Andrew Brown goes badly wrong on assisted suicide

I’ve been saying for a while that Andrew Brown’s public and painful slide into incoherence suggests that it’s time for the Guardian to let him go.  His latest example, a post called “Assisted suicide is never an autonomous choice,” shows the peculiar combination of stupidity and obstinacy that is Brown’s forte.

His argument, as far as I can make it out, seems to be that the decision to end one’s life in the face of intolerable pain or illness should be an autonomous one, but it can’t be because it’s made in the context of friends, family, and a harsh, depersonalizing society.  See what you make of this argument from Brown:

It’s already abundantly clear that Britain has hundreds of thousands of old people whose lives are worth very little to anyone else, and who are neglected at best, abused at worst. Let’s suppose that only one in a thousand of them thinks their lives are hardly worth living – and that’s a very low estimate. That still means hundreds of people who would take the chance of assisted suicide if it were offered without pain or condemnation; and if we treat their decisions as wholly autonomous there is no reason to argue with them.

But we know that in fact their actions and decisions would not be really autonomous. They are reactions to a world that others have made, and that we all have a part in.They are reactions to a world that others have made, and that we all have a part in. The fraudulence of this kind of autonomy talk is obvious when it’s applied to poverty. Rich and poor alike are free to choose to sleep under the bridges. We can all now see the damage that was done to society in the last 30 years by talking about choices that the powerless just don’t have as if they were real. When Tony Blair’s old flatmate Charlie Falconer extends this style of argument to judgments about life and death, the only sane response is to call it nonsense. [Falconer headed a British commission that recommended, when strict conditions were met, the option of assisted suicide for the terminally ill.]

What is Brown trying to say?  I have no idea, except that he doesn’t favor assisted suicide because other people advise one about it, or influence one’s decisions.  Yet I know from reading about the issue that those decisions, while often made in consultation with doctors, psychiatrists, and loved ones, seem completely autonomous.  Very few people will urge their friends, patients, or loved ones to take their own lives.

At any rate, someone with personal experience in this area, Eric MacDonald, takes Brown apart by recounting the heartbreaking story of the assisted suicide of his wife, Elizabeth, who took her life at the Dignitas clinic in Switzerland after years of horrible suffering from multiple sclerosis. In “Andrew Brown is an idiot. It’s time for him to go,” (this is very strong stuff from Eric!), MacDonald analyzes the meaning of “autonomy” in such a decision:

If assisted suicide is never an autonomous choice, is any choice ever truly autonomous in the sense desiderated? I think the answer to that is no, and because he cannot see this is the reason why it seems to me that Andrew Brown is now teetering inelegantly towards idiocy.

The subtitle of his article states: “There are many who consider their lives no longer worth living. Yet it’s fraudulent to ignore the part we all play in those feelings.” And this is just silly. We don’t have to ignore the part that we play in people’s feeling that the quality of their life is so low that they consider their lives no longer worth living, in order to hold that the decision to ask for assisted suicide can still be a perfectly autonomous decision. If a person cannot make this decision autonomously, then the meaning of ‘autonomy’ itself is in question.

And then he tells Elizabeth’s story. It’s graphic, heartbreaking, and leaves no doubt that her decision was absolutely autonomous.

For anyone with a long-term partner, the saddest thing in life is to lose that partner. When it’s through a long, debilitating, and terminal illness, it’s much worse.  If someone is rational and wants to end that kind of suffering via assisted suicide, a merciful society should allow it, with the proper precautions and strictures, of course. To deny someone this right—and yes, it is a right—because their decisions “cannot be autonomous” is the height of stupidity and cruelty.

If you read only one thing on assisted suicide this year, read Eric’s post.  Many of us will face this issue ourselves, and need to think about it.

48 Comments

  1. J
    Posted January 6, 2012 at 6:11 am | Permalink

    I have to disagree with Eric, I’m afraid. Specifically “Andrew Brown is now teetering inelegantly towards idiocy” – this isn’t a recent thing! Even when Brown writes about something that I don’t disagree with him on, he writes with such obfuscation that I’m left wondering what point he’s trying to make, if any at all!

  2. Michael
    Posted January 6, 2012 at 6:26 am | Permalink

    So, you’re a compatibilist about autonomy but not about free will? I suspect Dan Dennett would be perfectly happy with that outcome. “I’ll give you the words ‘free will’ as long as you’ll let me keep the word ‘autonomy’,” he might say.

    • sasqwatch
      Posted January 6, 2012 at 6:41 am | Permalink

      beat me to it. (smiling)

      • mike
        Posted January 19, 2012 at 10:45 pm | Permalink

        Yes, me too. By a long time.

        For me, it doesn’t matter if your ill, in pain, or just a fool. If you don’t have control over how you live and how you die, you don’t have real freedom.

    • Charles Sullivan
      Posted January 6, 2012 at 2:34 pm | Permalink

      I thought the same thing. If our choices are all determined (as Jerry believes) then what does autonomy even mean? Not forced at gunpoint?

    • Tim
      Posted January 7, 2012 at 10:34 am | Permalink

      I gues some emergent properties are “real” and some aren’t. Autonomy, yes. Free will, no.

  3. jay
    Posted January 6, 2012 at 6:33 am | Permalink

    Being forced to stay marginally alive under hopeless circumstances is cruelty beyond measure. I periodically have terrifying nightmares about such situations.

  4. Posted January 6, 2012 at 6:42 am | Permalink

    This is a great example of how, even in a macro-deterministic universe, people can make autonomous, pro-active choices and exert control in service to their desires, as opposed to being passive victims of circumstance or coerced against their will. The freedom of choice involved in dying with dignity is gradually being carved out by champions such as Eric, for which I”m most thankful.

  5. Posted January 6, 2012 at 6:50 am | Permalink

    “Rich and poor alike are free to choose to sleep under the bridges.”

    Well, yes, but the rich can sleep in a covered gondola underneath Ponte Pietra in Verona, Italy.

  6. BilBy
    Posted January 6, 2012 at 6:50 am | Permalink

    Brown seems to be conflating older, or indeed any, people who might be unhappy and lonely with people like Eric’s wife Elizabeth who was suffering from a medical condition that could not be ameliorated in any meaningful way. If he can’t tell the difference then he truly is an idiot.

    • jay
      Posted January 6, 2012 at 8:19 am | Permalink

      In any case, a critical component of human dignity is the right to make choices, even choices that others may find unpalatable. What gives Andrew Brown, or any freakin do-gooder, the right to impose their belief on an individual.

      • Rob Schneider
        Posted January 6, 2012 at 3:35 pm | Permalink

        “critical component… the right to make choices…” So say you. ;-)

        And this is the nub of the matter: religious folk abhor the thought that we have the right to make choices for ourselves, up to and including whether we want to continue living.

        “Why, it’s tantamount to thinking of oneself as God!!”

        I actually agree with you, and am “pro-choice” in the broadest possible sense of the words. We must suffer the consequences of our choices, but we do have the right to choose!!

    • Diane G.
      Posted January 7, 2012 at 3:50 am | Permalink

      At some point, old age itself becomes “a medical condition that c[an] not be ameliorated in any meaningful way,” too.

      I’m sure you know that; just wanted to emphasize the point…

  7. Posted January 6, 2012 at 7:29 am | Permalink

    I think there is a distinction between the concept of an autonomous, uncoerced decision and an act of free will. As I understand it, we do not really have free will because there are mechanisms at work, some of which we do not consciously perceive, that produce our decisions. Because of this many of our decisions appear, even to ourselves, as close to arbitrary. This is quite different from a decision that is imposed by another person or a court decision – Socrates had no choice about drinking the hemlock.

  8. Posted January 6, 2012 at 7:32 am | Permalink

    My dad died in 2008. He wanted assisted suicide, but it’s not legal in Canada.

    I blogged about it at http://filsalustri.wordpress.com/2009/10/07/in-defence-of-euthanasia/

    • Diane G.
      Posted January 7, 2012 at 4:16 am | Permalink

      Thank you so much for that! It is extraordinarily beautifully written and I can’t begin to tell you how much personal resonance it holds for me these days.

  9. Posted January 6, 2012 at 7:42 am | Permalink

    By this definition, no decision is autonomous. Which makes the word “autonomous” kinda useless.

    • TomZ
      Posted January 6, 2012 at 8:20 am | Permalink

      Yeah, that was my initial reaction too. What “decision” isn’t made in the “context of friends, family, and a harsh, depersonalizing society”?

    • Darth Dog
      Posted January 6, 2012 at 2:20 pm | Permalink

      Indeed. His solution is to have the government pass a law to decide for you. Seems scary to me.

  10. Posted January 6, 2012 at 8:05 am | Permalink

    Jerry,
    Thank you for writing about this important topic. As a physician, I’ve been with a number of people at the end of their lives, tried to help them through it, and have just as often come away dissatisfied with how things went as I have happy with them. It seems to me that the sophistication of the technology we have available to treat people near the end of their lives has outpaced the sophistication of our thinking about how it should be applied. For anyone interested, I wrote about my thoughts on assisted suicide here: http://www.happinessinthisworld.com/2011/10/16/the-right-to-die/#.TwcL3vJkjPo

    • whyevolutionistrue
      Posted January 6, 2012 at 3:59 pm | Permalink

      Very nice post, Alex, and I’m glad you agree. Pointless suffering is pointless.

  11. moochava
    Posted January 6, 2012 at 8:21 am | Permalink

    I think Brown is trying to say that autonomy is largely an illusion for the poor, since being “free” when one has no options is only the freedom to continue being poor.

    That seems obvious; it’s a good counter-argument to the Right’s self-serving arguments about “maximizing individual freedom.”

    What that has to do with assisted suicide isn’t clear. Maybe Brown is trying to say that, since the poor and vulnerable are not really free because of economic constraints, and the poor and vulnerable are those most likely to request assisted suicide, we should not give it to them because we cannot trust that their decision is freely made.

    That’s a terrible argument–and a malicious use of liberal principles to undermine liberalism–but at least it contains some premises and a conclusion, which is more than I can say of Brown’s normal style.

    • TomZ
      Posted January 6, 2012 at 8:44 am | Permalink

      You gave me an Andrew Brown-quality idea! Let’s privatize the euthanasia industry! Cause we all know that the rich are good at making decisions about when to end their lives, cause you know, they’re rich. They’re the mercy-creators. It’s those evil poor people trying to leach off the mercy-creators by getting unearned mercy, how dare they?!
      The privatized industry will need underwriters to ensure that no leaching poor person gets that earned mercy the rich have, so let’s check a few factors first.
      What’s the person’s DTI ratio – Disease-to-income? If it exceeds 40% then DECLINE! What is the amount of equity built in the disease? Does it exceed 80%? They’ll need MI – mercy-insurance. That’s to protect the industry in case that border-line poor person changes their mind during and actually doesn’t want mercy. Yeah, that would happen all the time.
      This plan is obviously much better than giving people, you know, dignity.
      /snark – but do I really need to say it?

      • moochava
        Posted January 6, 2012 at 11:10 am | Permalink

        Way too much of our world is already an improbable science fiction novella from the 1960s; this would fit right in with corporations deliberately using empathy tests to recruit psychopaths and unmanned killer drones that use videogame controllers.

  12. TomZ
    Posted January 6, 2012 at 8:30 am | Permalink

    So Andrew’s made the decision for all of us that no one can make a decision about their own life because they’re not making an autonomous decision. I’m sure he made his decision about other people’s decisions autonomously.
    Got it.

  13. DV
    Posted January 6, 2012 at 8:39 am | Permalink

    Would Brown take his cat to the vet rather than have it needlessly slowly suffer to death? If he is a decent person, we would expect him to do so. Why he would not do the same kindness to his terminally ill fellow humans is understandable. Squeamishness, and avoidance of responsibility come to mind. But worse, why would he prevent them from ending their suffering of their own free will?

  14. yesmyliege
    Posted January 6, 2012 at 8:45 am | Permalink

    “Many of us will face this issue ourselves, and need to think about it.”

    Thanks to Eric, I have thought about it.

    And after some research, the best answer, it seems to me, is a call to the local industrial gases company for delivery of a regulator and a tank of nitrogen. Foolproof, stressless, and legal.

  15. Posted January 6, 2012 at 8:48 am | Permalink

    Didn’t we just have a discussion here about free will and determinism? Free will lost. So to what extent is it even a “decision” to commit suicide, or evern to assist it?

    • Michael
      Posted January 6, 2012 at 9:44 am | Permalink

      I think you’re referring to Jerry Coyne’s public and painful slide into incoherence…

    • jay
      Posted January 6, 2012 at 10:04 am | Permalink

      mystical ‘free will’ is not significant to this discussion.

      Even if the choice to end suffering is made purely deterministically, it is still valid. We make all kinds of choices that affect our lives, and they are accepted. This is no different.

  16. Brygida Berse
    Posted January 6, 2012 at 8:53 am | Permalink

    It takes a lot of mindless arrogance to assume that terminally ill people, who seek assisted suicide, do that because they are influenced by their friends, family and the society to think that their life is not worth living. No, they want to die because they are in unbelievable pain and discomfort.

    • HaggisForBrains
      Posted January 6, 2012 at 11:01 am | Permalink

      Exactly

  17. Mr Claw
    Posted January 6, 2012 at 8:59 am | Permalink

    A UK govt advisory body recommends to the coalition govt that it change its legislation on assisted suicide for the terminally ill (it must be noted that the report makes this recommendation for the terminally ill *only*, and only within certain circumstances).

    Andrew Brown decides to descend from on-high and dispense some wisdom to the rubes.

    (You know at this point that it’s going to be a car-crash, and – yes – it’s a car-crash.)

    Andrew ‘ever modest’ Brown opens by stating that his opinion is the only one without flaws:

    “The arguments over assisted suicide are mostly conducted with obvious flaws on both sides. Defenders of the status quo are wrong about the sacredness of life; those people trying to change it are wrong about humanity.”

    Never fear! Andrew Brown is here(!) to reveal to us all how humanity works.

    First he starts with a false dichotomy:

    “No one wants either to prolong the life of the elderly into a grotesque torture, or to bump them off as soon as they become inconvenient…”

    Yes, Andrew, those are the only 2 options available: torture or murder.

    He then waffles on about depression and the Samaritans for a bit (what has that got to do with assisted suicide/end of life care for the *terminally ill*?)

    A further false-dichotomy follows. You can either:

    (a) kill yourself of your own volition and without talking to anyone, or

    (b) in the event that you talk to *anyone* at all (even, say, a Samaritan), in *any* way, you lose all autonomy; everyone now has a stake in decisions about your end-of-life.

    To begin with, the issue being debated here in the UK is *not* to do with depression but with assisted dying for the terminally ill; secondly, what right has the hypothetical Samaritan got to make decisions about anyone’s end-of-life? Family members, perhaps, but not just anyone you’ve ever spoken with!

    He then, rather confusingly, begins to blather about Harold Shipman – a serial killer(!). Not someone who – out of love – aided a close friend or relative suffering from a *terminal illness* to end their life at a time when they were unable to do it themselves and wanted to retain a bit of dignity. No; Brown chooses to waffle about a serial killer.

    From Shipman he then moves on to an anecdote about a carer killing and robbing a pensioner. Once again Andrew, that’s *MURDER*, not assisted suicide for the *terminally ill*!

    By now he has blathered and waffled and wasted the vast majority of his article, without once raising the real issue here: a UK discussion on assisted suicide for the *TERMINALLY ILL*

    He then goes back for a final stab at it. Is he actually finally going to deal with the issue at hand? After all, he’s only got one paragraph left…

    No. Instead he returns (like the proverbial dog to its vomit) to depressed, old people, before adding that we may decide to kill then for being, not only miserable and old, but poor to boot!

    Then that’s it! That’s the end of the article! A textbook example in how to miss the f*cking point!

    Oddly, there are loads of comments stating how ‘spot on’ and ‘well written’ the article is!

    I despair…

    • jay
      Posted January 6, 2012 at 10:12 am | Permalink

      His arrogance is disturbing. Because he can visualize a circumstance where someone’s rights might be abused, his solution is to deny choice to everyone. Some opponents of voluntary euthanasia get even more nebulous, suggesting that the choice of some tragically ill people to die is some kind of a psychic threat to those disabled how choose not to.

      Sadly, this is almost like a variant of Godwin’s law: instead of bringing up the Nazi spector, they want to shut down the discussion on the basis of ‘what about the poor?’ Alas the poor get used as proxy for a lot of very bad policy decisions.

      • Mr Claw
        Posted January 6, 2012 at 11:17 am | Permalink

        “…this is almost like a variant of Godwin’s law: instead of bringing up the Nazi spector, they want to shut down the discussion on the basis of ‘what about the poor?’ Alas the poor get used as proxy for a lot of very bad policy decisions.”

        Very true.

  18. Posted January 6, 2012 at 9:51 am | Permalink

    Having witnessed the suffering and misery of close family members as they struggled in agony to the end I have made my own provisions. I can’t say what others should or shouldn’t but I am pro assisted suicide should I become engulfed in terminal decline. This is my hope for a time when my wishes will be met.

  19. MAUCH
    Posted January 6, 2012 at 10:13 am | Permalink

    I am not sure how to handle assisted suicide. How can we truly tell whether the suicide is autonomous. Did Grammy make the decision on her own or is she fullfilling our unspoken wish that she not spend our inheritance?

    • Marella
      Posted January 6, 2012 at 9:03 pm | Permalink

      Well that’s up to her isn’t it?

  20. Posted January 6, 2012 at 10:18 am | Permalink

    I think what Brown is primarily missing is that he’s making the case *for* assisted suicide. He seems to be saying, “We’ve made the world so awful, who wouldn’t want to kill themselves?” But doesn’t that mean that the world is so awful that people should want to kill themselves? Essentially, he bemoans the fact we don’t have a better world, but blames people for wanting to escape it.

  21. Richard C
    Posted January 6, 2012 at 10:43 am | Permalink

    My main issue with assisted suicide is that so many people are making the decision with bad information: that they’re thirty minutes away from parting with Jesus in the afterlife, or sipping from Mohammed’s rivers of milk and honey, or being reincarnated as a butterfly. Or, if they’re Catholic, that the decision is an instant go-to-hell-for-eternity card.

    I wonder if the number of people requesting assisted suicide would change if they do so with the understanding that the end-game for their consciousness is simply nonexistence.

  22. Posted January 6, 2012 at 12:16 pm | Permalink

    On the same subject, here’s Church of England Bishop Nick Baines’ take:
    http://nickbaines.wordpress.com/2012/01/05/assisted-dyeing/

  23. Paul S
    Posted January 6, 2012 at 2:06 pm | Permalink

    Andrew Brown is a boob.
    I watched my grandmother suffer with Alzheimer’s and slowly deteriorate in a nursing home until her death seven years ago, not a pretty sight. A few years later I watched as my mother-in-law, a strong Wisconsin dairy farmer, succumbed to diabetes. First she was placed in a long care facility, shortly thereafter came the biweekly dialysis. Later they removed some of her toes, then her leg at the knee. After a year she realized she would never be what she considered valuable and she simply refused dialysis. She died two weeks later.
    I’m not sure if I am strong enough to make that decision for myself, I hope I would be if given the choice. But even if I did not agree with her for personally selfish reasons, I would respect her for her choice.
    Since assisted suicide is illegal, I’m glad she had the option to refuse treatment. I don’t understand how forcing someone to suffer isn’t considered cruel.

    • Dermot C
      Posted January 6, 2012 at 5:47 pm | Permalink

      I sympathise with you, Paul; you found yourself in an awful situation with your grandmother and it is deeply upsetting.

      My father deteriorated with Alzheimer’s and had not indicated to any of his three children how he would like his end to come. My brother, rather heroically, gave up his job and lived, on or below the poverty line, nursing my father. My brother provided as good a quality of life as he could for my father in his slow 9-year long descent into near nullity; at the age of 53, he cried at our father’s death, distraught that he happened not to have been in the bedroom when dad breathed his last.

      I find it very difficult to discuss the issue of assisted suicide in a detached, rational way, having regard to the principle, rather than the person. I do know that I would have no truck with a religionist determining, a priori, the law of the polity I happen to have been born into. Inconclusive, but too painful for me, and I suspect many, to draft definitive moral strictures.

  24. Marella
    Posted January 6, 2012 at 9:18 pm | Permalink

    My father died early last year of various lung diseases. He had been ill for years and very ill for months. Finally when my mother could no longer look after him he went into a nursing home. His doctor informed him that it was up to him to decide when he wanted to die and a couple of weeks later he announced that he’d had enough. They put a morphine drip in his belly and he died the following day. His decision was made taking into account all his circumstances, and my mother’s as well, including the cost of keeping him there and his own general misery, but it was entirely his own. This was in a Catholic nursing home in Australia. I was astonished at how simple and straightforward it all was.

    Unfortunately the Alzheimer’s sufferers are not in a position to make their wishes known, and since their physical health is often quite good they linger on for many years in a twilight world of confusion and anxiety. It seems to me that so long as you are in a position to state your wishes then you are unlikely to have a problem dying when you’ve had enough, in Australia anyway.

    And yes, Andrew Brown is a idiot.

  25. Dawn Oz
    Posted January 6, 2012 at 9:22 pm | Permalink

    Agree that his discourse is waffle. However, just to have a dig at you Jerry. What he means by ‘autonomous decision’, many of us mean by ‘free will’.

  26. Posted January 6, 2012 at 11:43 pm | Permalink

    Brown’s post demonstrates why people should be required to take at least one philosophy course in their lives. His entire argument was taken down by MacDonald pointing out a very basic flaw: If autonomy requires one not be influenced by those around him, then no one has autonomy.

  27. Posted January 8, 2012 at 8:22 pm | Permalink

    Thoughts:
    1. Ever since Dr. Jack Kavorkian made the news, I had a name for what I’d already hoped and planned for since reading Heinlein’s “Stranger in a Strange Land” at age 16: When my time comes, I hope to “kavork” in peace and dignity, unless I get to die nicely in my sleep.
    2. Old saying of mine: “Nobody gets out of this life alive.”
    3. Christopher Hitchens, interviewed during cancer treatment, acknowledged that everyone who is alive is moving toward death. Cancer simply meant he was moving faster than aging, alone, would have carried him.
    4. Whether Brown intended it or not, what I got from his ramblings is that since poverty adds to the misery of the poor, making their lives more likely to reach terminally miserable faster than for the rich, society, (i.e., the rich) should do something to address and alleviate poverty.
    5. The rich get rich by making profit. When rich hire poor, they don’t do this to break even but to make profit — i.e., by keeping some of the earnings produced by the work of the poor — i.e., by taxing poor employees. The higher the “profit tax”, the greater the resultant poverty.


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