Originally published at The Conversation; feel free to join in the discussion there.
The suspension of Philip Nitschke’s medical registration, and the events leading up to it, has sparked one of the most heated discussions about euthanasia in Australia for some time.
What’s surprising, however, is that the debate hasn’t split along the usual pro-euthanasia versus “pro-life” lines. Instead, advocates of both euthanasia and doctor-assisted suicide themselves have been condemning Nitschke for failing to urge a 45-year-old man, who had no terminal illness but who expressed a wish to take his own life, to seek psychiatric help.
Nitschke has insisted that it wasn’t his role to try to dissuade someone from “rational suicide”:
If a 45-year-old comes to a rational decision to end his life, researches it in the way he does, meticulously, and decides that … now is the time I wish to end my life, they should be supported. And we did support him in that.
The pushback against Nitschke from euthanasia campaigners such as Rodney Syme (as well as mental health advocates such as beyondblue’s Jeff Kennett) provides a valuable lesson about what can happen when two very different ethical approaches converge on the same policy prescription; it becomes important to discuss the principles, not just the policy.
The importance of liberty
This problem isn’t unique to the euthanasia debate. Last week, newly-minted Liberal Democrats senator David Leyonhjelm announced plans to introduce a bill to legalise same-sex marriage.
As a libertarian, Leyonhjelm has called for lower taxes and a massively reduced role for government. Yet his position on marriage equality aligns him with a policy more closely associated with the political left.
He’s not the only right-wing supporter of same-sex marriage of course. But when someone like British Prime Minister David Cameron declares “I don’t support gay marriage despite being a Conservative, I support gay marriage because I’m a Conservative,” he is doing something very different: he’s saying that marriage is a substantive good, and committed same-sex couples can and should be able to participate in that good.
Philosophers such as Richard Mohr have argued that committed same-sex relationships already are marriages in a substantive sense, and the law should simply recognise that.
For libertarians (for the most part), the only real substantive good is individual autonomy. Leyonhjelm doesn’t argue, as far as I can see, that certain types of relationship have a special, substantive value; he simply thinks “It is not the job of the government to define relationships.“ (In which case, we might ask, why should governments get involved in certifying marriage at all?)
Those of us who support same-sex marriage can probably live with that tension, if it delivers the outcome we want. But the philosophical tension between approaches is still there.
And the very moral thinness of libertarianism, its refusal to trade in any ethical currency other than liberty, sits uneasily with issues of life and death, where all sorts of other moral considerations are in play.
The limits of autonomy
That’s precisely why Nitschke’s comments about suicide are so shocking. Most arguments for euthanasia come down to a concern to alleviate needless suffering.
One reason death is viewed as normally being a harm to the person who dies is that it deprives us of goods we would have enjoyed had we lived. In a situation where there is nothing left in the patient’s future but pain and loss of dignity, there are no more goods to lose.
Compassionate regard for someone whose fate is in our hands may mean helping them achieve a quicker, more dignified death is the least-worst option.
Autonomy plays a crucial role in that, of course: we need to respect the patient’s decisions regarding their treatment, including their refusal of further interventions. Compassionate concern for others may mean allowing them a degree of control over their impending death.
What Nitschke’s libertarian position does, however, is strip out everything but autonomy and reduce the whole issue to one of individual choice.
Libertarianism’s moral moonscape
If you think, as Nitschke apparently does, that the question here is simply about exercising a right to suicide, why should it matter whether someone is terminally ill or not? If someone wants to die, and they’re clear-headed enough to make competent decisions, who are we to interfere with their personal liberty in order to stop them?
And yet most of us do have fairly clear moral intuitions that the suicide of an otherwise physically healthy person, possibly with treatable mental health issues, is a terrible thing.
Libertarianism either can’t make sense of that intuition, or treats it as irrelevant.
When teaching classes on the ethical debate over euthanasia, I’ve found that students often seem to struggle with explaining why it should matter whether the patient is dying (or at least permanently debilitated) or not. Yet from a mercy perspective, it matters very much that there are, in fact, no truly good options left open.
In part, this is because mercy is a particular kind of response towards another, a response that acknowledges their distinctive value – and understanding that value is essential to understanding the full tragedy of death, of what is lost when a person dies.
Acknowledging that value means accepting some limits on autonomy where avoidable death is involved.
Respect for patient autonomy needn’t involve the sort of wilful blindness Nitschke has shown. If we want to make the case for progressive reforms, such as euthanasia and marriage equality – as we should, vigourously and doggedly – we should resist doing so in terms that leave us unable to make sense of our moral environment.