philosophical debate. Move along, folks. Let's go back to talking about how all this is about choice. Which is, quite frankly, a lie. One wonders just how hard Leith even works to convince himself that it's not a lie. (By the way, his reference to philosophy leads me to the reflection that many modern Western bioethicists may be statistically among the most cold-bloodedly immoral people alive today.)

And Murray's conversation with Leith reflects conversations I have had myself, some in the very comboxes of this blog. You bring up the fact that people will be forced to die, and the other chap says, "Ah, yes, that is a hard case. Well, you know, perhaps my rational self should be able to make decisions on behalf of my less rational self and perhaps my less rational self should be bound by them."

This is not merely a sociological or inductive point--though there is nothing wrong with induction in public policy. It's also a logical point. Take some sort of premise to the effect that your present, rational self should be able to sign off on decisions that bind your later, mentally incompetent self. Now, take killing you and call it "medical care." Notice that this second premise allows you to claim there is no analogy with sex or anything else, y'know, recreational. This isn't like sex, because sex isn't medical care. This is the Present You making later "healthcare decisions" for the Later You. And we all believe that that's okay, right? The conclusion follows inevitably that you should be able to be held down in your bed and euthanised if you earlier consented to die. Here's approximately how the argument looks:

1. Euthanasia is just a form of medical care among others, to which the patient ought to be able to consent.

2. A mentally competent patient ought to be able to give consent for later medical care for himself, and his wishes ought to be carried out later when he is no longer mentally competent to make medical decisions for himself. This premise holds even if the earlier decisions appear to be against the will of the later, mentally incompetent patient.


3. If a mentally competent patient decides that he wants euthanasia for himself under some later set of conditions, and if he later becomes mentally incompetent and resists euthanasia, it should be forcibly administered in order to give him the medical care that he desired for himself while competent.

This is not a "slippery slope" argument. It is a display of the logic behind medicalizing assisted death. Killing the patient ceases to be in a category of its own. It becomes just another form of "medical care." And, as the logic goes, if the mentally competent patient can choose, say, to receive antibiotics when he's mentally incompetent, even if he tries to get out of taking them (maybe because he doesn't like the taste and doesn't understand that they are good for him), then he can choose for his later self to receive a lethal injection, even if he tries to get out of it when the "time comes."

Now, at a minimum it would seem that the purveyors of "death and choice" ought to make this explicit to people signing off on their own later death. After all, hoi polloi don't all understand that death is going to be treated just like any other "medical care" and dealt out to them while they struggle later on if they sign on the dotted line now. This seems especially true of the woman in the story, who expressly said that she wanted to choose the time of her own later euthanasia. It seems like in sheer honesty someone should have told her, "I'm afraid that may not be possible, because if you lose your mental competence later, you won't be deemed able to choose the time. So in that case you'll be held down and killed. Do you still want to sign?"

Funny how nobody ever explains it that clearly.

I don't want to be misunderstood. I don't care how rational you are (in some other sense). You shouldn't be allowed, much less assisted, to kill yourself. Period. I'm not saying this would all be okay if it were really restricted to people who presently are mentally competent and want to die.

What I am saying, though, is that there is an inexorable, deadly logic to euthanasia whereby choice does devour itself. If a lethal injection is just another medical treatment, then there is no reason why Competent You cannot choose to have it enforced upon later, Incompetent You, even to the point of holding you down. If you're not okay with that, then you shouldn't be okay with the "choice" of "medical aid in dying."

And maybe, just maybe, that should make you back up and rethink at a still more fundamental level. Consent has a leveling effect. Everything that we think we ought to be able to consent to is something that (we think) meets some minimal level of decency. If you ought to be able to consent to it, it can't be that bad, right? So even if all such things are not, precisely, equal, they are all equally not-too-bad. The older view was that quite a lot of things are such that no one should ever consent to them: Being degraded or brutalized. Selling one's body for sex. Having meaningless, commitment-free sex. Being killed. Maybe that older view was right. Making sex just another indoor contact sport certainly doesn't seem to be working out very well. Maybe sex is different. And as for Thanatos, is he just another god one might reasonably choose to follow? Maybe death is different, too. Way, way different. Maybe suicide isn't a proper object of choice at all.

It's worth a thought.

Comments (3)

It occurs to me that while they are not entirely co-extensive, there is quite an overlap between the group of people who advocate for "choice" in opting for a (future) euthanasia, and the group of people who are adamantly opposed to the death penalty and have as their main reason (or one of their main reasons) that in the DP the state will sometimes mitakenly put an innocent person to death. They find even one case of such a mistake to be intolerable. Well, as Douglas reported in the Spectator article of another doctor, THEY WILL sometimes kill people who don't want to die. And, even apart from the philosophically "difficult" cases of people who at one time did "want to die" at some later unspecified time but who changed their minds after becoming (possibly) incompetent, there are the inescapable cases of sheer mistake where the person earlier (when competent) wanted to be allowed to die later, and where the doctor decided later "this person is incompetent" but was mistaken.

Or, better yet, the cases where the person who earlier was assumed to be competent and signed the "kill me later" form, but was unduly pressured by either family or fear of pain, and later when fully competent decides "I don't want to die" but nobody believes at that point that they are competent. Why does nobody believe it? Because they are surrounded by people who believe that it is IRRATIONAL to want to live when life is unpleasant, if there is little prospect of it getting better.

So, the philosophical problem of whether a person should be allowed to choose to suicide (or to be killed) morphs into the different philosophical problem of whether it is irrational to want to live when life is unpleasant, which then pushes into the moral and procedural question of whether THE STATE (in the person of the doctor or the judge) gets to impose THEIR philosophical belief about the latter on the patient. Oh, yes, it's the patient's choice, as long as their choice is rational, according to OUR belief of what is rational. Hmmm, I don't know that the typical liberal realizes their freedom and right to consent is constrained by someone else's idea of what choices are rational.

Thank you Lydia, your analysis helps me understand this debate so much better.

"The older view was that quite a lot of things are such that no one should ever consent to them..." Naturally, another current example comes to mind: the juvenile self binding the mature self to sterility by getting surgery now. The juvenile self sterilizes the future self. One's biological sex is medicalized to try to make transitioning a healthcare decision for greater health.

Tony, right, and I didn't even get into that--the idea that desiring to live is a sign of dementia or irrationality! Which is bizarre. In the case in the o.p., they could claim that there was independent reason to believe the woman had major dementia, and I don't dispute that. But I think what you are describing is also at work. This is why one will hear those who defend these actions refer to the desire to live as "merely instinctual" or something like that. This arises as well when someone agrees to be suffocated to death in DIY suicide, has a plastic bag put over his head, and then starts struggling to take off the plastic bag. There's been an actual case of this sort where the "observer," who was *supposedly* merely there to give information so he couldn't be accused of murder, actually stepped in and held the person's hands. In that case the argument I actually saw was that struggling to take the plastic bag off was merely an instinctive movement and not a rational decision and that the decision to die was the considered, rational decision. I believe they are saying the same thing about the woman with dementia who is being spoon fed after previously having been an advocate for herself to die if she developed dementia: "Oh, accepting spoon feeding is not an indication of a rational decision."

What is crazy about this is that even if one acknowledges that struggling to breathe, struggling not to be lethally injected, or accepting spoon feeding are results of instinct, that doesn't mean that they are to be rejected. They are good instincts. The instincts are more rational (in a sense) than the abstract statement, "I want to die if I'm ever in that circumstance."

Tamsin, good comparison. And a particularly bizarre situation, because one would *think* that the juvenile self should be regarded as *less* capable of making such a lifelong decision. Once again we get a strange set of standards coming from people who are supposedly all in favor of some kind of Perfectly Rational Self who is making these decisions.

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