Assisted Suicide in Oregon: a Counterblast from the Antis

Ilora Finlay and Rob George* have a new paper in the JME that takes issue with Battin et al‘s 2007 paper, concerning who makes use of physician assisted suicide in Oregon and Holland.  Battin’s claim had been that there was

no evidence of heightened risk for the elderly, women, the uninsured (inapplicable in the Netherlands, where all are insured), people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS.

These findings were, unsurprisingly, used by defenders of PAS to soothe worries among the antis that legalisation would put the vulnerable at risk.

Finlay and George, by contrast, claim that there’s a number of methodological oddities with Battin’s paper, such as to mean that those reassurances mayn’t be as convincing as all that. “[V]ulnerability to PAS,” they say,

cannot be categorised simply by reference to race, gender or other socioeconomic status and that the impetus to seek PAS derives from factors, including emotional state, reactions to loss, personality type and situation and possibly to PAS contagion, all factors that apply across the social spectrum. [C]ontrary to the conclusions drawn by Battin et al, the highest resort to PAS in Oregon is among the elderly and, on the basis of research published since Battin et al reported, that there is reason to believe that some terminally ill patients in Oregon are taking their own lives with lethal drugs supplied by doctors despite having had depression at the time when they were assessed and cleared for PAS.

I have to admit – and this is going to surprise noone who reads this blog – that I don’t think that this paper settles matters by quite a long way.  To take the depression point, for example: just because someone has depression, treatable or otherwise, it doesn’t follow that a decision that they may make to end their lives is other than valid; while depression may give us cause to be a little suspicious of a request for PAS, it’s not a deal-breaker.

In respect of a lot of the rest of the paper, even at its strongest reading, it tells us only that Battin-inspired reassurances aren’t obviously compelling; but that’s still a long way from telling us that the vulnerable have a reason to fear legalised PAS, and still further from sustaining a claim that it shouldn’t be legalised.  (The paper doesn’t make that claim, but it is the sort of thing that could get used in an attempt to bolster it.)  And I think that there’s something strange about the way that Finlay and George seem to slide from a concern about “vulnerability in the context of PAS” to “vulnerability to PAS”.  This seems to me to beg the moral question about PAS against the defender; but the defender of PAS can admit that there is such a thing as vulnerability within the context of PAS without having to admit that PAS per se is something to which a person can be more or less vulnerable.  In one sense the distinction is slight; but in another, it’s very important.

But, actually, this is by the by, because it’s got me thinking about the use of statistics in moral argument, and – in the wake of hearing a paper by John Coggon earlier this week – about how context-free our ethics can be.

No amount of appealing to statistics can settle a moral argument, as far as I can see.  Partly that’s because they’re always disputable (and I can hear the scribbling of people writing rebuttals of Finlay and George, and counterrebuttals, even now…); but it’s partly because they’re fuel for a different sort of debate all together – we’re back to the is/ ought distinction here.

But I’m unashamedly unconcerned with policy applications; and plenty of others aren’t.  I’m concerned by the rights and wrongs of PAS, and no amount of slippage into the unacceptable by people in practice will show that the putatively acceptable isn’t acceptable after all.  Nevertheless, if it turns out that there are genuine worries that a theoretically defensible position is likely to be banjaxed in practice simply because people aren’t reliable moral actors, I can sort of see how that’d get in the way of policy implementation or adoption.

That seems very hard on, and perhaps even unjust in respect of, the people whose request for PAS was “authentic” all along – effectively, Smith would be denied something to which he had a moral claim because we’re concerned about the relationship between Jones and Robinson.  Bad luck Smith.

I guess that the problem is this related to the risk-aversion of policymakers.  Given that statistical disputes take a long time to be settled for good, I guess that realistically, policymakers have to draw a line and say that this is where they’re going to stop taking on board new interpretations.  This looks to be arbitrary, though – and we generally don’t like to think that arbitrariness has a big role in policy decisions.  I wonder if there’s ever going to be a satisfactory, non-arbitrary way out, though.

*I think I’ve identified “R George” aright, but will correct this if I haven’t…

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