Assisted dying – philosophical and religious perspectives

There may be many psychologists who disagree with the pro-assisted dying opinions voiced in the letter pages of the October 2014 issue of The Psychologist, though perhaps the majority of readers found themselves in agreement, or at least disinclined to actively resist a liberalisation of the legal framework.

It seems to me, however, that there is one overriding argument against such a change, namely that those people in society who are most vulnerable, either through their lived experience (including early experience and abuse) or because of societal structural inequalities (such as poverty, homelessness and old age), are much more likely to consider themselves as a burden on 'others', be it the state, their family or carers. This sense of being unvalued, which can be seen as arising from internalised relative powerlessness, would in turn inevitably act as a pressure to 'choose' assisted rather than natural deaths. As far as I can tell, assisted dying legislation attempts to deal with this through manifestly inadequate 'safeguards' involving the psychiatric diagnosis of depression or other limitations that have rapidly been challenged and diluted in countries where legislative reform has been enacted (e.g. in Belgium the application of law on assisted dying is now extending to children and prisoners serving long-term sentences).

The point is that legislation to support individual freedom is rarely some kind of neutral act, which only promotes individual choice promoted by particular advocates: rather, because our lives and choices are socially and politically interconnected, such changes can disempower more vulnerable others. This moral argument is directly related to similar economic arguments about the iniquities of the free market, it is just much less visible in modern Western culture and certainly much less fashionable (MacIntyre, 2007)

Philosophical justifications in support of assisted dying grow out of the liberal-individualist position that permeates so much of modern Western life. And the discipline of psychology – its methods, concepts, conclusions and, at times, its application in clinical settings – is deeply permeated by this way of thinking (and interestingly was notably highlighted in the last page of the most famous and important philosophical text of the last century (Wittgenstein, 1958).

Notable attempts have been made by people such as David Smail to challenge and make visible liberal-individualist assumptions in psychology practice; not surprisingly, given the scale the task, the success of such projects has been limited. It thus seems quite possible that the psychology profession may yet find itself advocating an opinion in favour of assisted dying that seems entirely just and rational without recognising 'whose justice or which rationality' is being given the dominant voice (MacIntyre, 1988) nor understanding the unintended consequences that follow for society's most vulnerable and powerless members.
Damian Gardner
Consultant Clinical Psychologist
Hereford

References
Wittgenstein, L. (1958). Philosophical investigations (2nd edn). Oxford: Basil Blackwell.
MacIntyre, A. (1988). Which justice? Which rationality? London: Duckworth.
MacIntyre, A. (2007). After virtue (3rd edn). Notre Dame, IN: University of Notre Dame Press.

The article 'We should bring death back to life, into the open' (September 2014) generated some robust response to your journalist's comment 'Where are the supporters?' It is clear from both the original article and the responses that this is an emotive issue on which there are opposing views, even allowing for the quoted figure from Dignity in Dying that 80 per cent of the general public support assisted dying. What I did observe from the article and the responses was the minimal reference to religious considerations. Christine Kalus (October 2014) does recommend that the BPS should engage with interested parties including faith groups, and Carla Willig (November 2014) states that the Christian legacy of 'sanctity of life' includes the notion that suicide is a sin.

We are officially a Christian country, although in practice we are a multi-faith one. Unfortunately, professionals who dare to bring up the topic religion with their clients, or who even sport Christian symbols on their persons, risk sanctions from their professional bodies and even the law of the land. The reluctance to direct clients who are contemplating ending their own life toward pastoral counselling is, therefore, understandable even if regrettable, as this is a resource that can bring a fresh perspective to end-of-life issues.

Surprisingly, the Bible does not make a clear pronouncement on the rights or wrongs of taking one's own life. At least four suicides are reported in the Scriptures, and they are without any evaluative judgement: Saul (1 Samuel 31:4), Abimelech (Judges 9:54), Samson (Judges 16:30) and Judas (Matthew 27:5; Acts 1:18). Some add that Jesus' death was also suicide, as he said that he gives up his life of his own free will (John 10:18).Inevitably, calling on the Scriptures can result in support of both views. In the red corner, against suicide, is the sixth commandment 'Thou shalt not kill' (Exodus 20:13), although this is usually interpreted to be just a prohibition against murder, as capital punishment and killing in warfare are permitted. There is also the belief that only God has control over life and death (Deuteronomy 32:39; 1 Samuel 2:6) and, in similar vein, the Lord gives and takes away (Job 1:21). In the green corner, tolerant of suicide, is the Beatitude 'happy are those who are merciful to others' (Matthew 5:7) and the commandment 'do for others what you want them to do for you' (Matthew 7:12) (all quotations from Good News Bible).

Obviously this publication is not the venue to conduct an exhaustive debate on the Scriptures, but it is clearly difficult to reach consensus on the ethics of suicide and euthanasia from either a religious or secular perspective. All opinions must be considered and respected, but it is prudent not to neglect the comfort and insight that can be gained from including a faith viewpoint in the debate on this crucial issue going through the parliamentary process at this time. Nor should practitioners in the caring professions shy away from it.
Michael J. Lowis CPsychol, AFBPsS
Northampton