Living Wills and Assisted Suicide

Kerrie Wooltorton is believed to have been the first person to use a living will as part of a successful attempt to commit suicide: http://www.guardian.co.uk/society/2009/oct/01/living-will-suicide-legal . The 26-year-old wrote her will, and then three days later took poison and called an ambulance. The will said that no steps were to be taken to prolong her life, and that she desired only to be made as comfortable as possible and not to die alone.

If doctors had kept her alive, they may have been open to legal action. Indeed any interference with Wooltorton against her wishes could have been interpreted as an assault. But might there nevertheless be a moral case for ignoring a living will in such circumstances?

One immediate concern may be that the patient is not sufficiently competent to make such an important decision. But here one must be careful not to judge competence by the content of the decision. Individuals are, in most cases, the best judges of whether their lives are worth living, and the fact that someone chooses to end their life in circumstances in which we would not is not sufficient to justify an attribution of incompetence. Even if we think the decision is evidence of foolishness and imprudence, these are not incompetence. Indeed in this case the coroner was clear that Wooltorton had the capacity to consent, and full knowledge of the consequences of her actions.

Another argument, put forward in the Wooltorton case by the ‘ProLife Alliance’, is the so-called ‘thank you theory’, according to which, since most people saved in such circumstances are glad to have been rescued, a policy of general interference with a person’s stated wishes is justified. But most people believe that their right to run their own lives isn’t something they have because they benefit from it, or from its being respected, so that the right lapses in the absence of the benefit (I am making the not implausible assumption that the glad survivors have indeed been benefited). And even if the right is in general to be respected because of the balance of benefits over harms in allowing people to govern their lives, this does not mean that individual cases are to be judged according to their consequences. Other than in exceptional cases, John Stuart Mill’s position that we should interfere with other people’s autonomous decisions only to prevent harm to others seems a good working principle for any liberal society.

But what if the patient has obligations to others, such as young children? Would doctors not then be entitled to prevent her committing suicide in the hope of ensuring that she fulfils those obligations? Consider, for example, the fact that the state can require a parent who leaves the family home to continue to provide financially for his or her child. The analogy fails, however, since maintenance payments are highly unlikely to prove as great a burden as the living of an unwanted life, and the decision over whether to continue living or not is – if any decision is – a highly significant one protected by the right to autonomy.

The same sort of point can be made in response to the argument that suicide is wrong in itself, independently of obligations to others. Even if it is, it must be recognized that within the sphere of individual liberty the individual has the right, in certain cases, to do wrong. It is up to me whether I gamble, waste my talents, or commit suicide, and you have no right to stop me.

Doubtless Kerrie Wooltorton would have preferred the option of a more dignified and safe form of assisted suicide, such as that offered by the Dignitas clinic in Switzerland. It may turn out that her actions bring the day closer when that option will be available within the UK. For if significant numbers of people follow her example, then even those who currently oppose assisted suicide may see a Dignitas-style clinic in the UK as the lesser evil.

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2 Responses to Living Wills and Assisted Suicide

  • Dennis Tuchler says:

    Very interesting post. The case of Kerrie Wooltorton is somewhere in between assisted suicide and the usual living will situation, in which the patient did not come to the hospital to die, or did not come to the nursing home to die right away. Here, the freshness or currency of the decision to die is undoubted and the doctor need do nothing to honor her apparent decision.

    So, there remain three problems: At the time to decide whether to let the person die according to the will the question is whether the patient desires to die now. Is that her intent? The older the will, the more stale and unconvincing the decision stated in that will to die. Such living wills should be renewed periodically to avoid this problem. The second problem is one of competence at the time the decision is to be made, which should usually be framed in terms of the age of the person wishing to die. That’s a legal question; however it is also an ethical question, which the parent or spouse or physician must consider. Can a very smart 15-year-old effectively choose to die? The third problem is what counts as taking no steps to resuscitate or to prevent death. Here the theological-sounding but potentially very real legal problem of action versus inaction. Is removing a tube “not taking steps” or “not preventing”? The doctor needs to know before (s)he decides what to do.

    Finally, there’s the problem of the parent’s or spouse’s veto of the decision to honor the will. How does one handle that, not legally but ethically/morally? Deciding whether to honor that question cannot be a legal question; it must be a moral question. The law can’t do more than let the doctor decide to honor the parent’s or spouse’s (or adult child’s) wishes.

  • Roger Crisp says:

    Thanks, Dennis. There is much to think about here. One quick point, about the fifteen-year-old. Of course some fifteen-year-olds are better than most adults at making informed decisions about their lives. But the question is whether, as a matter of policy, all fifteen-year-olds should be able to write binding living wills. I’m inclined to think they shouldn’t, though that might be hard on certain individual teenagers.

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