Would Legal Assisted Suicide be the Final Triumph of Market Capitalism?
Tomorrow in the House of Lords Lord Falconer’s bill on assisted dying will be debated. The bill would allow those who are terminally ill and likely to die within six months to request life-ending drugs from their doctor for the patients to use as and when they see fit.
As might have been expected, there has been huge discussion over the bill, but most of the arguments presented so far are not new, and the same will probably be true tomorrow. But there is one I haven’t seen before, put forward recently by Giles Fraser: that assisted suicide is the ‘final triumph of market capitalism’.
Fraser begins with the description by the artist Marion Coutts of the last eighteen months of her husband’s life, which involved NHS case conferences where no one would take any responsibility for what was going on. This, Fraser says, is the ‘inevitable corollary to “patient choice”’. I haven’t read Coutts’s book, but nothing Fraser says suggests that this particular failure to take responsibility was the result of offering any choices to Coutts’s husband. And often, when choices are offered to patients, it is quite acceptable for them to ask for medical advice. Allowing someone greater autonomy isn’t really a failure to take responsibility oneself; indeed, when patients should be given a choice, not to give them a choice is a violation of their rights.
Fraser goes on to suggest that the reality of patient choice, in most cases, is that patient care is replaced by ‘another bloody questionnaire’. Even if he’s right, it’s misleading to imply that the failure of care is the result of offering the patient a choice. That is much more likely to result from mismanagement, under-resourcing, or negligence. Removing the opportunity for choice would make things worse, not better.
Fraser then offers the well-known argument against assisted dying that it will result in many terminally ill people choosing to die so as to ease the burden on their relatives, and because of the very nature of that choice being unable to let their loved ones know the real reason for their having made that choice.
It is undeniable that there will be such cases, and they may even involve the relatives putting unwonted pressure on the ill person to end their own life. Some people do horrible things to one another. But the state does not, and should not, police personal relationships in the crude way Fraser is advocating. Any responsible doctor is not going to hand over life-ending drugs without properly discussing the implications of the choice with the patient, and ensuring as far as possible that this choice is being made in an informed and uncoerced way. It’s also important to remember that not wanting to burden one’s relatives is a perfectly respectable reason for choosing assisted dying, and not one that the state is entitled to prevent an adult from acting on.
Fraser ends with the claim that ‘choice’ is now considered the only important value in medicine: ‘the moral language of the supermarket has become the only moral currency that is accepted’. And this is why assisted dying is the final triumph of market capitalism. Even in matters of life and death, he says, we have become ‘consumers’, and history suggests that it will be the most vulnerable who end up as losers.
This last part of his argument moves rather quickly. First, it seems quite implausible that the only value underpinning modern health care is choice – or ‘autonomy’, as one might prefer to put it. The very nature of the choices patients are asked to make demonstrates that: they are being offered options each of which in some way is expected to benefit them. So beneficence matters as well as autonomy.
What about the connection with market capitalism? It can’t be that Fraser is claiming that the idea that each of us has the right to decide when and how we die has emerged only in recent centuries – he will know the works of the Stoics as well as anyone. Rather, his thought must be that the rise of market capitalism, which involves enabling people to make choices within a market, has made it possible for societies to consider extending the right to choose into inappropriate areas.
Now this is not the argument sometimes used against practices such as surrogacy – that they marketize practices which should not be marketized. For assisted dying does not involve any commercial transaction. So the analogy between a consumer and the terminally ill person requesting assistance with suicide is also somewhat dubious. Further, even if you disagree with market capitalism and think it has had bad effects overall, it does not follow that the legalization of assisted suicide is bad. That would follow only if you claimed that every effect of market capitalism is bad, and – so far as one can make sense of it – this suggestion isn’t credible. And if you think the legalization of assisted suicide is a good thing, then its being an effect of market capitalism is at least one thing to the credit of market capitalism (even if otherwise market capitalism is a bad thing).
The analogy that really seems to matter for Fraser is that between the effects on the most vulnerable of market capitalism and of assisted suicide, and I’ve already discussed that. Few of us accept that society should be organized to maximize the well-being of the very worst off group, but we do think that their position should be ameliorated as far as possible. So any institutionalization of assisted suicide should, as I’ve suggested, seek to minimize the coercion of the terminally ill. But it is not appropriate for the state to do that by continuing to violate the rights each of us has over central aspects of our own lives.