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Choosing To Die

Matthew Rallison is a sixth-form student who is visiting the Oxford Uehiro Centre for Practical Ethics for his work experience placement.

Sir Terry Pratchett’s documentary, “Choosing to die” and the recent deaths of Ann McPherson and Jack Kevorkian (inventor of the Mercitron) have recently raised the debate of the legalisation of euthanasia, alongside criticism of the BBC’s bias favour towards the subject.

The latter of these issues is, to an extent, accurate as the programme echoes Pratchett’s support of euthanasia. Yet the conclusion of the programme, for me, offered personal reflection, rather than an affirmation that euthanasia (or assisted suicide) is morally correct. Watching, on screen, the death of Peter Smedley was not a compelling argument but humbling. Peter was unassuming as he fell out of consciousness. “A good death,” as Pratchett describes it. The scene offered a powerful impression of human dignity and spirit, rather than promoting death, or suicide. It supported virtue in life (or in leaving it). I reject the ex-Bishop of Rochester, Michael Nazir Ali’s claim that it the programme depicted “glorified suicide.” It did not.

Campaigners for Care Not Killing argued that portrayal of suicide would lead to further suicides. This assertion also has little basis. Pratchett never endorses suicide, in poor health or otherwise. The emphasis is upon personal autonomy as two mens’ journey to Dignitas (euthanasia clinic based in Zurich) is followed. Pratchett offers equal respect to an individual’s decision to live with illness just as much as he respects those choosing to die; no option is judged morally proper. Furthermore the process of using Dignitas involves extensive health evaluations, tests of clarity of thought, travelling to Switzerland and around £10,000. There is nothing impulsive about the procedure and such a programme could not ‘open the floodgates’.

It is important to consider whether euthanasia is morally correct in itself. For me, this argument is overwhelmed via belief in one’s autonomy, which extends to how one dies. In theory rather than practice, euthanasia is a debate of rights. The argument to refute such a position has traditionally been concerned with the sanctity of life, a concept manifesting in much of mainstream religion but which may be held otherwise. However sanctity of life (the value of existing) is too simplistic in contemplating euthanasia. The value of life is far more profound than whether that life is in existence. Pratchett raises the point that it is not the sanctity, but the dignity of life which matters. Thus why should anyone be subject to a painful and suffered anticipation of death? That is not what being alive is about.

Pratchett remarked, having been diagnosed with Alzheimer’s disease, that the disease would regret choosing him and that his death would not be that which the disease intends. That he would die peacefully in the sunshine, with Thomas Tallis playing on his IPod as opposed to enduring the degeneration of all he values in life; Pratchett’s ability to type has already left him.

Consider Monsignor Thomas O’Brien who was 83 when he suffered a massive stroke and lost the ability to swallow or speak.  He was put on a nasogastric feeding tube, which he pulled out of 15 times. Despite being examined by four psychiatrists who testified that he was capable of rational decisions affecting his life, a judge ordered he be put on a feeding gastronomy (a tube inserted directly into the stomach). The life-support mechanism was continued until he died.

I believe that an overwhelming compassion leads us to the conclusion that O’Brien should have been allowed to die at his will.

However the euthanasia debate centres on its potential legislation. The topic is not limited by its ethics, as discussion of policy infers more than the rightness or wrongness of an action in itself. As a policy, opposition cites concerns regarding how euthanasia would affect society if introduced. Consideration must be given to the protection of the vulnerable, the problem of doctors administering death and how such a policy impacts upon society’s outlook on life as a whole.  These practical arguments against a euthanasia policy deserve to be taken seriously, but I believe they should be looked upon more as stipulations to be added to a euthanasia law, rather than arguments against having one; they would ensure a rigorous and effective policy in the UK.

It is such cases as Monsignor O’Brien and Peter Smedley that leave me convinced euthanasia is morally justifiable and correct. While practical fears of such a policy exist, I find it impossible for these to overwhelm my position in favour of euthanasia and thus it must be made possible for such a policy to be implemented well. The ethic is too important to be rejected due to various practical concerns.

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22 Comment on this post

  1. Dmitri Pisartchik

    Thank you for an interesting post, Matthew.

    I am very disappointed at not having access to Pratchett's documentary in my region (Canada) but I'm fairly sure I would have enjoyed it immensely. If his writing is at all reflective of his character and position, I am confident in its reasonableness.

    Despite its thorny nature, the issue of euthanasia can be meaningfully distilled into one key and fundamental question: Do individuals own themselves and their lives? If so, then there can only be instrumental and practical obstacles to suicide, assisted or otherwise. None of which actually speaks directly against making assisted suicide legally available, but rather demands that institutional supports and safe-guards be set in place to facilitate the process.

    The Pro-life camp is firm, if rarely explicit, on their answer to the fundamental question: Individuals do not own their lives. (See the end of this article for an example: Given that most are religious, their answer is that God owns our lives, not us (the secular minded, of which there are the unfortunate few, sometimes appeal to our lives being owed to others and society at large) Having thus answered the key question in the negative, no further considerations are relevant or truly substantial. The appeal to the slippery slope of society disintegrating if assisted suicide is made available is at best a weak (and easily refutable) supporting argument, if not a red herring outright.

  2. Matthew, the principle of indivisibility is one of the founding principles of modern international human rights law.

    The sanctity of life principle and the inherent dignity principle are indivisible–inextricably linked. To honour one principle, we must simultaneously honour the other.

    Not so with the concept of personal autonomy–in the foundation human rights instruments there were very strict limitations placed on this concept. The autonomy of the person who is seeking assistance to commit suicide is limited by respect for the rights of others and for the security of all. Autonomous rights cannot be lawfully separated from the natural context of responsibilities to the community. Even persons who are terminally ill cannot unilaterally divorce their human rights from their human responsibilities to their family, their community, and to those who are even more vulnerable than they are.

    It is historical fact that the whole architecture of modern international human rights law is deontological–based on human rights principles that are permanent and immutable. Human rights protection was created most carefully to ensure a holistic unity. Withdrawal of legal protection from arbitrary deprivation of life guaranteed by the Universal Declaration is not permissible—under any circumstances. This is made clear in Article 30:

    "Nothing in this Declaration may be interpreted as implying for any State, group or person any right to engage in any activity or to perform any act aimed at the destruction of any of the rights and freedoms set forth herein."

    Article 30 is an explicit prohibition of revisionist interpretation aimed at the destruction of any of the rights recognized in the Declaration. Having recognized the right to life as inalienable and non-derogable "even in public emergencies", the Universal Declaration may not be reinterpreted to condone activities such as arbitrary deprivation of life through State-condoned medicalized suicide.

    Charles Malik called this last article of the Universal Declaration “the article of inner consistency”:

    "…it states that nothing should flow from this Declaration that can contradict or nullify its effect. Thus no person aiming at the destruction of the fundamental rights can take cover under any of the freedoms granted by this Declaration…"

    International human rights protection is not "a patchwork quilt" but rather a fire blanket woven on principles that can be deepened and strengthened over time to give more protection but never ruptured to give less protection to any members of the human family.

    We, today, can't hold a candle to the exceptionally gifted group of post-World War II philosophers, international lawyers and politically astute men and women delegates who drafted the Universal Declaration. Their collective intellectual powers were formidable, sharpened by the still red-raw experience of massive human rights atrocities perpetrated by the Nazi state.

    With scrupulous honesty, they debated and then tested exhaustively every plank, every principle that was to form the foundational structure to protect the human rights of absolutely every human being.

    Those who framed the inalienable sanctity-of-life protections in the international covenants on human rights were no ivory tower academics. Drafters like René Cassin experienced the pain of losing nearly all his family members during World War II in State-condoned routine medicalized killing programmes that had "shocked the conscience of mankind". And so in the International Covenant on Civil and Political Rights (ICCPR), it is recognized that all human rights derive from the inherent dignity of the human person.

    The term "inherent dignity" applied in the spirit and purpose of the Universal Declaration means that every human being has an immutable dignity, a dignity that does not change with external circumstances such as levels of personal independence, satisfaction or achievement, mental or physical health, or prognoses of quality of life, or functionality or wantedness.

    The terminally ill, although they are dying, are still alive. It is their live humanity, their living membership of the human family that entitles them to "…recognition of the inherent dignity and inalienable rights of all members of the human family". It is this recognition that obliges us to travel in human solidarity with the terminally ill, to provide them with the best attainable palliative care, in their homes or hospices or intensive care units, or even on the streets (as exercised by Mother Teresa's Sisters) to be attentive to their needs, to be with them in loving support to the moment of natural death.

    This inherent dignity is inalienable, and applied to a person at risk of suicide, it means that all human rights, including the right to life, cannot be taken from one’s person, not by anyone, not by one’s doctors, nor by one’s family, and not even by oneself.

    Human beings cannot be deprived of the substance of their rights, not in any circumstances, not even at their own request–the principle of inalienability.

    While every person with a terminal illness has a right to refuse burdensome treatment intended to prolong life, no person has a right to demand of doctors an intervention intended to kill.

    For even while living through the natural process of dying, the terminally ill retain their inherent dignity. The term “inherent dignity” applied in the spirit and purpose of the Universal Declaration means that every human being has an immutable dignity, a dignity that does not change with external circumstances such as levels of personal independence, satisfaction or achievement, mental or physical health, or prognoses of quality of life, or functionality or wantedness. There is no conceivable condition or deprivation or mental or physical deficiency that can ever render a human being "non-human". Pejorative terms such as "just a vegetable" or "non-person in a permanent vegetative state" and dismissive attitudes such as “he’s better off dead—he’s going to die anyway…" cannot justify violation of the human rights of the human person so described. Such prejudices cannot destroy the inherent dignity of the human person. As long as a human being lives, he or she retains all the human rights of being human, all the rights that derive from his or her inherent dignity as a human being.

    1. Even if one holds that rights are inalienable, one can still claim that certain rights outrank other ones when they come into conflict: as they often do. For example, in the recent UK debates over superinjunctions, the right of individuals to privacy (covered in article 12) conflicted with right of freedom of expression by individuals and the press (covered by article 19).

      In the case of euthanasia, one could argue that allowing someone to suffer, against their will, when you have the ability to stop this suffering, could be considered cruel (or even torture),which contravenes article 5.

      Alternatively, article 25 states that "Everyone has the right to a standard of living adequate for the health and well-being of himself". If someone does not believe that, even with the best palliative care available, that their standard of living and well-being are adequate, then this article is being contravened.

      Finally, article 3 expresses that "Everyone has the right to life, liberty and security of person". What if one considers one's right to liberty to be restricted by preventing the possibility of euthanasia? Why should the 'right to life' outweigh all these other rights?

      1. You are right, Matt: the drafters of the foundation covenants recognized that non-derogable rights such as the right to life outranked other rights. See International Covenant on Civil and Political Rights (ICCPR), Article 4 (2). regarding the right to life, there was no "if we feel like it" at the bottom in small print.
        The right to life is the source of all other human rights: it is “the supreme right” and “basic to all human rights”. See UN Human Rights Committee General Comment 6 & General Comment 16. As you know, these General Comments are the most authoritative statements on our human rights obligations issued by the UN treaty monitoring Committees.

        However, Matt, you are wrong in your interpretation of article 25–it applies to the living and the drafting history of this article makes it clear that this relates exclusively to the minimum demands of the living and our obligations to meet these demands. The corollary of this right is that we must lift our game in supplying the needs of those who are suffering–not that we should kill them.

        Finally, liberty is not licence to kill, yourself or anyone else. Again the drafting history makes it clear that liberty is to be exercised always with respect for the right to life and security of the person.

        1. Thanks for the additional information.

          If what you say is correct then it is clear that I fundamentally disagree with aspects of the UN Declaration of Human Rights. And regardless of what it says about changing it…well, it's a document constructed by humans, and humans make mistakes. We are also capable of learning from our past mistakes, and making improvements. Therefore we should engage in a moral debate about euthanasia, and not assert that it must be wrong simply because a legal document says so.

          I value quality of experiences above preserving life at any cost.

      2. Regarding your argument, Matt, about allowing someone to suffer, against their will, when you have 'the ability to stop this suffering', I believe you conflate human 'ability to stop suffering' with stopping life–which is distinctly different.

        One has to be very very careful about claiming to have the ability to stop someone suffering by killing him or her, or arranging for him or her to commit suicide.

        The drafters of the original human rights base understood all too clearly from still red-raw memories of Nazi euthanasia programmes just a easily and swiftly 'compassionate' medicalized interventions become a duty for both doctors and patients.

        They understood just how easily Nazi euthanasia propaganda was able to target those who are in that most vulnerable of all positions of being disabled. terminally ill or suicidal.

        They understood that medicalized killing or other forms of lethal self-harm cannot be promoted as a legitimate response to the suicidal distress of any person as it is in violation of the fundamental human rights principle of inalienability. Human beings cannot be deprived of the substance of their rights, not in any circumstances, not even at their own request.

        Laws permitting the medicalized killing of persons who are terminally ill must alter most unjustly our present social environment in which the terminally ill are entitled unconditionally to whatever palliative care, financial and other resources are necessary.

        Social environmental economists might recognize in the making here in our present push towards legalized lethal interventions a tragedy of the commons. Legalized medical killing of the terminally ill sets a socially engineered trap, in which individual interests freely and legally gain access to a public resource (a health care system that provides unconditional specialized care for the terminally ill) and proceed to change drastically the ethos of that public resource—to change it from unconditional palliative care to optional care together with the option of medically assisted suicide.

        A tragedy of the commons will unfold as the terminally ill are pressured subtly to accept the cheaper swifter option. This will lead eventually to the complete depletion of the shared resource—the end of a truly universal, unconditional and beneficent system of care for the terminally ill. A gradual reduction of specialized clinics, hospices, palliative care resources and research dedicated to the needs of the terminally ill is therefore a typical "externality" – i.e., the unintended and negative consequence of private decisions that ends up affecting everyone.

        Inexorably, more research resources, more clinics, more medical personnel will be directed towards ktenology—the science of killing.

        We should not venture down that road.

        1. If we observe what happens in Switzerland, or Oregon, or wherever else allows assisted suicide, for several decades, and your 'slippery slope' predictions do not come true, would you then consider that it may be a road worth venturing down?

          1. No, Matt.

            Human rights protection according to the present rule of law is by its very nature both principled and precautionary.
            In meaning and purpose, it is structured to guard everyone, including and especially the most vulnerable, against grave violations.
            For the common good, it requires both States parties and individuals to surrender of their own good will some of their sovereignty in order to better protect the most vulnerable.

          2. If you're opposed to making changes even if evidence from other countries shows the most vulnerable can still be properly protected, then you're just being stubborn.

    2. Dmitri Pisartchik

      The only acceptable limit here is that assistance is not morally required from others. The point for which advocates of assisted suicide fight for (primarily) is that willing benefactors are morally permitted to assist if they so choose. Appeal to inherent dignity is dubious, since it can be made out to support either position – either it is indignant to kill a person at their request, or it is indignant to deny a person an opportunity to die on their terms.

      On a more general note, it is not at all clear why the UN Declaration, for its accolades and praise, should have moral authority that it is given in this discussion. There are coherent and cogent criticism of the Declaration and the doctrine of human rights generally that restrict their scope and influence significantly, if not undermine them entirely. The use of the Articles as if they are the equivalent of the Ten Commandments and the ultimate guide to solving the ethical issues surrounding euthanasia (or any other issue, for that matter) is quite dubious as well in my humble opinion.

  3. Anthony Drinkwater

    Thanks for your post.
    If you have read Rita Joseph's comments, I suggest you read (or re-read) the Universal Declaration of Human Rights ( and determine for yourself the jusification (or not) for her comments. (You might also enjoy Prof JP Griffin's "On Human Rights" if you have some time available in or after your placement.)

  4. Anthony Drinkwater

    You might also care to look on the UN web-site at the general comments mentioned above by Rita Joseph and be astounded (or not) at the logic (or lack , as you may decide) of her interpretations…….
    Good luck with your work experience – hope you find all the answers before it finishes !

  5. You miss my point, Matt. Human rights principles are not contingent on the outcomes of possible scenarios–though the results of the experiments in the countries you mention appear far from satisfactory–the recorded growth in involuntary euthanasia over recent years is most disturbing.

    Perhaps I expressed too clumsily the point I was trying to make–that the human rights principle of inalienability is permanently and very deeply embedded in the critical architecture of modern international human rights law. The Universal Declaration principles are codified in all our subsequent human rights Conventions.

    You can’t contravene the grave obligation to protect the non-derogable right to life by introducing a right to medically assited suicide, not without abandoning reason and logic, not without compromising the inner coherence of the whole international human rights system.

    Historically, our human rights legal system is deontologically based – that means, it’s based on principles. To allow, now, a 'right' to suicide with medical assistance would be to over-ride the inalienable right of life. It would be to switch horses midstream. It is to try to move across to a different philosophical basis, consequentialism or utilitarianism, a system in which expediency trumps principles.

    An awful lot of academics, politicians, judges and commentators have made this switch but they refuse to be honest about it. They have changed horses midstream and now pretend that they are still on the same horse we set out on.

    1. I view rights as being a means to maximising well-being, or least stopping it from falling below a particular level. Where rights fail to support this, I believe we should change them. By 'maximising well-being', this does not have to mean the overall level/average in society (as with utilitarianism). It can be within one individual. I believe 'maximising well-being' is a pretty good principle.

      I know very little about international law or how it is constructed, so I will give you the benefit of the doubt that making such changes would be very drastic and would involve a big overhaul of legislation. However, this says nothing about what we *should* do if such an overhaul were to occur.

  6. We should take in account that Rita Joseph seems to be a strong believing catholic women (see:

    Therefore, her views in regard of assisted suicide are not from our time and have no value at all. Unfortunately, she seems not to know the position of the Holy Thomas more in his "Utopia":

    "I have already told you with what care they look after their sick, so that nothing is left undone that can contribute either to their ease or health: and for those who are taken with fixed and incurable diseases, they use all possible ways to cherish them, and to make their lives as comfortable as possible. They visit them often, and take great pains to make their time pass off easily: but when any is taken with a torturing and lingering pain, so that there is no hope, either of recovery or ease, the priests and magistrates come and exhort them, that since they are now unable to go on with the business of life, are become a burden to themselves and to all about them, and they have really outlived themselves, they should no longer nourish such a rooted distemper, but choose rather to die, since they cannot live but in much misery: being assured, that if they thus deliver themselves from torture, or are willing that others should do it, they shall be happy after death. Since by their acting thus, they lose none of the pleasures but only the troubles of life, they think they behave not only reasonably, but in a man-ner consistent with religion and piety; because they follow the advice given them by their priests, who are the expounders of the will of God. Such as are wrought on by these persuasions, either starve themselves of their own accord, or take opium, and by that means die without pain. But no man is forced on this way of ending his life; and if they cannot be persuaded to it, this does not induce them to fail in their attendance and care of them; but as they believe that a voluntary death, when it is chosen upon such an authority, is very honorable."

    And it was exactly this Holy Thomas More who has been declared the Holy Patron of Politicians and Statesmen by John Paul II on 31 October 2000. Does any one think that this Pope and his staff have never read what Thomas More has written?

    By a recent decision of the highest Court of Europe, the "right to suicide" exists in all 47 member states of the European Council. See the judgment of the European Court of Human Rights at Strasbourg in the case HAAS vs. Switzerland, 20 January 2011, para. 51 ( And it is very clear that this does not violate a "right to live" of anybody: A person committing suicide is never violating his or her right to live. Such a person doesn't even waive his or her right to live; he or her just waives his or her biological life.

  7. If you re-read my contributions here, Ludwig, you will see that my arguments are based on careful research of the UN archives, especially the drafting histories of the founding human rights instruments. My interpretations respect the Vienna Convention on the Law of Treaties (particularly the "ordinary meaning" and "contrary to the purposes and principles" requirements.

    You will find that my arguments do not rely on Catholic doctrine. My expertise is in the philosophy of language and I have had considerable experience at the UN in examining and advising on the meaning (purely secular of course!) of particular articles in the human rights instruments. My publishers are respected in most circles as among the foremost academic publishers on international human rights law.

    I am happy to engage in discussion with you, Ludwig, but please don't raise religious prejudice on my part or your part. Let's just deal with the arguments.

    The European Court of Human Rights has no authority to create new rights. All it can do is muddy the waters and invoke the murky and dubious "margin of appreciation" doctrine which regrettably contravenes the non-derogability and inalienability requirements of the most essential of all human rights.

    In any case, in this particular judgment, we should take seriously the Court's warning that the risk of abuse inherent in a system which facilitates assisted suicide cannot be underestimated (para 58). And we should acknowledge that the Court concluded that the restriction on access to the lethal substance (sought to assist a suicide in this case) was intended to protect health and public safety and to prevent crime (para 58).

    Your Thomas More quote is an interesting opinion but irrelevant to this particular argument.

  8. Firstly, thank you for the interesting article, Matthew. I believe this is a very important discussion, because it exposes problems within the UN human rights legislation that sooner or later we all will have to deal with, due to inevitable changes in the world scenario.

    The group of intellectuals that wrote the UN declaration was indeed composed of gifted people, but dangerously biased: emotionally, by the post-war shock, and intellectually, by the Anglo-European culture (to my knowledge no East- or Middle-Asian (except Taiwan), South-American or Sub-Saharan scientist was present). The fact that Rita mentioned the Nazi genocide, and not the Chinese or Japanese (each being three times more lethal) just proves my point. They are hardly the best choice for universal, permanent and immutable decisions.

    Moreover, their knowledge of science and technology is 60 years outdated. They did not take into consideration everything that technology can do. Simple things such as omnipresent surveillance by mobile phones, virtual identities and immigration would definitely have been taken in account, had they known them. Current technological advances in, say, genetics, cybernetics and artificial intelligence pushes the definitions of the charta to its limits and makes us ask, for example: “what is a human? When does one become one?".
    And what are human rights and human dignity, anyway? My president had recently “threatened” to censor all media content which does not accord to “human rights”. It seems that everyone interprets it as it pleases them.

    And finally concerning the topic at hand: although they all stand in the charta as inalienable, what are priorities between the rights of privacy, of freedom and of auto-determination? How do they relate to each other? Who decides which one is more important at a given moment? Where is this written?

    All this is just an attempt to ground my opinion that, firstly, we cannot discuss ethics using laws as an argument without getting our feet wet in complex collateral issues; and secondly, that clear and precise defintion of the concepts is required for this kind of discussion. The charta is too vague.

    I have learned that laws must change with the world. I learned, also, and that laws must be the result of ethical discussions, not the beginning. To me, keeping the UN declaration indefinitely is not only irrealistic, but also greatly damaging for the purpose of the UN itself.

    On to the actual topic: to connect with Thomas More and contribute to seeing things from a different side: the philosopher Seneca (1st century CE) had methodically argued that the “right to die” is the greatest gift nature has ever given to us. For him, being free to die whenever one wishes is a human gift, and it is wise to use it either when pain and suffering are permanent, or when one risks loosing rational thinking. These are similar criteria that most pro-euthanasia activists use today. The human rights declaration then removes this natural right from us.

    1. Anthony Drinkwater

      You make lots of good points, Theo, but I don't think that we should throw out the baby of the UN declaration simply because of Rita Joseph's very particular and eccentric bathwater . (In case you missed my reply to Mathew, I highly recommend Griffin's On Human Rights as a valuable philosophic contribution to the topic.)

      1. Thank you, Anthony. I did get the reference above, it's waiting patiently in my's basket.
        Yes, I also believe that the UN declaration is still very important, but it needs some amendments – if nothing else, just for clarification. I just wonder what will be of it if (if I understood Rita's points correctly) it cannot be changed any further.

        Oh, and for the record: Pratchett's documentary also doesn't work in Germany.

  9. Nice debut there Matthew!

    Unfortunately, Rita Joseph seems to have fatally confused rights and obligations in her objection to your post, and induced some confusion about what international human rights treaties enshrine as a result . Ludwig's clear and obvious point in response to her remains unanswered:

    "A person committing suicide is never violating his or her right to live. Such a person doesn’t even waive his or her right to live; he or her just waives his or her biological life."

    Moreover, the "non-derogability" of the right to life, which Rita Joseph mentions as if to support her remarkable interpretation of UN instruments, has nothing to do with the question at hand. What "non-derogable" means in an international law context is that that *states* can't file a "notice of derogation" during a state of emergency to reduce or remove the rights otherwise granted. It certainly doesn't mean that individuals are always obligated to maximize their use of the right granted them!

  10. You must know Simon, if you have read the travaux preparatoires of the International Covenant on Civil and Political Rights that 'non-derogability' covers a great deal more than merely refraining from filing a "notice of derogation" during a state of emergency to reduce or remove what you call "the rights otherwise granted".

    One of the most profound agreements arrived at by the international community drafting this Covenant is that the State does not 'grant' rights–it 'recognizes' and 'protects' rights that are agreed to be 'inherent' in our humanity. The concept of non-derogability in international law also covers and prohibits specifically the introduction of measures inconsistent with States parties' other obligations under international law. An absolutely essential part of those 'other' obligations is application of the principle of inalienability to the protection of the right to life from arbitrary deprivation.

    Again, Simon, when you say that individuals are not 'always obligated to maximize their use of the right granted them',you strip those rights of their fundamental inherent and inalienable character. The principles of inherency and inalienabilty cannot be disposed of summarily, not without damaging the established international human rights architecture.

    Irrespective of any wriggle room that may be cleverly manufactured, the States remain obligated to maximize, without discrimination, legal protection of the inherent and inalienable right to life of every human being.

    States Parties' human rights obligation to provide legal protection of everyone's right to life means that governments are prohibited from legalizing, promoting, condoning or paying for medical interventions where the intended outcome is arbitrary deprivation of the life of any human being, including the suicidal and the terminally ill. (The only exception of course is ICCPR Article 6(2)regarding the death penalty for only the most serious crimes.)

    Any State's law which legalizes medicalized killing of the suicidal and the terminally ill must be overturned sooner or later. It will be found to have been void at the very time of its enactment because it is incompatible with the universal human rights commitments of the ICCPR to protect by law the inherent right to life of every human being, including the inherent right to life of the suicidal, the terminally ill and other vulnerable persons.

    States which have ratified the ICCPR must at all times take positive steps to effectively protect the right to life of every human being. The right to life of persons at risk of suicide, as protected by international human rights law, means, inter alia, that States parties have a strict legal duty at all times to prevent, investigate and redress threats to the right to life wherever such violations occur, both in private and in public. (Article 4(2) ICCPR)

    With regards to rights and obligations,they are inextricably 'interdependent'. Again, this was made clear in the drafting histories. "Everyone has duties to the community." (UDHR Article 29 (1)). Mahatma Gandi's contribution to the drafting of the Universal Declaration was the invaluable truth:"The Ganges of rights flows from the Himalayas of duties".

    The autonomy of the suicidal is limited by respect for the rights of others and for the security of all. Laws endorsing medicalized killing of suicidal persons result in an arbitrary disconnect of autonomous rights from the natural context of responsibilities to the community.

    States have a duty to maintain their part in a social and international order in which the rights and freedoms set forth in the human rights instruments can be fully realized for everyone. (UDHR Art.28)

    Finally,the point Matthew makes concerning a proposed distinction between violating a person's 'right to live' and the 'waiving of his or her biological life' is a dangerously unstable one.

    It echoes rather disturbingly the original Nazi concept of "a life unworthy to be lived" that was used to establish what Dr Tessa Chelouche describes as the "biomedical paradigm [which]provided the theoretical basis for allowing those sworn to the Hippocratic principle of nonmaleficence to kill in the name of the state".

    This conceptual shift culminated in a medicalized killing programme that still today generates moral revulsion in all decent human beings. The medical profession in Nazi Germany, like the Courts, were too easily seduced into accepting that the value of life is differential, and not equal, inherent and inalienable as was subsequently recognized in the Universal Declaration principles and codified in all subsequent Covenants.

  11. This discussion seems to have drifted from ethics into the interpretation of the UN Declaration of Human Rights. As that document has ethical force only if it adequately represents the requirements of justice, the other human virtues, and the common good of society, it seems it is to these ethical concerns one should return rather than dwelling on hermeneutical niceties.

    Ethically speaking there is clearly a grave injustice in killing an innocent human being who values his or her own life. It becomes difficult to spell out something more basic than this moral requirement, for the danger is that abstracted 'principles' whch are little more than rationalisations will be substituted for what is a more profound moral truth. Here I am influenced by Elizabeth Anscombe, but also to a much longer philosophical tradition going back to Aristotle.

    Euthanasia is a euphemism, though not as much of a euphemism as 'assisted dying'. Mercy killing is imperfect as a description (for if 'mercy' is considered as a virtue and not only as a sentiment, then it must be informed by other virtues, especially justice) but at least it clearly identifies the kind of act under consideration, which is a species of killing. Assisting suicide, while also imperfect as a description (for it implies that facilitating this action is 'assisting' i.e. a kind of helping, which is precisely the point of contention) also has the benefit of identifying an action as suicide, self-killing. Matthew Rallison claims that 'Pratchett never endorces suicide' but this is hard to maintain. Pratchett supports suicide as an option among options and campaigns vigorously for an ending to the legal prohibition on assisting or encouraging suicide. What goes on at dignitas is suicide. It is suicide that is not prevented but is facilitated. What goes on in the Netherland is medical killing (primarily on request and with various other more or less well observed conditions).

    The key ethical question (as opposed to the legal or public policy question) is whether the prohibition on killing the innocent should depend on whether the person is currently valuing his or her own life. Traditionally neither law or ethics have made wishing to die an excuse for someone else's act of killing. There are of course schools of thought that make the 'value' of a person's life contingent on claims, wishes or abilities he or she happens to possess. However, this is to build respect for the person on foundations of sand. It is an insight of modern righst talk, that ultimately derivces from Kant, that moral respect for the dignity human nature (in oneslef or in another) must be based on 'inalienable' characteristics not achievements or experiences where one has advantage over another. This is also the basis for the calim that human ebings are equal in dignity, a claim that is otherwise utterly opaque.

    There is an important argument to be had about whether legalising mercy killing and assisted suicide leads to the killing of those who have not explicitly asked to be killed. The Groningen Protocol is one striking example of this (for more evidence see W Hiscox 'Non-voluntary Euthanasia in the Netherlands and Belgium' in H Watt (ed) Incapacity and Care (Linacre Centre 2009)). Nevertheless, there is also a more fundamental ethical argument which concerns the ethics of killing. To address this requires more than the limited considerations typical in modern debates.

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