Is the campaign for euthanasia a byproduct of neoliberalism?

h/t Bioedge

Debates about the ethics of euthanasia often centre on the issue of patient autonomy. One common argument made by proponents of legalised euthanasia is that patients should have the right to choose when and how they die, particularly when they are terminally ill and suffering intolerably.

Yet perhaps there more to the euthanasia debate than just individual autonomy. A new article in ABC Religion and Ethics presents a novel socio-economic critique of euthanasia rhetoric, analysing the global campaign for assisted dying from the perspective of contemporary economic theory.

St Vincent’s Health Australia ethicist Daniel Fleming argues that the push to legalise euthanasia is symptomatic of an ideology known as neo-liberalism. While the precise meaning of the term is debated, neo-liberalism is usually used to denote an approach to economic and social policy -- popular in the late 20th Century -- that seeks to profoundly augment consumer choice and market freedom. It has been criticised for reducing the human person to a self-regulating economic actor with no connection to community or history.

Fleming argues that this mentality is reflected in the way in which people use terms like ‘compassion’ in the euthanasia debate. Compassion, in the context of arguments for euthanasia, is really just a byword for a desire to augment the autonomy of individuals at the end of life -- as if the way in which we die were just one more market choice. Fleming writes,

“...According to [the neoliberal narrative], physical suffering is less a concern than the suffering incurred by the dependency that fragility and illness entails, and its consequent loss of autonomy, self-regulation and self-surveillance. To be compassionate according to the neoliberal narrative is to suffer with these particular concerns. The commitment following such suffering with is to open up hitherto unavailable options for the exercise of autonomy in order to reinstate what has been lost, even to the extent of that ultimate expression of individual choice: to end one's life.”

Fleming analyses assisted suicide statistics from Oregon, and comes up with some interesting conclusions. It appears that the quintessential neoliberal actor -- a white, well-educated male -- is exceedingly more likely to request euthanasia than a member of a minority group:  

“...on balance white people are over 35 times more likely to access this option at the end of their lives compared to the African American population…[those with a university] degree or higher...are 36 per cent more likely to access VAD than the rest of the population”.

It’s a long article, but well worth the read. 

Assisted dying: Doctors' group adopts neutral position

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Hospital doctors have dropped their 13-year opposition to the concept of helping terminally ill patients die.

Following a poll of its members, the Royal College of Physicians has now adopted a neutral stance on the issue of assisted dying.

Some groups have spoken out against the change, saying a respected medical body's reputation has been damaged. Others called the decision "absurd".

Under UK law, it is illegal to encourage or assist a suicide.

Nearly 7,000 doctors voted in the online poll:

• 43% thought the college should oppose a change in the law
• 32% wanted the college to support a change
• 25% were neutral

And the college has shifted to a neutral stance because neither side achieved a majority of 60%.

However, a group of doctors opposed to any change in the college's position are planning to challenge the decision to ask for a majority result.

Royal College of Physicians (RCP) president Prof Andrew Goddard said: "It is clear that there is a range of views on assisted dying in medicine, just as there is in society.

"We have been open from the start of this process that adopting a neutral position will mean that we can reflect the differing opinions among our membership.

"Neutral means the RCP neither supports nor opposes a change in the law and we won't be focusing on assisted dying in our work.

"Instead, we will continue championing high-quality palliative care services."

'Absurd decision'

Dr Gordon Macdonald, chief executive of Care Not Killing, said most doctors didn't want a change in the law on assisted suicide or euthanasia.

"We hope that the RCP will listen to this message from their members and reverse their absurd decision to adopt a position that is the least popular and commands the support of just one in four of doctors," he said.

"This is why our view is clear, society should be doing everything in our power to prevent suicide, not assist it."

Campaign group Living and Dying Well said the shift had damaged the college's reputation as a professional body.

Analysis by Fergus Walsh, BBC medical correspondent

This shift by the Royal College of Physicians has no effect on the law and does not bring assisted dying any closer.

But it is symbolic that a respected body should change its stance and has been warmly welcomed by campaigners aiming to change the law.

The decision has infuriated and dismayed those opposed to the change, however, who argue that it is unreasonable to demand a supermajority in order to maintain the status quo.

The RCP has revealed that only one of the 39 specialisms it represents met the 60% threshold.

Of palliative medicine doctors, 80% voted to maintain the college's opposition to assisted dying.

This is a group who will spend more time than any other with patients at the end of life, so their view is significant.

The RCP also pointed out that it had adopted a neutral position until 2006 and so this move was a return to its previous stance.

The BMA, the doctors' trade union, is opposed to assisted dying. Motions calling for it to adopt a neutral position have been repeatedly rejected.

Dr John Chisholm, BMA medical ethics committee chair, said: "Our focus remains on improving the standard of palliative care available for patients, through calling for greater investment and support to enable staff to deliver the highest quality end-of-life care."

From the BBC news website

Back to the source: the Hippocratic Oath re-examined

Over the centuries the Hippocratic Oath has expressed the ideals of the medical profession, although nowadays other versions have supplanted it for graduating medical students– if they take any oath at all. If taken literally the Oath is an anachronism. Who today “swears by Apollo Physician, by Asclepius, by Hygieia, by Panacea, and by all the gods and goddesses”?

But T. A. Cavanaugh, a philosopher at the University of San Francisco, argues in his recent book Hippocrates' Oath and Asclepius' Snake: The Birth of the Medical Profession that the Oath is still relevant in establishing the fundamental ethics of the medical profession—to help and not to harm the sick.

Steeped in Hellenic culture and philosophy, Cavanaugh argues that deliberate iatrogenic harm, especially the harm of a doctor choosing to kill (physician assisted suicide, euthanasia, abortion, and involvement in capital punishment), amounts to an abandonment of medicine as an exclusively therapeutic profession.

Medicine as a profession, Cavanaugh contends, necessarily involves declaring the good one seeks and the bad one seeks to avoid on behalf of the sick. The idea of taking an oath implies that doctors set boundaries around what they are permitted to do. Medicine must reject the view that it is purely a technique lacking its own unique internal ethic.

h/t Bioedge