Bioethics Poetry, Another Dannie Abse Edition

A DOCTOR’S REGISTER

And yet God has not said a word!

“Porphyria’s Lover,” R. Browning

Half asleep, you recalled a fading list

of girls’ sweet names. Now to old women

these names belong—some whom you tumbled and

     kissed

in summer’s twilit lanes or hidden by heather.

You were a youth who never stayed long

for Gwen or for Joyce, for Rita or Ruth,

and there were others too, on a lower register.

Then, suddenly, a robust, scolding voice

changed your dream’s direction and the weather.

“That much morphia, doctor? Wrong, wrong.”

Surprised to discover your eyes still shut

you wondered which dead patient or what

(whose accusing son and when?) as any

trusted doctor would who did not murder

any pleading one with sovereign impunity.

“I found a thing to do,” said the lover

of Porphyria. Porphyria? Awake you add

the other pretty names too: Anuria,

Filaria, Leukaemia, Melanoma,

Sarcoma, Euthanasia, amen.

Dannie Abse

Euthanasia in Quebec?

Quebec legislators are reportedly within days of passing a law that would permit euthanasia for competent adult patients with incurable disease which causes constant and unbearable physical or mental suffering. The euthanasia-related portion of Bill 52 (an English-language copy of which can be download here) seem modeled on euthanasia laws in Europe, in that it requires a diagnosis of incurability rather than of terminality, and explicitly ties access to euthanasia to suffering. A person is eligible to receive a physician's aid in dying only if he or she "suffer[s] from an advanced state of irreversible decline in capability; and suffer[s] from constant and unbearable physical or psychological pain which cannot be relieved in a manner the person deems tolerable." The term "aid in dying" is not actually defined in the bill, presumably in order to leave methodology in the hands of physicians.

Euthanasia is illegal according to Canadian national law, and it's not clear that the Quebec provincial law's alternative reference to "aid in dying" will skirt that national prohibition. Parti Quebecois officials are reportedly thinking of simply asking Crown officials not to prosecute euthanasia within Quebec after the law passes.

The bill covers a great deal of ground in addition to the euthanasia innovation. It creates a provincial commission to gather information on end-of-life care, establishes a regime for the creation and registration of advance directives, and addresses the provision of hospice and palliative care.

The bill has attracted a fair bit of high-profile opposition from groups of physicians, from the Catholic Church, and from some bioethicists. Here's a piece on the slippery-slope argument ("Soon we'll be killing children and the demented, just like in Belgium") being advanced by prominent conservative Canadian bioethicist Margaret Somerville.

Bad Argument Linking Belgian Euthanasia With US Death Penalty

Eugene Kontorovich (Northwestern Law) has penned an egregious argument over at the Volokh Conspiracy. Go read it, if you're entertained by egregious arguments. In sum, it goes like this:

In Roper v. Simmons (2005) the Supreme Court found unconstitutional the execution of persons who had committed their crimes while under 18. In doing so, they "caved in to pressure" from Europeans who opposed the death penalty. Indeed, the court "cited the European position as support for its conclusion." Part of the court's reasoning was that juveniles were "too immature to understand the consequences of their decisions, or the meaning of life and death." But now Belgium is permitting juveniles to decide to have themselves euthanized. This proves that Roper misread the European's belief system. It wasn't one of "paternalistic concern for youth."

"Rather [Kontorovich continues], a system that permits the euthanasia of innocent 12 year-olds but not the punishment of guilty 17-year-olds is one that exalts autonomy without culpability....So it comes out that the juveniles cannot really make accountable decisions when it comes to killing people, unless it is themselves. Or to put it differently, Belgium will not hold children responsible when they hurt others, but gives them free license to hurt themselves."

All of which goes to show you that the US Supreme Court shouldn't pay attention to what other countries do, because they're different from us. And because the Supreme Court misunderstood what other countries stand for, Roper should be overruled.

I feel a bit unclean picking up this rotting fish of an argument, so I'll summarize its major faults quickly:

1)   Roper mentioned, but was not based on, the broad consensus of other countries that juveniles shouldn't be executed. "The opinion of the world community," wrote the court, "while not controlling our outcome, does provide respected and significant confirmation for our own conclusions."
2)  The Roper majority did not get the idea that juveniles were immature from Europe, but from developments in the Supreme Court's own death penalty jurisprudence and that of many states, which were in turn based on ample expert psychological testimony about juvenile judgment. Read the opinion and see. 
3)  A system that lacks capital punishment for juveniles is not, on that account, a system that does not permit "the punishment of guilty 17-year-olds." It is not actually constitutive of the idea of "holding someone responsible when they hurt others" that you must kill them.
3) The Belgian law doesn't "permit the euthanasia of innocent 12-year-olds" unless they are terminally ill and in untreatable pain, and unless they are deemed competent to make the decision by a physician. And their parents have to agree! So Belgium does not give children "free license to hurt themselves."

Sorry, Eugene. The fact that Belgians now approve euthanasia for terminally-ill, competent, suffering children who request it (and who get their parents' permission) doesn't actually give Americans a reason to execute juvenile offenders. I'm baffled that anyone thought that it did.

Belgium Passes Law Permitting Voluntary Euthanasia for Children

Belgium has become the first country to permit euthanasia for children. Amendments to the country's 2002 euthanasia statute will now permit competent terminally-ill children in a "medically hopeless condition of constant and unbearable physical suffering" to request euthanasia. For the request to be honored, a medical professional must deem the child mature enough to understand the meaning of the request. The child's parents or guardians must also approve. A Google-translation of the text of the amendment is here.

In January, the Parliamentary Assembly of the Council of Europe voted to condemn the Belgian Senate's approval of the measure. The measure also attracted the opposition of a substantial number of Belgian pediatricians, 170 of whom signed a petition urging delay of passage of the law. But the Chamber of Representatives has now approved the measure (86 to 44 with 12 abstaining), and King Philippe is expected to sign it.

Council of Europe on Euthanasia

The Parliamentary Assembly of the Council of Europe ("PACE") has issued a non-binding declaration (mainly aimed at getting member states to beef up their laws governing living wills and advance directives) in which it opines that "[e]uthanasia, in the sense of the intentional killing by act or omission of a dependent human being for his or her alleged benefit, must always be prohibited."

A number of different publications are mistakenly alleging that PACE has called for a permanent ban on assisted suicide. The resolution explicitly says that it "is not intended to deal with the issues of euthanasia or assisted suicide," and while it goes on to condemn euthanasia, it says nothing additional about assisted suicide.

The PACE declaration may indeed have some political effect on movements within Europe toward legalization of euthanasia. But it's a mistake to report it as a condemnation of assisted suicide, or to anticipate that it will have strong effect on pending cases involving assisted suicide. The European Court of Human Rights, for example, has repeatedly recognized the distinction between assisted suicide and euthanasia, and has held that Article 8 of the Convention for the Protection of Human Rights and Fundamental Freedoms protects the individual's choice to avoid a painful and undignified death.

Paralyzed Man Seeks Right to Be Killed

Tony Nicklinson, a British man who is paralyzed from the neck down as a result of a stroke, is going to court in order to challenge the law against murder. He is asking that he be permitted to have a physician euthanize him at his request. Last year's guidelines from the Director of Public Prosecutions on prosecution for assisted suicide made it clear that, while some sorts of assistance in patient suicide would not be prosecuted, "[i]t is murder or manslaughter for a person to do an act that ends the life of another, even if he or she does so on the basis that he or she is simply complying with the wishes of the other person." Mr. Nicklinson's case against the Ministry of Justice seems to be an effort to carve out a medical exception to the manslaughter/murder law. I don't expect it will succeed.

Royal Society of Canada: Assisted Death

Have a look at this report from the Royal Society of Canada on end-of-life care. It's headline-grabbing recommendation is that both assisted suicide and voluntary euthanasia should be legally available; but the full report, with its overview of current Canadian public opinion and law on end-of-life options, is well worth reading.