Euthanasia is NOT the same thing as assisted suicide.

As there have been several recent* stories in the mainstream news about assisted suicide (such as this one, found via BBC Ouch, this one and this one, found via FRIDA, and this rather surreal one, found via the "Breaking News" blog at Fortean Times), i've been thinking about my views on the subject, and decided to try to dig up an old post of mine from a couple of years ago, in which i tried to sum up my position, on Barbelith:

Right, i'm going to try to articulate my position now.

I believe euthanasia is utterly different from assisted suicide (often wrongly conflated with it), and that the difference is basically that the latter is suicide and the former is basically murder.

I believe the only consistent libertarian position that can be taken on life-and-death issues is that the individual, and only the individual, has an absolute right over hir own body and hir own life (and, to make this possible, the only limit to that is that ze absolutely and categorically has not got a right over any other individual's body or life).

This means that i do believe every person, regardless of disability, illness or lack thereof, has the right to suicide, as the right to life, IMO, is rendered utterly meaningless if it is not accompanied by its converse, the right not to choose life. In the case of a person too severely physically disabled to commit suicide without help, therefore i believe that, just as ze has a human right (IMO) to free assistance with every other task ze wants to but is physically unable to do (as far as is possible), ze has a right to be assisted to commit suicide (although i do recognise the potential ethical difficulties in requiring someone employed as a personal assistant to effectively end their own employment, and to do something they may have major moral problems with... so i'm not sure that anyone should be required to assist in an individual's suicide).

Where i think assisted suicide as a right does get into extremely dodgy ground is the issue of doctors or family members putting pressure on a person to commit suicide (to free up hospital beds, say, or relieve the burden of caring responsibilities), or of people's choice to die being motivated primarily be society not accommodating their needs or impressing on them that their life is not worth living or that they don't deserve to live (part of my response to that is, of course, a call for change in social attitudes towards illness and disability; another part is the assertion that assisted suicide should be carried out by someone who the disabled person has authority over, such as a personal assistant, rather than by someone who has authority over them, such as a doctor).

However, assisted suicide is not euthanasia - euthanasia is the killing of one person by another, not by hirself. Euthanasia, to me, is totally morally unacceptable because it is a total violation of the principle of autonomy over one's own body/self - it is not carried out at the request of the patient (or if it is, it should be categorised as assisted suicide), but at the decision of a doctor based on criteria of whether there is any chance of recovery or whether "suffering" is unbearable - criteria which to me are irrelevant, because to me the only possible judge of whether the suffering of life is unbearable is the "sufferer" hirself.

If the person in question has no capacity to consent or no ability to communicate, as in the case of a small child (such as Charlotte Wyatt) or a person who is unconscious or in a vegetative state (such as Terri Schiavo), then IMO the presumption has to be in favour of life - because, if the person's desire, were they conscious or able to consent/communicate, was to die, then they would be being kept alive against their will, but they would not be in a state to know or express that will, whereas if their desire, were they conscious or able to consent/communicate, was to live, and they were "allowed to die", then they would be being killed against their will - and the only word for that is murder.

IMO it makes absolutely no difference if the motive is "ending the person's suffering" as opposed to "hating or wanting to exterminate the person" - in fact, if anything, IMO, the former is worse - paternalism on such a level that the state/doctors/whoever actually gets to overrule your own (actual or speculative) wishes on whether you want to live or not (reminiscent of when Hell is taken over by the angels in Gaiman's Sandman: Season of Mists...) Only the person suffering can decide if hir suffering is great enough to render their life unliveable or not, and if there is no way of finding out their feelings on the matter, or they are not sufficiently capable of rational thought to make such a decision, then IMO the only morally acceptable thing is to keep them alive - just as, if you believe the death penalty is appropriate for a particular crime (rape, say), then it's still not acceptable to execute unless there is proof beyond reasonable doubt that the accused actually did it...

Also IMO there isn't a fundamental difference between killing someone by withdrawal of nutrition, etc (as has been quite correctly pointed out is already routinely done, just not talked about) or by "actively" killing - except that the former could, at an extreme stretch, be sort-of-semi-justified by "lack of resources" arguments, whereas the latter never could...

The "lack of resources" argument is, to me, a bit of a red herring anyway - you could equally well say that, say, gender reassignment operations were not "life-saving" as such, and thus resources should not be spent on them but on more "urgent" operations (which argument is actually used to force transsexuals in the UK to pay (in part) for their own operations even on the NHS, which i'm sure no one here would regard as defensible)... likewise abortion on demand, or anything else...

And i'm not sure why you can dismiss "slippery slope" arguments - if doctors (as opposed to the individual living it) are given the power to decide whether a life is worth saving or not, then what if they decide, say, that a life paralysed isn't worth saving, and don't bother trying to save the lives of people who have had spinal cord injuries? Or, say, that a life with under a certain IQ (itself a highly dodgy concept) isn't worth living, and don't bother giving essential medical treatment to mentally disabled people (which category could include myself)? Many hospitals already deny heart surgery to children because they have Down's syndrome. I personally know people who have recovered from prognoses considered "terminal". These are very real concerns for many disabled people - who do see a slippery slope, and themselves (ourselves) in very real danger of ending up at the bottom of it...

(the original thread is here... there was an interesting, but IMO incomplete, debate there, which IIRC i didn't really feel up to returning to at the time... i also posted a link to a discussion of the same topic on the BBC Ouch message board)

I think i made my views reasonably clear there. If they have changed at all since, it's probably slightly - but only slightly - in the "Not Dead Yet" direction - if only because i'm even less comfortable with the idea of asking a PA to assist with suicide than i was then. I still agree with the MindFreedom/Antipsychiatry Coalition position on suicide in general, for all the reasons outlined above (and that, in fact, was pretty much the origin of my whole libertarian belief system which led me to the philosophy of the Independent Living Movement in the first place), but i do have to stand with Not Dead Yet in their argument that very many of the lives considered "not worth living" are only so because of social conditions - the most obvious being life in institutions - and that those people would not want to commit suicide if the proper social support to enable them to live lives of independence, dignity and equality were available.

There is a point here relating to depression and how it gets conceptualised - the prevailing view in mainstream/"establishment" discourse seems to be that depression is "endogenous", or a result of chemical abnormalities within the individual brain, whereas a social model or "personal is political" viewpoint would argue that it is more likely to be caused by oppressive and unacceptable social conditions, whether at a home/family/immediate surroundings level or at a wider systemic level. However, like with most iterations of the "nature vs. nurture" debate, I don't find the position held by some antipsychiatrists that all depression is social in origin useful - there is solid evidence that, in some cases, depression does have a clearly biological origin, and in some of those cases, it is treatable by biochemical means (an obvious example being gender dysphoria and the extremely high success rate of treating it with hormones and surgery, as opposed to the extremely low success rate of "treating" it with "normalisation" therapy - in fact, most attempts at the latter end in suicide).

If most depression is (and I do think most depression is) caused primarily by social conditions, then the obvious, non-medical solution to the problem is to change those social conditions (which, obviously, is easier said than done). However, if someone has truly endogenous depression (that is, in social model terms, their depression is not a result of disability, but is in fact their impairment), to the extent of unrelentingly feeling suicidal, and no drug treatment is successful in having a positive effect on it (as does happen in many cases), then is forcible suicide prevention - that is, denying death to someone who truly cannot find anything positive in life - really justifiable? If someone I loved was in that position, while of course I would tell them how much I valued them and wanted them to stay alive, ultimately it would be utterly selfish, and even arguably a form of torture, to keep them alive when life was intolerable for them - and so, ultimately, I think I would, albeit deeply regretfully, if necessary help them to die.

However, this is actually a slight digression (and something that really deserves its own full post) - the purpose of this post was really to say that euthanasia is not the same thing as assisted suicide, and that, while some of the same issues tend to be present in individual cases of both, conflating them with one another is inaccurate, confusing and helps no one - indeed, it potentially endangers a lot of people, especially when the kind of arguments most properly used in regard to assisted suicide get used in clear cases of "mercy killing" (aka murder) - the Latimer case, for example - in which there is no evidence whatsoever of suicidal feelings on the part of the victim. It shows, to me, a disturbing lack of understanding of the most fundamental aspects of the ethics of life and death on the part of writers and journalists to conflate such concepts with each other...

* "recent" here now meaning a couple of months ago, as this post was written in early April and is only being posted now because of having been offline for so long...

The Thing Itself Is The Abuse

The headline of this recent BBC story is "Stroke victim was misdiagnosed as mad". While reading it was pretty scary (especially as temporary aphasia can also occur in autism, and in fact i experienced it (albeit only for a few very brief periods) in my teens), it follows a certain pattern that annoys me: in describing the horrible treatment that Steve Hall experienced when "misdiagnosed", it implicitly suggests that the same treatment would be appropriate and acceptable if he actually was "mad".

It reminded me of this case of a woman who was put in a men's prison because she was percieved to be a transsexual woman (and, therefore, in the eyes of the police who arrested her, "really a man") - and of similar cases i've heard of where gender-ambiguous-looking women have been refused entry to women's toilets or other single-sex spaces where they were thought to be MTF transsexuals. As nodesignation says:

The police don’t question the practice of regularly placing trans women in situations where they will be raped. They only lament that they accidentally subjected a non-trans woman to the violence that they regularly subject trans women to. I would assume that as this story gains traction the emphasis will be about how horrible that a woman who was not trans received such mistreatment. That much is clear already from the fact that there are so few stories on trans women receiving this mistreatment despite being its being a regular occurance.

It's not the inherent wrongness of the treatment that is discussed, it is the supposed "horrible mistake" of subjecting someone to that treatment when that person actually turned out to be not a member of the category of people that it's considered acceptable to do this sort of thing to. No thought is given to why it's supposedly "acceptable" to do it to people who are in that category, despite the fact that, in both cases, the reporting of the incident blatantly begs the question: if it was horrible and inhuman and inacceptable to do this to one person "by mistake", what is it to do it to a whole "Othered" class of people deliberately?

It was, and in some places still is, common for autistic people (particularly those who don't fit certain aspects of the commoner autism stereotypes) to be "misdiagnosed" as "schizophrenic", leading to institutionalisation, forced drugging, etc. Similarly, many non-verbal autistic people (who are/were nonetheless capable of communication through other means) are or were "misdiagnosed" as "mentally retarded", again leading to institutionalisation and other abuses "justified" by the "fact" of their supposed incapacity for rational thought or communication. On autism message boards and other communities, these cases tend to be talked about primarily in terms of the horribleness of the "misdiagnosis", often with comments to the effect that "I/you/ze should never have been treated like that, because I'm/you're/ze's autistic, not schizophrenic/mentally retarded/whatever", or seeing the case similarly to someone who was acquitted of a crime after new evidence proved them not guilty, as if to be found to be autistic rather than some other diagnostic category "after all" is what makes all the difference. Even if the people making these sort of comments don't realise it, they're implying that it would be OK to do all those things to someone who actually is "schizophrenic" or "mentally retarded".

(Let's not, here, get into the fact that i actually don't think anyone is "schizophrenic" or "mentally retarded", as i don't think either of those terms is a useful diagnostic category at all... regardless of the label used, if something is unacceptable to do to anyone, it's unacceptable to do to anyone...)

Similar stuff goes on when people who are cognitively "normal", but who have physical impairments (particularly ones such as CP which affect speech) are harassed or discriminated against because they are "mistakenly" assumed to be mentally impaired, and express outrage at having been categorised as such, often asserting their intelligence or educational qualifications in response - implying that harassment or discrimination would be justified if they really were mentally as well as physically impaired (see, for example, Cal Montgomery's fantastic article "Critic of the Dawn", particularly the beginning of the first and the 8th part of the second section).

In the BBC news report, a "spokesman for the Aphasia Alliance" said: "People with aphasia are often wrongly pigeon-holed as stupid... However aphasia does not affect intelligence..." - clearly motivated by a desire to render the particular category of cognitively disabled people he is employed to "speak for" a "respectable" category, because they're not really mentally impaired - again, as if it would be acceptable to mistreat people if they did have the "beyond-the-pale" category of impairment.

I recently found this quote at Rad Geek People's Daily (it's one of the rotating "frontispiece" quotes). While i was surprised to see it coming from who it comes from (he was one of the political philosophers i had to study in the first year of my Politics with International Studies degree, and i remember him as an arch-conservative and one of the least pleasant writers, both in opinions and in style, i ever had to study), it makes it pretty clear (well, apart from the fact that i actually can't identify 3 things that make up the "all three" in the second paragraph) where these kinds of critiques fall far short of logical or ethical consistency.

To prove, that these Sort of policed Societies are a Violation offered to Nature, and a Constraint upon the human Mind, it needs only to look upon the sanguinary Measures, and Instruments of Violence which are every where used to support them. Let us take a Review of the Dungeons, Whips, Chains, Racks, Gibbets, with which every Society is abundantly stored, by which hundreds of Victims are annually offered up to support a dozen or two in Pride and Madness, and Millions in an abject Servitude, and Dependence. There was a Time, when I looked with a reverential Awe on these Mysteries of Policy; but Age, Experience, and Philosophy have rent the Veil; and I view this Sanctum Sanctorum, at least, without any enthusiastick Admiration. I acknowledge indeed, the Necessity of such a Proceeding in such Institutions; but I must have a very mean Opinion of Institutions where such Proceedings are necessary.

I now plead for Natural Society against Politicians, and for Natural Reason against all three. When the World is in a fitter Temper than it is at present to hear Truth, or when I shall be more indifferent about its Temper; my Thoughts may become more publick. In the mean time, let them repose in my own Bosom, and in the Bosoms of such Men as are fit to be initiated in the sober Mysteries of Truth and Reason. My Antagonists have already done as much as I could desire. Parties in Religion and Politics make sufficient Discoveries concerning each other, to give a sober Man a proper Caution against them all. The Monarchic, Aristocratical, and Popular Partizans have been jointly laying their Axes to the Root of all Government, and have in their Turns proved each other absurd and inconvenient. In vain you tell me that Artificial Government is good, but that I fall out only with the Abuse. The Thing! the Thing itself is the Abuse!

—Edmund Burke (1757), A Vindication of Natural Society

Ballastexistenz has many, many incredibly powerful posts that are essential reading on the subject of institutionalisation, and why it's never acceptable, but one of the best is this one, in which Amanda Baggs contrasts the well-known horrors of the Judge Rotenberg Center with the subtler horrors of "nicer" institutions. Just as, in the case of the recent scandal over the prank-calling incident at the JRC, it was not this "abuse" of the electric schock treatment, but the entire treatment regime itself, that was the abuse, it is not just the particular forms of torture practiced at the JRC that is an "abuse" of an institutional system, but the whole institutional system, the whole concept of institutions in which to incarcerate people categorised as "Other", which is abusive at its core.

I had a friend as a teenager who lived in a local authority-run "children's home" (actually for 14-18 year olds) type institution (she wasn't classified as "disabled", although i'm fairly sure she wasn't neurotypical), in which many of the same techniques of oppression and dehumanisation used in disability institutions were commonly used. However, she failed to recognise the inherent wrongness of that type of institution, insisting during the many heated arguments we had about the subject that the staff who had physically abused or pettily taken rights and possessions away from her were just "bad staff", and that others there were "good staff", and that the "home" itself was fundamentally a "good" place. Possibly it was clearer to me, on the outside, than it was to her, on the inside, that it was not "corruption" within Social Services that was the problem, but the entire set of premises on which the concept of "Social Services" was based.

Of course, this argument applies to a whole host of other things: "anti-war" activists and commentators who stop short of being full-blown anti-militarists, for example - those who argue that the Iraq war is wrong, but would have been right if there actually had been weapons of mass destruction in Iraq; a certain category of "gay rights activists" who argue that gay people are not promiscuous as they are stereotyped as, but just as likely to have stable, monogamous relationships as straight people (thus implying that it's acceptable to shame or discriminate against people who are promiscuous); apologists for the oil or nuclear industries who accept that certain particularly blatant examples of environmental destruction were wrong, but insist they were "anomalies" rather than part and parcel of inherently polluting industries; the examples could, in all probability, go on for ever. It's the fundamental basis of the anarchist argument against all government, not just "bad government", and one of the main reasons i identify as an anarchist.

Whether or not we want to adopt an overarching political/philosophical label like "anarchist", however, all of us who fight, with actions or words, for any oppressed groups and against oppression need to actively oppose the hypocrisy of outrage at people being "mistakenly" treated like they are members of a "supposedly OK to exclude, abuse or oppress" category, when the real outrage should be that such a category even exists. The thing itself is the abuse...