The relaxation of the law prohibiting intentional killing would be both dangerous and unnecessary, writes Nigel Biggar.
Let's be frank: some of us face truly dreadful ways of dying. Those who suffer from motor neurone disease (MND), for example, might have to look upon the prospect of suffocating to death. Others with obstructive tumours might have to spend their last days vomiting their own faeces.
But it is not only the dying who have reason to fear. Some of the living are burdened with lives that are miserably restricted and isolated. The chronically disabled Irishman who sought Swiss help to kill himself late last year, whose story was reported this week, was unable to swallow and had to feed by means of a tube inserted into his stomach. His capacity to communicate was very limited.
Is human life under such conditions really worth persevering in? Why on earth should we be forced to endure a meaningless or excruciating life to the bitter end? What could possibly be the point?
Surely compassion obliges the law to let us seek a swift and efficient escape, whether through help in killing ourselves (assisted suicide) or through someone else killing us at our request (voluntary euthanasia)? Besides, don't we have a right to autonomy? After all, an individual's life is his own and who is better placed to decide when it has become intolerable?
This is the gist of the argument for the relaxation of the law's traditional prohibition of intentional killing - an argument that is being made throughout the western world, and which has won ground in the Netherlands, Belgium, and the state of Oregon in the US. We wait to hear whether it has won further ground in Britain, when the House of Lords select committee reports on Lord Joffe's Patient (Assisted Dying) Bill on Monday.
It is perfectly true, as the leading editorial in Thursday's Irish Times commented, that it is not enough to contradict the case for liberalisation by simply shouting the slogan: "All human life is sacred and inviolable." Nevertheless, there is a serious argument that can be made against it.
First of all, if the law was to allow competent adults absolute autonomy over their own lives, then it would have to permit consensual vivisection and killing. In other words, should an individual consent to being mutilated and killed - say for sexual gratification - then the law would have no objection. In his/her eyes, the individual would be master of his own life and if he should choose to spend it in what other people consider to be a macabre fashion, then that would be his business and his alone.
In case this sounds just too bizarre to be worth considering, we should remember that in 2004 Armin Meiwes was tried in Germany for mutilating, killing and eating a 43-year-old computer engineer, who consented because, according to the judge, "he wanted to get the kick of his life". The fact that Meiwes was convicted of manslaughter, and not just acquitted, is witness to the commitment of German law - as of all traditional western law - to some concept of the objective value of human life that is independent of the subjective preferences of individuals.
In spite of the consent of the engineer, his life had a value that both he and his killer violated: that is why Meiwes was punished. It follows from this that if Irish law wishes to maintain a commitment to upholding the objective value of human life, then it cannot grant to individuals absolute autonomy over their lives.
But surely it could grant limited autonomy? Surely it could give individuals the right to assistance in suicide or to voluntary euthanasia under certain stringent conditions?
Yes, it could, in principle. But I doubt that in practice it would. Once we choose to breach the law's absolute prohibition of intentional killing, we will then have to decide how to limit permissible killing. We might well all agree that dying patients whose suffering is unbearable and beyond adequate relief should be eligible for the right to die. But there would still be plenty of room for disagreement among us about when suffering is unbearable and when relief is inadequate.
Further, some will remind us that unbearable and irremediable suffering is not confined to the dying: Why should the chronically ill or disabled be denied the "benefit" of merciful assistance in suicide or killing? Further still, some will rightly urge that one doesn't even have to be physically ill to regard life as an intolerable burden. What about the chronically and severely depressed? Don't they also deserve the right to escape misery via death?
Once we decide to breach the absolute prohibition of intentional killing, we might agree upon the need to limit the conditions under which assisted suicide and voluntary euthanasia are permissible, but we will find that there are no compelling reasons to draw the line in one place rather than another.
Given the intrinsic difficulty of deciding where to draw the line, given the popular appeal of the rhetoric of autonomy, and given the propensity of the media to focus on graphic personal stories rather than the larger social context, there is good reason to fear that any liberalisation of the law will tend towards granting death on demand.
If this should seem fanciful and alarmist, then consider the Netherlands, which has had 20 years' experience of trying to design a suitably stringent legal framework for regulating assisted suicide and euthanasia. Since 1984 Dutch law has in effect permitted doctors to assist patients to die or to be killed upon request under certain conditions.
These conditions do not stipulate terminal illness. They do not clearly stipulate physical illness. They only require that the candidate's suffering be unbearable and without hope of improvement.
Accordingly, in 1994 the Dutch Supreme Court ruled that Dr Chabot had been acting within the law when he reckoned eligible a patient who was suffering persistent grief at the death of her two sons. Six years later a court in Haarlem implied in the case of Dr Sutorius that a patient who wanted to die, not because of any serious mental or physical illness, but because he felt his life to be "pointless and empty" could be considered subject to "unbearable suffering".
And in December 2004, the Royal Dutch Medical Association concluded after three years of deliberation that the right to euthanasia should be extended to those who want to die because they are "tired of life".
The liberalisation of the law that currently prohibits intentional killing will tend to undermine any societal commitment to the objective value of human life. This may make us a more liberal society, but it won't keep us a humane one. That is one strong reason not to relax the prohibition. Another strong reason is that there are alternative solutions to the problem.
Insofar as the problem is the fear of being kept alive in intolerable circumstances, current morality and law does not oblige patients to strive to stay alive at all costs, and it already grants them a right to refuse treatment that doctors must respect. This should not be read as sanctioning suicide. It merely recognises that some may reasonably prefer to conserve their limited energies for the process of dying rather than expend them in straining to stay alive.
It is true that some doctors are overzealous in trying to "save" their patients, and this poses a major challenge to medical education. Doctors need to be educated to see their proper task as helping patients to die well, and not simply as fending off death.
Certainly, that should involve their being made far more aware of the considerable resources of palliative medicine and care. But it also requires more than technical training. It requires a spiritual formation in which doctors are made into the kind of people who, when faced with death in the eyes of the dying, have the moral strength to resist the natural instinct of mortal human beings, and not to turn away.
Butwhat about those patients whose suffering cannot be dealt with by normal palliative means? In those rare cases there is the option of permanent sedation. Sometimes doctors fight shy of this, because it risks killing the patient. However, provided that the treatment is designed to relieve suffering, and that death is an unavoidable side-effect, there is no moral or legal objection.
The human suffering to which assisted suicide and voluntary euthanasia are offered as solutions needs to be taken seriously. But the relaxation of the law prohibiting intentional killing would be both dangerous and unnecessary. There is another way.
Nigel Biggar is Professor of Theology at Trinity College Dublin and the author of Aiming to Kill: the Ethics of Suicide and Euthanasia (2004).