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Pain Confuses Our Ethics

Earlier this year a Massey University survey showed that Kiwis considered assisted suicide more acceptable if the patient is in severe pain.  Which makes no sense unless pain is the ultimate evil in our society, which would presumably make pleasure the ultimate good.  Here's why, unless we have an irrational aversion to pain, this is an example of poor ethical thinking:
  • If a person is in pain they will be less rational with regard to considering their death, therefore their opinion should be given less weight not more.
  • Most people who suffer extreme pain will do almost anything to make it stop, in such circumstances a decision to die is actually a decision to stop the pain, not a calculated and rational decision to end their life.
  • If a painful human life can be legally disposed of but one void of pain should be preserved we are essentially valuing human life based on how much pleasure those lives are capable of?  That would mean those who hedonistically pursue their own gratification at the expense of others are worth more as human beings than those who sacrificially choose to suffer in the service of others.
A second issue arising from the study is the idea that having an incurable disease means you should be helped to die.  Why does the fact that you are possibly going to die a little sooner than the rest of us mere mortals mean we should help you make it even quicker?  Surely your life has been shortened enough?  But I digress.

Unless we are willing to say that human life is devalued by the existence of pain, which I am not, then pain should not be a criteria for whether or not you help someone to kill themselves.  I think this could well be a case of confusing our own aversion to anything that interupts our pursuit of pleasure with compassion for the suffering.  Or am I wrong? 

Comments

  1. Are you talking about actually taking a life? Because I'm not so sure this is as clear-cut as you make it.

    For a start, an awful lot of pain can be managed that isn't. Why do we worry, for instance, that an 85-year-old with extreme chronic pain shouldn't get opiates, for instance? Our health system worries about this as if it were a 25 year old taking recreational drugs. A good deal of pain can be managed. That's what hospices do.

    What about a 95 year old patient with multiple severe health problems and a 2-year-old pacemaker battery? They would be dead were it not for the pacemaker. Do you turn it off or not? Many families and hospitals choose to do so.

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  2. Hi Pam. Thanks for your comment. This wasn't an argument against euthenasia or assisted suicide as such, but an argument against making such decisions based on the level of pain being experienced. The study suggested people were less willing to allow assisted suicide if the patient were not in pain. To me that was extremely muddy ethical reasoning.

    I do think the articial extension of life poses massive ethical problems, but i don't know where you'd start to resolve that one. How would you unravel it?

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  3. Yes, I think you're wrong.

    1. When people are approving of assisted suicide in the cases of painful, incurable diseases, they are projecting themselves into that situation, thinking, "I would not like to suffer pain for the rest of my life," and are therefore willing to offer the other person a way out of their pain. They consider the patient's request rational from their standpoint (which, remember, is a standpoint not personally affected by pain).

    2. Assuming that incurable pain does make assisted suicide valid, it does not automatically follow that the value of a life is measured by pleasure. Life may be valued by wholeness instead, or functionality, or life may be considered (as I suspect) intrinsically valuable.

    3. Supposing that life is considered intrinsically valuable, those who would provide assisted suicide in the case of incurable pain no doubt consider their position to uphold the value of the individual, because their choice is respected. Or, in the other cases presented in the survey - incurable disease and permanent dependance on others - a person's value is considered to be upheld through assisted suicide because by taking their life (if that's what they choose for themselves) frees them from the indignity foisted on them by disease or dependance.

    4. I think individualism has had a lot of influence on these issues. And Glenn Miller over at the Christian Think Tank has some interesting thoughts on euthanasia when discussing Israel's slaughtering of the Canaanites.

    I personally think, however, (not being an annihilationist - in contra-distinction to many other Carey Baptist College alumni) that an unbeliever could not make a bigger mistake than to try and avoid pain in this life by dying. Immediately they will experience suffering that would cause them to regret their decision and would rather choose their previous incurable pain over what they experience after death.

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  4. Hi Ali, thanks for your comment.
    Your point 1 i think affirms what i am saying, it is an unhealthy aversion to suffering and pain which influences those opinions. My point is that that survey shows (as far as a survey can show anything) that life is not consideed intrinsically valuable but only life without pain. Freedom of individual choice probably does contribute also but as that was not a variable in that survey is a moot point here, the variable was how much pain an individual was experiencing.

    I appreciate having to think through these things, i am aware of some unresolved inconsistency in my willingness to 'mercy kill' animals but not humans, although in very simple terms human life is sacred in a way the animal life simply isn't.

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  5. Hi Jonathan,

    How is choice not a variable in the value of life here? The survey asked about assisted suicide. In other words, they would help someone who had chosen to kill themselves. It did not ask about merely killing someone regardless the person's choice.

    I agree with your general point that an unhealthy aversion to suffering and pain influences those opinions, but I still don't think it follows that life is not intrinsically valuable if it does not have pain.

    For instance, my wife and another person are in mortal danger. I have only got time to save one. It takes the same amount of time and effort to save either. I choose my wife. Why? Because I don't think the other person is intrinsically valuable? No, but another factor has overridden that understanding.

    Another question for you, are you talking about intrinsic value of the person, or intrinsic value of a person's life? They are two different (though intimately related) things.

    And I think you have yet to answer my other points :).

    (Hey, I like this disagreement!)

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  6. I do think the articial extension of life poses massive ethical problems, but i don't know where you'd start to resolve that one. How would you unravel it?

    Well, there is an entire field of Medical Ethics to think about these things. I'm not sure what question you're asking. Regarding the pacemaker battery question, I heard a case study presented by someone on a medical ethics panel and it was precisely the case I presented. They turned off the pacemaker and she died.

    Regarding pain, I'm not an expert and I hope to learn more about these things, but I've been told that there really isn't any reason that someone has to live with pain that extreme. We do have the means to control it.

    I have a family member who was in precisely the situation you describe; although they were not asking to kill themselves, they did say they wished they were dead until the right combination of drugs was found to control the pain. The pain is caused by a chronic condition and is not going to go away.

    Have you ever seen anyone in excruciating pain? Writhing and screaming from it? I take your point but I'm not as clear in my mind as you are that I'd have the right to make someone live for years or decades in that kind of condition or to judge them as unethical or even to utter the phrase "You are unwilling to live a life of suffering."

    I've known people who have bravely endured very bad pain from arthritis but when someone gets to the point of literally not being able to stop squirming and crying out, the phrase "You just don't want to live a life of suffering" seems incredibly callous and blithe.

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  7. Ali: choice was not a variable in that survey as all the options examined were a patients request. The dignity of a patient, in terms of dependency, was mentioned and did not affect the outcome in the same way as pain did.

    In your hypothetical situation the consideration that overides you then is presumably (and understandably) selfishness. However, not a good ethical motivation.

    As for valuing people or a person's life, the point is that for the respondents of the survey they valued painless people and their lives more as they were less willing to allow them to commit assisted suicide.

    Pam: I wasn't actually arguing that we shouldn't put people in chronic pain out of their misery if they want, although I might do so on another date, but that pain was an exagerated factor in the ethical reasoning of the survey respondents, which to me showed a lack of ethical substance and a culture typical evaluation of people according to their ability to live the "good life." Hence celebrities and young wealthy people are more valuable to our society than the old and frail and the educationally subnormal.

    Your point that pain can be controlled is pertinent, and i think the survey question assumes untreatable pain. if there is no such thing then it is a rather pointless question, of course you should treat the pain. however, regardless, it still highlights the way that the respondents to the survey evaluate the requests of sick people who want to die. They are more willing to let them die if they are in pain and more willing to prevent them if they are not.

    This certainly wasn't supposed to be casting judgement on those and their families actually going through such decision making at the moment.

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  8. Pam: I wasn't actually arguing that we shouldn't put people in chronic pain out of their misery if they want, although I might do so on another date, but that pain was an exagerated factor in the ethical reasoning of the survey respondents, which to me showed a lack of ethical substance and a culture typical evaluation of people according to their ability to live the "good life."

    I really feel I need context here because this all seems a bit too hypothetical to me. I'm now getting the impression - this is a question - that you're thinking about a problem more like "Can a person with chronic pain whose life is not easy still live a life that has meaning and value?" rather than the question "Should we make value judgments about the quality and severity of other people's pain?"

    Hence celebrities and young wealthy people are more valuable to our society than the old and frail and the educationally subnormal.

    According to the way our society behaves, I would agree with you that we value youth over years, ease over suffering and pristine beauty over physical imperfections. That's why we need prayer and discipleship.

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  9. Hi Jonathan,

    I think it would take a while to unravel this, but let me see if I can be succinct (fat chance):

    You cannot simply extrapolate from this survey that the lives of patients in pain are of less value unless people are willing to kill patients in pain regardless whether those patients give their consent or not. Otherwise, you need to nuance your conclusion with the issue of the patient's choice.

    Secondly, valuing people and valuing people's lives are more different than you allow. Undervaluing a pain-filled person and so deciding they don't deserve life is quite different from valuing a person and so colluding in their decision to end their pain.

    Third, in the situation I posed re. my wife and someone else, I am not selfish, but I'm responding to my greater love for my wife. Modern Christians seem to forget in their cultural captivity to equality that there are degrees of love and the Bible itself commands that we put greater love over lesser (eg. Matt 22:37, Luke 14:26, 1 Tim 5:8).

    ;)

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  10. Thanks for the interaction Pam and Ali, I can see I need to go away and think about this some more. :-)

    But yes Pam it was very hypothetical because the survey was purely hypothetical. This was not an attempt to arrive at a rubric for pastoral care!

    And yes Ali obviously if a patient didn't want to die it would make a difference, but in the survey questions the matter of choice was constant, in all the hypotheical situation the patient wanted to die and yet the respondents were less willing to let them do so if the were not in pain which means that they put a value on that pain free person's life that made them counteract their choice, but did not give that same value to those patients who made the same choice but were in pain!

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