When it’s time to go …

Ross Douthat is against physician-assisted suicide, but can’t provide a single reasoned argument to support the current policy.

Ross Douthat provides a completely argument-free rant against assisted suicide. Apparently his emotions are self-justifying, needing no assistance from reason.

He points out that if suicide is sometimes an appropriate choice, or at least a choice with which the state shouldn’t interfere, that must logically apply to some people who aren’t currently terminally ill, and then triumphantly reports that some practitioners have helped non-terminal as well as terminal patients.

So what? If Mr. Douthat doesn’t want to kill himself, that’s his right. But by what right does he presume to make the choice for others? He reports being “proud” that, here in the Land of the Free, his prejudices are reflected in current law. But he never says why.

A reasoned account of the matter would try to deal with two difficult issues: people whose suicidal impulses are the transient consequences of despair or mental illness and who, if prevented from doing the deed, will retrospectively be happy to have been stopped, and the risk of the aged and elderly feeling social pressure to off themselves. (That pressure will get worse if Mr. Douthat’s political allies manage to wreck Medicare.)

But when someone makes the considered judgment that his or her life is better ended sooner rather than later – “My work is done,” wrote George Eastman. “Why wait?” – that person should be able to act on that judgment, with whatever technical help is required.

Ironically, the need for assisted suicide is restricted to those with severe physical limitations. Anyone with the full use of his limbs can take himself off cheaply and painlessly with equipment easily obtained from a party-supply store and a hardware store. The fact that the law denies an easy out to those physically incapable of doing the job themselves is not, I submit, something to be proud of.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: Markarkleiman-at-gmail.com

25 thoughts on “When it’s time to go …”

  1. “But when someone makes the considered judgment that his or her life is better ended sooner rather than later – “My work is done,” wrote George Eastman, “why wait?” that person should be able to act on that judgment, with whatever technical help is required.”

    This statement is every bit as devoid of reason, and every bit as based on emotional preferences, as is Mr. Douthat’s argument. You’re both making value judgements about ultimate things with no recourse to rational proof.

    Mr. Douthat says that people don’t have the right to kill themselves, because they don’t You say that people do have the right to kill themselves, because they do. But in each case the moral imperative (“the state must interfere with the desire for suicide” or “the state must not interfere with the desire for suicide”) is asserted as being true without any demonstration that it is true. And that’s fine, because there can be no ultimate logic pointing in one direction or the other on the matter. There can only be moral committments grounded in a worldview.

    We would all agree (I hope) that I don’t have the right to kill you. For most of the history of Western civilization we almost all would have agreed that you don’t have the right to kill you either. In recent decades public opinion has shifted, such that now at least a sizable minority would say that you do indeed have the right to kill you. But public opinion isn’t the ultimate driver of morality. If it were, then it would have been moral to own slaves in 1825. One can I suppose defend from the perspective of “pure reason” (whatever the hell that is) the idea that a person doesn’t have the right to harm another person. But good luck trying to defend from the perspective of pure reason the idea that a person does have the right to harm their own self, especially in a manner as permanent and ultimate as killing one’s self.

    After all, just as easily as you could argue that only Mark Kleiman has the right to decide if Mark Kleiman should ingest a bottle of sleeping pills this afternoon, I could argue that July 6 2011 Mark Kleiman has the right to prevent June 6 2011 Mark Kleiman from killing him. And given that people change their minds about important things all the time, there is just as much “rational” reason for the law to protect the option value of future selves from the choices of current selves as there is for the law to allow current selves free rein. Nobody (I hope) would defend the rights of children to kill themselves. But the rationality and judgement of a small child differs in degree, not in quality, from the rationality and judgement of an adult. If a 10 year old can be legally prohibited from killing himself, then can a 16 year old? An 18 year old? The day after his 18th birthday?

    At some point the law must impose some arbitrary cutoffs in which options it allows to people. So we all accept that a 20 year old can be prohibited from buying beer, while a 21 year old cannot. But the point is that the cutoff is arbitrary. We grant 18-21 year olds most of the rights of adulthood but not all of the rights of adulthood because we acknowledge that certain choices are more consequential than others and thus a higher degree of maturity and reason are required before a person is granted the right to make the choice. But if raising the stakes on a choice implies that the state has a legitimate interest in restricting the ability to make that choice, then why can the state not say that no person is ever sufficiently mature and rational to make the choice of ending their own life?

  2. But by what right does he presume to make the choice for others?

    Ross was a nanny in an earlier incarnation…
    And shouldn’t a nanny have it both ways?
    Namely: If the State can take a life, should it not also be empowered to prevent you from taking your own?

    That pressure will get worse if Mr. Douthat’s political allies manage to wreck Medicare.

    Aye.

    And I see a new definition of “assisted suicide” in the offing.
    Namely, those with no future reaching out with cheap and plentiful guns to take along those who voted their Medicare away.
    That’s why I always disagreed with those who said Ryan’s Plan wasn’t truly serious.
    In a country that loves violence and guns taking away someone’s healthcare seems like a dangerously serious thing to do…

    True, passivity seems to rule the land; especially on the Left.
    And yet, for someone dying, who can’t get help, and who is pissed off, the potential to seek revenge will be very tempting indeed…
    After all, at the very worse, you go to jail and trial, and probably get some medical attention in the interim.
    After all, the government will want to keep you alive, so they can put you on trail, find you guilty, and sentence you to death…

    You ever get the feeling these Vouchercare folks really haven’t thought things out very carefully?

  3. sd assumes – naturally, without argument – that death is always a harm. Once you assume that, then the question how to prevent that harm arises automatically. I assume that, in the absence of harm to others or strong evidence of impulsiveness or mistake of judgment, people’s own decisions about how to live (or end) their lives ought to mostly be respected. (Note that the criminalization of suicide is obsolete; the remaining ban is only on helping someone to do what he or she may already lawfully do.)

  4. The guy is making the slippery slope argument. ‘If we let one person kill himself pretty soon everybody will want to kill themselves.’ Gosh knows I’m saving up my sheckles in eager anticipation.

    But these clean cut conservatives are all the same. In fifty years when he is looking an agonizing and dragged out death in the face he will come to an epiphany an rail against the unjust government that will take away his right, HIS RIGHT to die in the manner of his choice. It’s a free country fer gosh sakes.

  5. The Douthat piece was remarkably free of analysis. To say people have the right to kill themselves seems obtuse. People CAN and DO kill themselves — the “right” under examination is whether they should be able to get assistance to carry it out in less surreptitious, extreme, or violent ways (jumping from a building or shooting themselves as opposed to taking a lethal dose of narcotics), and even more to the point, whether people (doctors) can help them without fearing for their freedom or at least their medical license.

    It seems appropriate to me that the practice would be regulated, to ensure that people are being evaluated to see whether they are suffering from depression or fear of pain or simple reaction to devastating personal loss — conditions that can be treated or at least ameliorated or might just improve over time — rather than terminal illness or some other permanently intolerable situation. In this sense, the issue is, to what extent are we comfortable with the notion that doctors are legally permitted to enable death — understanding that some people who are denied the assistance might otherwise off themselves anyway.

    It is important in analyzing this that we look at research on people who survive their suicide attempts because it really is clear that many thought that it was the only solution to their problems until they tried it and managed to get assistance. I don’t think such assistance should be administered lightly because most physicians are not adequately trained in mental health. And this isn’t so much a desire to force someone to conform to my morals as an acknowledgment that it might not be all that simple to conclude whether someone sincerely wishes to be dead.

  6. Let me try to phrase my objection to Douthat’s column in a way that a freemarketeer will understand. Presumably, the reason he is opposed to letting me kill myself is that he thinks that somehow, the world is a better place with me in it, that I add value to his existence in some way. I’ve had a number of people tell me this over the years, and I am someone who has attempted suicide (pretty weakly) and is not immune from considering it again. In part, that stems from having been unemployed for five years.

    As a believer in markets, I firmly believe that people should be paid for the value they add to the products they make. That’s a basic requirement of economic justice. If I’m adding value to the world, I should get paid for that. If no one will hire me, I’m getting ripped off. Ross Douthat has frequently proclaimed himself to be a believer in free markets. He also subscribes to an economic philosophy that says that, if I can’t find a job, that’s my own problem, and not something that anyone has an obligation to help me with. If you throw on top of that an insistence that I am required to continue to live so that I continue to add value to the world, then he believes that it is proper to rip me off.

    Conservatives, albeit not Douthat to my knowledge, often talk about going Galt and refusing to continue to add value because they think that they are being undercompensated for it. At the same time, they insist on receiving value from me without anyone providing any compensation at all.

  7. This whole post and thread would be better if it weren’t premised on the absurd notion that we should take Douthat remotely seriously. This is a debate worth having, but connecting it to Douthat accords him undue respect while unfairly wedding the anti-suicide position to the banal and unsubstantitated pronouncements of a useless pseudo-pundit. And I say that as someone who is in favor of highly regulated assisted suicide.

  8. @Mark Kleiman:

    “sd assumes – naturally, without argument – that death is always a harm. Once you assume that, then the question how to prevent that harm arises automatically…”

    No, I assume, as is amply demonstrated by opening ones eyes, that the vast majority of human beings in the vast majority of situations regard death as a harm. Otherwise, folks wouldn’t take such great pains to avoid dying, which they in fact do every day. Given that, and given the fact the people change their mind about what they want all the time, it is reasonable for the state to give some weight to the wellbeing of your future self in deciding whether you have the right to kill your current self.

    If I kill a man who is demonstrably pre-suicidal (he has been talking to friends about ending his own life; he has collected instructions on how to do so and the equipment needed to carry out the task), then the law doesn’t allow me even the tiniest bit of relief from punishment because my victim valued his life less than does a man who has no thought of suicide at all. Because the law values the man’s life apart from the degree to which he values it himself. Indeed, if I murder someone who is depressed and prone to self-destructive behavior (excessive drinking and drug use, engaging in violence and risky activities) I also cannot plead that my punishment should be reduced because my victim did not value his own life less than the typical man does. The state values his life, and that is why I am punished. So why can the state not say that it values your life, and thus intervene to keep you from killing yourself?

    Also:

    “…I assume that, in the absence of harm to others or strong evidence of impulsiveness or mistake of judgment, people’s own decisions about how to live (or end) their lives ought to mostly be respected.”

    Yes indeed – you ASSUME. Which is to say that you doing exactly what you accuse Ross Douthat of doing. Namely, making an argument from your emotional biases and stating it as fact. Again, I don’t think there’s anything wrong with that, because I think that fundamental moral questions must always be answered with appeals to authority or to sentiments that pre-rational or non-rational. We have a worldview or a set of fundamental moral assumptions that then drive our moral reasoning. But its for that reason that I think your criticism of Mr. Douthat is weak.

  9. Note that on this topic Douthat the free-market guy is being completely over-ridden by Douthat the Catholic. This reflects that while in much of “Western civilization” (and why exclude the East?) suicide was not viewed as immoral, in Christianity it was, to the point of being criminalized (though the usual loophole to avoid this was to decide, retroactively, that the person had been of unsound mind and hence not really responsible). I don’t know the Judaic view but suspect it was negative; perhaps Mark could summarize it.

  10. @sd,

    you doing exactly what you accuse Ross Douthat of doing. Namely, making an argument from your emotional biases and stating it as fact

    No. He’s not doing exactly what Douthat is doing. There is no mirror symmetry here.

    I don’t know about you, but I start from a default position in favour of personal autonomy. That’s merely the default, of course. Obviously one’s autonomy is limited in all sorts of ways, and properly so. (We can and do argue over where exactly the limits are to be drawn, but only mental perpetual adolescents crippled by reading Ayn Rand would deny that there are legitimate limits.)

    Thing is, one needs to justify any such limits. Absent compelling justification (e.g., “your freedom to swing your fist is properly limited from the point where my nose begins, because if it isn’t, you’ll break my nose and it isn’t yours to break”), the default prevails. In this case, it’s not Mark Kleiman who bears the onus of justification, it’s Douthat. And as Douthat does not offer any justification for limitations on assisted suicide (and his implicit but unstated justification is merely his belief in fairy tales), he has failed to carry the day.

  11. sd’s argument appears to be based on the same basic ideological proposition that the state should forbid women from having sovereignty over their own bodies, and that they should be compelled to give birth

    Mark’s “assumed” assertion was simply a statement recognizing an individual’s sovereignty over their own personal being, and in that regard; sd’s disagreement has the odor of the claim that people with dark skin couldn’t be “assumed” to have equality, because anyone who made such claim was simply advocating a bias, not a rational indisputable truism.

    sd also seems to be unfamiliar with the fact that, you know, everybody dies eventually, ergo, following the logic, the state should coercively prohibit everyone (well, perhaps only US citizens) from the presumptive “harm” which by his “open eyes” attends all dying (he neglects to mention just how this might all be accomplished, but maybe by freezing everyone who has terminal cancer or multiple gun shot wounds, etc ad infinitum, before they die, so they can be reanimated in the future?)

  12. And of course being overweight, a sedentary lifestyle, and cigarette smoking are all forms of slow suicide, so, Douthat and SD have now fully embraced the nanny state.

  13. As a proud Oregonian whose mother died in unspeakable misery and suffering thanks to liver cancer, I can happily contemplate Douthat never moving here and I wish him every opportunity to experience what I did because there was no option for aid in dying. In fact, let me wish Mr. Douthat eternal life, spent enjoying his superior morality at work on his loved ones.

  14. “In fifty years when he is looking an agonizing and dragged out death in the face he will come to an epiphany …”

    Or an agonizing non-drugged death, because he can’t afford the painkillers. Even if he stays on wingnut welfare for the next 50 years, he’ll find that it doesn’t cover much in the way of medical costs.

  15. sd, the state can and should value my life (and the lives of everyone else). That is a logical default application of the golden rule. But when the state’s valuation goes beyond what I desire, and in fact, significantly impinges on my freedom as well as (potentially) consigning me to live in a state that I find painful, incapacitating and degrading, then one might ask: upon what principle does the state base its valuation in those circumstances? One hears arguments based on the fear of a “slippery slope” all the time, but one fails to grasp the equal if not quite opposite problem, which is that of “lack of proportionality,” which causes one to take extreme positions out of abject fear of ever being on any slope of any kind. This is where personal autonomy should come into play, so that the state (or your family) is not applying hard and fast rules but is enabling a process that allows you to go out on a slope that affects no one else but you — and also why, in my view, there should be some assurance built into this practice that one who does avail themselves of the right to assisted suicide is actually acting autonomously.

  16. “And given that people change their minds about important things all the time, there is just as much “rational” reason for the law to protect the option value of future selves from the choices of current selves as there is for the law to allow current selves free rein.”
    Wow. If you’re going to let decisions be made on the basis of the slippery slope argument, without considering offsetting values and lack of proportionality, just consider where the above quotation could lead. E.g., you might change your mind about marrying your current beloved; people do, after all. So the State should decide for you whom you can, or can’t marry.
    No thanks.

  17. I’m not sure the free-market arguments are right. There’s a pretty strong case that Douthat and people like him don’t so much gain value from the continuing lives of folks like J. Michael Neal, but rather gain value from the knowledge that folks like Neal are prevented from living (or ending) their lives as they (Neal et al, not Douthat et al) choose. That’s where the whole “pain caucus” thing comes in: given two fiscally equivalent alternatives, one of which involves a lot of “undeserving” people experiencing misery and the other of which doesn’t, pain-caucus members will unerringly select the one that involves more misery. (See, for example, the legislators who vote down both subsidies for contraception and those for pre-natal care.)

    In general, it seems to me that positions on assisted suicide are a lot like positions on less-regulated international trade. A lot of people see the potential for improved pain management and treatment of temporary conditions such as depression and come to the conclusion that assisted suicide should be barred. In this, they’re like the economists who note that the winners from “free” trade gain more than enough to compensate the losers, and then never stop to ask if they actually do.

  18. “I could argue that July 6 2011 Mark Kleiman has the right to prevent June 6 2011 Mark Kleiman from killing him”

    If so, sd, then why not protect July 6 payer-of-usurious-interest-rate from June 6 borrower-from-payday-loan store?

  19. … or for that matter, why should July 6 2011 convicted-murderer suffer for June 6 2007’s murderous spree?

  20. @Betsy:

    “If so, sd, then why not protect July 6 payer-of-usurious-interest-rate from June 6 borrower-from-payday-loan store?”

    I’m not arguing that its always good for the state to limit the freedom of persons in the interest of benefitting their future selves, only that in some cases it is reasonable to do so. Suicide is irreversible and ultimate. Therefore it makes sense that it would be more heavily regulated than payday loans, which are not irreversible in the same way (you can pay down the principle and be out of debt) and are certainly not ultimate in the same way (taking on a bad loan may lower your expected future wellbeing but it doesn’t obliterate your expected future well being).

    Now, that’s not to say that we definitely should limit freedom of choice in the case of suicide, or that we definitely should not limit freedom of choice in the case of payday loans. My point was simply that sometimes we pass laws that limit current choice in the interest of protecting a person’s future wellbeing (its not exactly legal to take up heroin use, and most “consumer protection” legislation effectively limits the freedom of consumers to engage in certain types of transactions). And if we’re going to do that, then our threshold generally is (and certainly should be) higher for choices which have irreversible and/or bigger consequences.

    I did not intend to get into a discussion of whether assisted suicide should be legal per se (I think not, but its a thorny issue and one that I’m not likely to change any minds on). But Mark’s original post was critical of Ross Douthat for arguing against assisted suicide without providing any reasons beyond “just because,” when in fact Mark himself argued that assisted suicide should be legal without providing any reasons beyond “just because.

  21. Douthat is just offering another variation on a favorite tactic of the sophomoric silly-clever, the argument of the beard. ‘Well, it may seem as if people suffering from horrifically painful, incurable cancer have some case for assisted suicide, but if you really think about it, is there any essential, definitional difference between the cancer patient and the person with a mild headache?’ I’m sure anybody who’s been to a few high-school debates has had more than their fill of this style of reasoning. (“You object to my proposal for an all-out thermonuclear attack on China, as if that were so uniquely horrifying, and yet is it not true that all war kills people?”)

  22. “but if you really think about it, is there any essential, definitional difference between the cancer patient and the person with a mild headache?”

    I’ve had headaches, and I’ve had cancer, thankfully curable. Yes, there’s a difference, and for a while there, I was looking at a future which might have included the legally approved form of assisted suicide: Prescribing enough pain killers to actually deal with the pain, and never mind that the patient will stop breathing.

    I suppose this is prompted by the recent death of Dr. Kevorkian. Did you know, they couldn’t get a jury to convict until he got a bit impatient, and moved on from assisting suicide, to euthanasia? Guy wanted to go to prison, that’s all I could figure out.

  23. This trope of headache versus cancer typifies the lack of proportionality that is so evident in much of cultural conservative thought — whether the issue is abortion or assisted suicide. I’ve had headaches and my father had terminal cancer and I therefore feel that I am somewhat qualified by experience to say that yes, I do know the difference, and the difference is profound: no headache (even the really bad ones) has ever prompted me to think about my own mortality. I am not well-schooled in philosophy, but I think this kind of thought depends on a Platonic framework — that things have an essence and all things that are of essentially the same nature need to be treated in essentially the same way. Hence, something like the Platonic form of “Disease” exists and must guide our morality with respect to how we treat all disease. This is very evidently the kind of reasoning that prompts the RC Church to claim that a zygote is equivalent in substance and nature and moral worth to a human being at any other stage of development.

    There is no answer to this kind of reasoning that will satisfy someone who can only be guided by the brightest of lines — and that’s what leads not only to the taking of extreme positions but in ascribing extreme positions to other people who cannot define their own ethics by resort to a similarly bright line. In other words, they cannot allow themselves OR OTHERS to live where prudential judgment has to be exercised. (Just as an example, if you read enough pro-life content you will find people who assert that there is no difference between an early abortion and killing a two year old, and pretty soon, if we accept the legality of abortion without protest, people will be lining up to euthanize their two year olds.) That kind of reasoning is really not that much different from what Douthat utilizes in his article.

  24. “no headache (even the really bad ones) has ever prompted me to think about my own mortality.”

    I’d venture to guess you’ve never had an eardrum rupture…

    “This is very evidently the kind of reasoning that prompts the RC Church to claim that a zygote is equivalent in substance and nature and moral worth to a human being at any other stage of development.”

    I can’t say I’m much impressed with the reasoning that prompts many liberals to claim that a viable infant half-way up the birth canal is equivalent in substance and nature and moral worth to a fertilized egg, either. Pro-choicers often aren’t all that much better, when you get down to it.

  25. I did have an eardrum rupture and my most immediate thought was to get myself to a doctor who could treat it, not to start thinking about the end of my life.

    I didn’t mean to turn this into a discussion over abortion, of course people will argue over where the line should be drawn, but I just wanted to highlight the kind of reasoning that sees the most rigid and extreme position as being the only permissible one, that is, there is no reasonable line that can be drawn by anyone anywhere, no matter what the circumstances.

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