Ion Effects

ION EFFECTS


by Ruth von Fuchs

2004 (Revised 2006 and 2007)


     Keep reading. This section does indeed cover arguments about the legalization of euthanasia and assisted suicide.
     But instead of presenting a list of specific objections and replies, it identifies some general principles. Their usefulness is not limited to the arguments that happen to be mentioned here; they will almost certainly be effective in dealing with arguments that are not included here or that have not even been made yet.
     The list which this section does present is a list of "ions" processes or activities whose names end in "-ion". When you want to evaluate an argument against help in dying, run your eye down the list below. You will probably find an appropriate "ion".

Assumptions
Connotations
Definitions
Discrimination
Distinctions
Distortion
Evasion
Extension
Extrapolation
Idealization
Predictions
Projection
Selection
Substitution

Assumptions


     The parts of an argument are called the premises and the conclusion. It is very common, in everyday argumentation, for some of the premises to be unspoken or unwritten. The arguer just takes them for granted, and often is not even conscious of doing so.
     To ferret out such assumptions, you take the arguer's conclusion and ask "What are all the statements that would have to be true, in order to justify this conclusion?" Some of the statements you find may be very questionable.
     Here are some assumptions that are quite prevalent among opponents of euthanasia and assisted suicide.

1. "Death is the worst thing that can happen to someone."

     Most of the countries in which assisted death is being debated are countries in which torture is hardly ever thought about. But among those people who have been moved to think about it such as veterans who were prisoners of war, or immigrants from places where political prisoners are routinely tortured the phrase "a fate worse than death" does not sound like nonsense.
     That phrase also suggests itself to many who witness the slow dying of a loved one caught in a system designed for times gone by. At the funeral of someone who has endured such an agonized departure, mourners are often heard to comment on the person's death by saying "It was a blessing".
     When arguers make Assumption 1 it affects the meanings they give to several words that occur quite often in the euthanasia debate. Examples are "... do no harm ..." and "... protect the vulnerable ...". These are discussed at greater length under Definitions, below.

2. "On the whole, human beings are more inclined towards evil than towards good."

     This belief lies behind the assertion that a system providing for euthanasia or assisted suicide cannot possibly be constructed so as to make the benefits outweigh the risks. (Interestingly, people who have this view of human nature usually consider themselves to be among the exceptions.)

3. "There is a duty to live."

     We are often exhorted to "Choose life". To whom do we owe this supposed duty?
     Some would say to God, though if pressed they would concede that death is part of the divine plan.
     Others would say it is our duty to our family members, who will miss us when we die and who will therefore be happier as long as we are not completely and undeniably dead. But if they are getting pleasure from our lengthy maintenance in a state which is giving the opposite of pleasure to us, do they truly love us?
     Finally, some may unconsciously assume that we have a duty to the economic engine of our country to the shareholders or employees of all the companies and other entities for whom our continued existence means ongoing revenue, whereas our death would produce only a bit of one-time income.


Connotations

     Sometimes it is not a statement that must be questioned, but rather a word. "Loaded words" may have been chosen, to slant the discussion in the direction the arguer wants. Two examples follow.

1. "Victim"

     A person who received support with self-deliverance may be referred to by journalists as the "victim" of the other person. The person who died, however, might have felt that "beneficiary" was a more suitable term.

2. "Commit"

     As long as "suicide" rather than "self-deliverance" is used (and problems with the word suicide will be discussed later, under Distinctions), the verb "commit" tends to be used along with it. The unpleasant smell created by a word ending in "-icide" is thus intensified. But we do not speak of someone committing retirement, or resignation, or emigration. These transitions are described with more neutral words.


Definitions

     Like the preceding "ion", this error involves words, or semantics. With Connotations, we were not asking "Does this word mean what you think it does?", we were asking "Does this word have the right flavour for this context?" With Definitions, however, we are indeed asking "Does this word mean what you think?" Three examples follow.

1. "Harm" by what?

     Arguers who consider it useful to cite the Hippocratic oath typically point to the passage where the doctor pledges to "do no harm". They claim that this prevents a doctor from hastening a patient's death. But patients whose conditions have progressed to a certain stage may well feel, when they look at the likely scenario for the coming time period, that a doctor who keeps them alive will be harming them far more than a doctor who ends their life.

2. "Protect" from what?

     Politicians who want to justify the absence of choice-in-dying legislation sometimes say "We don't want it to look as if we are unwilling to protect our old people." They mean "We must be seen as postponing the deaths of our old people, as a general principle". However, many of those old people are less concerned about death than about other dangers. They want to be protected from misery, from humiliation, and from the unremitting despair caused by knowing that tomorrow will be at least as bad as today and quite possibly worse.

3. "Vulnerable" to what?

     Those who speak about protecting often say that it is needed by "the vulnerable". Usually the idea is that people who could be placed in categories such as "elderly" or "disabled" are at risk for being pressured into ending their lives out of guilt at being a burden to their families or their fellow citizens.
     Other kinds of pressure or exploitation are never mentioned, but they are just as possible.
With some old people, brain malfunction will precede heart malfunction by many years. Such patients can make quite a contribution to the bottom line of companies that operate nursing homes or manufacture products used therein.
     And disabled people may be urged by their peers to "show the flag" and drag themselves through many unwanted years of increasing wretchedness, far past the misery level at which an able person would have been allowed to go in peace. Rochester quadriplegic Bill White would have met this fate if Not Dead Yet had gotten its way in 1999.


Discrimination

1. Discrimination against one decision-making process

     Risk-benefit analysis is widely used when public-policy decisions are being made.
     One example is the policy of allowing private individuals to drive motor vehicles themselves, instead of only riding in vehicles (such as buses) operated by specially trained and certified drivers. Early in the history of the "horseless carriage" we learned that this policy very frequently has very serious negative effects. Many innocent people have been killed or maimed. But the good effects of the policy the power to go exactly where you want, exactly when you want are so intensely appreciated, by so many people, that the benefits are felt to more than counterbalance the risks.
     With this decision, as with most risk-benefit decisions, there is no insistence on zero possibility of negative effects. But when risk-benefit analysis is applied to the question of whether we should allow aid in dying, there is often discrimination against this particular decision. Opponents of the practice apply a far higher standard than is applied in other risk-benefit decisions, even other life-and-death decisions such as the one about car driving. They insist that aid in dying must be forbidden if even one person might miss even one day of life that could have been somewhat pleasant.
     But the fair way of approaching the analysis is to ask "How much happiness is likely to be prevented (when errors lead to premature exits), in comparison with how much unhappiness is likely to be prevented (when doomed sufferers are enabled to avoid months or years of oncoming misery)?" The margin by which benefits outweigh risks, in this case, is probably far greater than it is in many other cases arguably much greater than the margin by which the benefits of amateur car-driving outweigh its risks.

2. Discrimination against one species

     When death may involve suffering in companion animals (cats, dogs, etc.) or in meat animals (cattle, pigs, etc.) we have considerable faith in our ability to tell whether suffering is occurring or not, and we usually try to ensure that it does not occur.
     But critics of aid-in-dying proposals would have us discriminate against the species homo sapiens. They seem to feel that our powers of empathy suddenly fail when we are called upon to judge whether or not a fellow human is suffering. People who cannot explicitly ask for release unconscious people, demented people, babies are to be left in the situations that cause their faces and their bodies to give highly plausible evidence of torment.
     However, our empathic abilities are likely to be greater, not less, with members of our own species. And in order to be fully equitable, aid-in-dying laws need to allow for substitute decision-making by loving relatives or by compassionate professionals and public servants.


Distinctions

     With distinctions, two kinds of problem can occur. Arguers may create a distinction where they should not, or they may fail to notice one where they should.

(A) Distinction made where it should not be made

     Probably the best example of this error is the adversarial and mutually-exclusive relationship which many people consider to exist between palliative care and assisted dying.
     It is true that the two options often involve different support groups. But even this separation does not always exist, as has been revealed by several polls in which doctors were allowed to respond anonymously to questions about their past actions with patients who were near death.
     If we compare "terminal sedation" with euthanasia by injection, and look at the two approaches in terms of what the patient feels, we see that there is no difference. Up until a certain moment, the patient has experiences; after that moment, there are no more experiences.
     In time, it will probably happen that all those who serve patients give primacy to their clients' viewpoint, and help with dying will come to be understood as simply the ultimate palliation.

(B) Distinction not made where it should be made

1. Value of life versus quality of life

     These two phrases are often used as if they were synonymous, the only reason for choosing one instead of the other being to introduce variety into one's prose.
     But "value of life" suggests that the appraisal is being done from the outside, by someone other than the person who is living the life, and perhaps with a rather cold-blooded approach. The Nazis who wrote about "useless eaters" were doing a value-of-life analysis.
     "Quality of life", on the other hand, suggests that the assessment is being made from the standpoint of the person who is inside the life, the person in whose brain the life experiences are being felt.

2. Loving an object versus loving a person

     Many of us have had a beloved jacket which we wore until it was in tatters. We dreaded the day when our eyes could no longer fall upon its tweedy folds and our hands could no longer stuff themselves into its familiar pockets.
     Too often we react the same way to a mother or a father who is wearing out. We dread the day when our eyes can no longer fall upon their dear face and our hands can no longer clasp theirs. Driven by our own separation anxiety we look away from hints of their desire to be at peace, and request on their behalf increasingly burdensome "holding actions".
     But whereas a jacket cannot suffer as a result of being held onto, a mother or a father can.

3. Rational depression versus irrational depression

     It is frequently claimed that requests for euthanasia or assisted suicide should be denied because the requestors are depressed.
     Sometimes the reasoning is at a trivial diagnostic-manual level: "Well, they are thinking about suicide, and suicidal ideation is a symptom of depression, so it follows that they are depressed."
     A less glaring mistake happens when the objector fails to distinguish pathological depression from depression that could be called reasonable or even healthy. In pathological depression, the person's hopelessness is not justified by reality; when the patient's body chemistry is tweaked by drugs, the hopelessness often disappears. Reasonable depression, on the other hand, involves hopelessness that is quite justified by reality. Some of the circumstances in which people can find themselves are so grim that an absence of depression would indicate mental illness (one of the conditions marked by "inappropriate affect").

4. Lamentable suicide versus laudable suicide

     The basic meaning of "suicide" is "self-killing". The self-killings that have received the most attention are the ones which even their enactors would classify as mistakes, if they had lived to do the classifying. Groups and professionals who work to prevent such suicides are engaged in a noble entreprise, striving to prevent error and tragedy.
     But some people who end their lives are not making a mistake. On the contrary, they are thinking more clearly and more bravely than human beings customarily do. Their decisions do not call for diagnosis or treatment.
     To handle such mature and fully-informed behaviour, the terms "exiting" and "self-deliverance" have been proposed. So far they are not catching on very well, and the phrase "assisted suicide" may triumph as the standard subject-heading. If it does, remembering that there are two kinds of suicide will continue to be important.


Distortion

     This requires that the argument involve something which is a matter of degree. The facts get pushed along the scale, in the direction desired by the arguer. Some examples follow.

1. "Canada is comparable to Nazi Germany, regarding the likelihood of population purging."

     On the contrary, we have learned from the terrible crimes of the Nazis and from our own errors in a similar direction. Being forewarned, we are forearmed, and are extremely vigilant in this area of social policy.

2. "Sue Rodriguez was comparable to Stephen Hawking, so she should have hung on, as he is doing."

     Some medical conditions display wide variation in the extent to which they affect their victims and in the rate at which they progress. Conditions involving the nervous system, and the brain in particular, are especially noted for being matters of degree.
     Two people who both "have cerebral palsy", for instance, may differ astronomically in the level of their disability. One may simply need a cane, whereas the other may be afflicted with cognition deficits, frequent seizures, and breathing difficulties due to skeletal deformities caused by abnormal muscle tensings while bone tissue was being formed.
     We must look at the person, not at the label.

3. "Palliative care can eliminate suffering at the end of life, so instead of legalizing euthanasia or assisted suicide we should just make palliative care universally available."

     Various studies have examined the level of unrelieved suffering usually defined as pain among patients receiving palliative care. There has never been a finding of 0%; levels between 5% and 15% are typical. The percentages would be even higher if researchers included all types of suffering: nausea, shortness of breath, weakness, helplessness, hopelessness, humiliation, and more.
     Palliative care should of course be made universally available, but respect for minority rights demands that it be supplemented by access to euthanasia and assisted suicide.


Evasion

     Responsibility is what gets evaded most frequently and most energetically. When potential helpers such as medical professionals detect a situation in which they might be asked to bear the responsibility for ending a life, they start looking around for a door. They may try several doors, in succession.

1. "People can end their lives all by themselves."

(a)   A famously controversial and outspoken Canadian doctor expressed irritation with patients who asked doctors for euthanasia; they can always slash their wrists, he said.
(b)   Canadian author Heather Robertson was similarly irritated with Sue Rodriguez for wanting death assistance: in her 2000 book Meeting Death she writes "... just do it ... jump off a pier, Sue ... Fall overboard on the ferry. Stop eating." (page 55).
(c)   In the 2002 book The Case Against Assisted Suicide, Felicia Cohn and Joanne Lynn state that carbon monoxide is "readily available to a layperson" (page 242).

However:
(a)   Wrist-slashing is more painful than an intravenous injection, and much more painful than swallowing some drug-fortified jam.
(b)   In drowning, the subjective experience is one of intense terror. And although refusal of food and fluids often comes naturally to people whose bodily destruction is 95% complete, not everyone wants to go that far along the road. For those who are not quite at death's door, starving and dehydrating themselves can involve considerable distress.
(c)   The only readily-available form of carbon monoxide is car exhaust, which is hot and smelly. And bureaucrats are being lobbied to reduce the availability of even this source: Canada's Ministry of Transport has been pressured to create regulations forcing car manufacturers to "suicide-proof" vehicle tailpipes.

     Furthermore, those who consider taking matters into their own hands are faced with a problem of timing. They are in a situation of "damned if you do, damned if you don't".
     If they wait until considerable deterioration has occurred, most of the methods recommended by the authorities cited above are likely to be impossible.
(a)   The people may be in a facility where they cannot acquire and conceal a razor blade, or where they are checked so frequently that they would not have time to bleed to death.
(b)   If they are bedridden, they cannot drown themselves. And even if they are only in a wheelchair, they may not live near a large body of water with wheelchair-accessible piers.
(c)   Even if they are not bedridden or chairbound, they may no longer be able to enter and operate a car.
     On the other hand, misunderstanding and even obstruction may face a person who decides to practice preventive medicine and leave "before deterioration sets in" (to quote from the farewell letter of Mireille Jospin, mother of former French prime minister Lionel Jospin, who ended her life in December 2002). If friends and relatives do not oppose the person's plans, they too may face criticism. After 79-year-old Lisette Nigot ended her life in a spirit of "quit while you're ahead", an interviewer speaking with Nigot's friend Dr. Philip Nitschke implied rather strongly that he should have tried to talk her out of it.

2. "OK, maybe I will have to give some help to some people, but they must be patients who are so close to death that it will be credible for me to say "They did not die from my actions, they died from their disease."

     This situation prevails when aid in dying is given to a terminally-ill patient. Doctors are not the only ones who prefer the lightened responsibility load that accompanies these circumstances; voters prefer it too. The initial version of assisted-death legislation, in any given place, usually restricts the assistance to people who are expected to die within six months.
     However, a rather perverse state of affairs results from this limitation. We end up saying to people "If you are only going to suffer for a few weeks or months, you can obtain release. But if you are going to suffer for years or decades, you cannot."

3. "OK OK, maybe I will sometimes even have to help someone who would not have been expected to die soon, but I must be allowed to tell myself that I only did it accidentally, rather than intentionally."

     Sometimes patients can bring this situation into being, and sometimes they do. They can refuse treatments, including nutrition and fluids, and they can then demand to be sedated thoroughly enough that they will not feel any distress as a result of their decision. In other cases, the patient's disease may begin to cause extreme suffering, but at a stage where the words "life-threatening" could not yet be used.
     Medical personnel who provide deep and uninterrupted sedation in these circumstances are able to feel that all they are trying to do is prevent suffering. They can "foresee" that the sequence of events will end in the patient's death, but they do not "intend" that effect.
     The term "double-think" would probably occur to ordinary folks, when they first hear about this manoeuver, but the official name is "the doctrine of double effect". (Besides suppressing pain, the drugs have a second effect such as depressing respiration, or inducing unconsciousness and an inability to eat or drink.) Nevertheless, those same ordinary folks may accept that compassion is a two-way street, and allow their doctors the solace of this little mind-game. "If you maximize my comfort, I will maximize yours."


Extension

     Occasionally a word does what might be called empire-building. In recent years the word "disabled" has done this. Some users of the term have greatly extended its realm of applicability.
     The original application of the term was to people who had been changed by a past event (a genetic exceptionality or an accident or an episode of an illness such as polio) but who were no longer continuing to go downhill, apart from growing older just like everyone else.
     Most of these people came to accept being "differently abled". They found, however, that outsiders often had trouble believing that someone could accept such a fate and relish life in spite of it. They felt endangered by such misunderstanding and they therefore banded together, forming the disability-rights movement.
     Like many other social movements, this one sought to recruit new members. But their leaders made the same mistake as they accused outsiders of making: they failed to look beyond the superficial level of such things as wheelchairs. People who were in a wheelchair because their MS or ALS had progressed to that stage, or because terminal cancer had made them too feeble to walk, were brought under the disability umbrella because they were assumed to be just like people who were in a wheelchair because of having fallen off a horse.
     A very important difference was overlooked. The true members of the group had disabilities that were static. Their leg muscles might not work anymore, but they were not facing the certainty that their arms would go next, and eventually the muscles which enabled them to breathe would stop working.
     Having a static disability is not the same as having a progressive disease. In the former case, people are quite likely to look forward to the future; if they want help, it is help with living. In the latter case, people are quite likely to dread the future; if they want help, it may be help with dying.
     But the chances of their receiving that help are greatly reduced if the tag "disabled" has been pinned on them. The leaders of the disability-rights movement maintain that if a wish for death is expressed by anyone who "is disabled", it is only because society views that person's life as having low value or worth, and the person has accepted this view. This situation would be so sad, even shocking, that help with dying would never be given.
     Only when disease victims manage to get out from under the "disability" umbrella are they likely to be given a hearing. Then they can make it plain that their thinking involves quality of life (judged from the inside, by themselves) rather than value of life (judged from the outside, by onlookers).
     Eventually, of course, many people who at present have only a disability will develop a disease also having had polio or a diving accident does not make someone immune to cancer or ALS. And when that happens, they too may want to insist that they are speaking from self-awareness and self-respect, instead of having bought into a tragic disrespect which is alleged to prevail within society.


Extrapolation

     When you take the present situation, and assume that the future situation will be essentially the same, you can be said to be extrapolating. Many who discuss euthanasia and assisted suicide are doing this. They speak as if people confronting death in the 21st century will have basically the same attitudes and expectations as the people who confronted death in the 20th century.
     People who died in the twentieth century were on the whole unacquainted with the end-of-life medical system, and unprepared to deal with it. They also had a kind of innocence about dying: they had not been exposed to much of it, except on television. They thought they were always supposed to fight death off, and they expected their doctors to fix them up an infinite number of times. Planning death struck them as something they could not do, perhaps even should not do. (This is a bit surprising, since their generation was the one in which the great mass of ordinary people finally bent their minds around the idea of planning birth; but perhaps one mental revolution is enough, for any given generation.)
     These people, therefore, stumbled unthinkingly into what for many of them turned out to be a trap. But their experiences were observed by their family members. And those observers were changed by what they saw.
     One of the commonest reasons people give, for contacting a right-to-die group, is having watched a close relative die a slow and miserable death because of getting trapped. Two examples:

1)  A man nurses his wife through three years of being incrementally destroyed by a series of small strokes. A few years after her eventual death, he himself has a small stroke. Right after he recovers, he starts planning his exit, and implements his plan as soon as he has explained matters to his children.

2)  A woman whose mother died of Alzheimer's disease is diagnosed with the same condition, and is determined to avoid what her mother went through. Medication slows her decline for a while, but she knows that for her husband's sake she must act while she is still competent enough that neighbours being questioned by police will say "Yes, she would have been able to do it all by herself." When her condition progresses enough to make her worry that soon her neighbours will not be able to say this, she ends her life.

     People who are in such situations would likely prefer to live on, as long as they are not suffering and are receiving good care. But in a world where being helpless means being trapped, they do not dare.
     What they can do is to work for change, as long as they are able to. After they are gone, their spouses and their children continue the work. And the upshot of it all is that dying in the 21st century will be done by "educated consumers", who will have considerable sales resistance to the product which their predecessors settled for.


Idealization

     Idealizing often shows up as ethical condemnations based on mistaken ideas about what the alternatives are, or were, in a given case. Usually the critic imagines at least one non-existent alternative. Two examples:

1)  The opponents of euthanasia and assisted suicide often describe themselves as "pro-life", implying that the advocates are "pro-death". The idea seems to be that they have chosen to live, presumably forever, whereas we have chosen to die. However, it is only in an imaginary and idealized world that the choice is between (a) living and (b) dying. In the real world the choice is frequently between (a) dying after slightly or moderately horrible experiences, and (b) dying after extremely horrible experiences.

2)  In a February 2004 article in Psychiatric Times, Herbert Hendin cites a case which he considers to be a good argument against euthanasia. Here is how Hendin outlines the situation:
     "A wife, who no longer wished to care for her sick, elderly husband, gave him a choice between euthanasia and admission to a home for the chronically ill. The man, afraid of being left to the mercy of strangers in an unfamiliar place, chose to have his life ended; the doctor, although aware of the coercion, ended the man's life."
     Hendin explicitly notes only two options for the wife: (a) showing kindness by continuing to care for her husband in their home, and (b) showing selfishness by having him institutionalized. It is likely, however, that he omits some important details of the situation. If we postulate some details that often characterize cases like this, we find some additional but implicit options non-existent ones.
     Suppose that the wife is 5'2", weighs 110 pounds, and has worked as a salesclerk rather than as a longshoreman. Suppose that her husband weighs 220 pounds and has become unable to move. Suppose that they live in a small rural centre where the publicly-provided visiting nurse can come only once a day and only for half an hour. Suppose that the couple's savings have been used up in making their home "disability-friendly".
Here are some of the options the wife probably does not have:
a)  Taking a body-building course that will turn her into a Charles Atlas in two weeks.
b)  Robbing a bank to get enough money to hire more in-home nursing help from a commercial service.
c)  Packing herself and her husband into a time machine which will transport them to a future world in which the policies and the possibilities will be significantly better.


Predictions

     When scientists make a prediction, they are usually watching to see how reality unfolds, so they can learn whether the theory behind the prediction has received support. When opponents of choice in dying make a prediction, it is often more like a prophecy: they simply declare that such and such a thing will happen, period.
     Even when this non-empirical tendency is moderated, there can be other weaknesses in the thinking.
     Two quite common ones are exemplified in these claims:

1) "If we legalize euthanasia or assisted suicide, there will be more and more cases each year."

     "... and that will be a bad thing." Why will it be a bad thing? "Because euthanasia and assisted suicide are in themselves bad things." Hold on, I thought that was the question at issue here.
     This is an instance of what logicians call "circular reasoning": the conclusion is used as one of its own premises. A good way to expose the fallacy is to put forward a parallel argument about a hypothetical social change involving an activity less likely to be feared: "If we legalize eating chocolate, there will be more and more chocolate-eating, and that will be a bad thing, because chocolate-eating is in itself a bad thing."

2) "Canada will go down the same slippery slope that (a) Germany went down, or (b) the Netherlands and Oregon are going down."

     Predictions like this are based on reasoning by analogy. For the prediction to have credibility, two requirements must be met: (a) there must be strong similarities, in relevant respects, between the two entities being compared; and (b) the alleged fact about the second entity must be undisputed or at least widely accepted.
     When the above claim is completed by a reference to Germany, the requirement of strong similarities is not met (as was discussed under Distortion, above).
     When the claim is completed by a reference to the Netherlands or to Oregon, the requirement of undisputed factuality is not met. Some people who have talked to some Dutch experts have heard that terrible things are going on in Holland, but other people who have talked to other experts have heard that fear has been reduced and more people are having a good death. And polls of the Dutch public have shown that the more they have seen of their country's right-to-die policy, the more they approve of it support has risen, not fallen, over the decades during which the policy was maturing and being fine-tuned. This would not likely have happened if tragic abuses were rampant, as is sometimes claimed.



Projection

     Psychology researchers have identified and studied a mechanism which they call projection, because the people who use the mechanism "project" traits of their own onto other people they believe that the way they themselves are is the normal or natural way to be.
     Among opponents of choice in dying, acceptance of proselytizing behaviour (that is, behaviour aimed at converting other people to your way of thinking) is a fairly widespread trait. And if the people who have this trait project it onto us, they will expect us to pressure them into accepting our beliefs and practices.
     This makes them fear the legalization of euthanasia and assisted suicide. They assume that because we might choose these options for ourselves, we will try to make others choose them too, without regard to the views those other people might hold. Perhaps because they have little experience with respecting individual differences, they cannot imagine receiving such respect from us. But they would receive it.


Selection

     Claims made by opponents of help in dying are often based on a very selective sampling of the relevant data. Those who present palliative care as the universally sufficient option are usually speaking from their own experience, which is largely reassuring hospice workers do indeed produce good deaths for most of the patients who come into their care. The problem is that many patients are not within their experience. Almost all the people they have helped have been dying of cancer; it is estimated that only 5% of hospice patients have a non-cancer diagnosis. In the real world, however, far more than 5% of deaths result from conditions other than cancer. And many of these conditions ALS, MS, Huntington's, Alzheimer's kill very slowly and cruelly. Their victims might need "terminal sedation" for years or even decades, to be fully protected from the torments inflicted by their condition.
     Even when research is reported, the sample may be selective in an important way. Much was made of some Dutch data showing that 0.8% and 0.7% (in 1991 and 1996 respectively) of "medical decisions at the end of life" had involved doctors administering life-shortening medication without an explicit and recent request from the patient. The figures were said to show that non-voluntary euthanasia was the inevitable by-product of permitting voluntary euthanasia. But when surveys were done in Australia and Belgium, where euthanasia was illegal at the time of the surveys, the comparable figures were 3.5% for Australia (in 1997) and 3.3% for Belgium (in 2000). A person looking at the more complete data might be tempted to conclude that forbidding voluntary euthanasia causes a five-fold increase in non-voluntary euthanasia.


Substitution

     Even though empathy can and does occur, the nature of our nervous systems is such that our own feelings have a greater presence and vividness than the feelings we imagine to be occurring in others. It is therefore understandable that we occasionally substitute our own feelings for those of the person we are supposed to be focussing on.
     Most of us feel considerable gratification when we do things that have traditionally been considered in the category of "caring for" another person such things as providing nourishment, and fending off death. There may even be a genetic basis for the warm feelings which these activities produce in us. Unfortunately, our determination to experience this warmth can be so strong that it blinds us to the possibility that in a given set of circumstances the traditional caring activities may be the wrong response.
     An example of this mistake is provided by comments from the executive director of the Oregon Catholic Conference, in response to the state's report on assisted suicides during 2000. He said "As a community, we are called to solidarity with vulnerable dying persons ... As difficult as it may be to accept at times, we also are called to open ourselves to be loved by the community during our own time of need and vulnerability." The second half of this statement seems to tell the dying "It will make us feel good to fuss over you, and you are obliged to grant us this pleasure, regardless of how you feel about the matter." This constitutes an unacceptable substitution of the observer's feelings for the patient's feelings, as determinants of the observer's actions.