NOTE TO USERS This reproduction is the best copy available. REVlSlTlNG EUTHANASIA AND ASSISTED SUICIDE: THE ISSUE OF SUFFERING Benoit Morin A thesis submitted in conforrnity with the requirements for the degree of Ph.D. Graduate Department of Philosophy University of Toronto O Copyright by Benoit Morin (2001) Narianal Library Bibliaaiéque nationale 1 ,-da du Canada Acquisitions and Acquisitions et Bibliographie Sefuiœs seMoes bibliographiques The author has granted a non- L'auteur a accorde une licence non exclusive licence allowing the exclusive permettant à la National Library of Canada to Bibliothèque nationale du Canada de reproduce, Ioan, disbniute or sel1 reproduire, prêter, distribuer ou copies of this thesis in microfonn, vendre des copies de cette thése sous paper or electronic formats. la forme de microfiche/&, de reproduction sur papier ou sur format électronique. The author cetains ownership of the L'auteur conserve la propriété du copyright in this thesis. Neither the droit d'auteur qui protège cette thèse. thesis nor substantial extracts fiom it Ni la thèse ni des extraits substantiels may be printed or ohenvise de celle-ci ne doivent être imprimés reproduced without the author's ou autrement reproduits sans son permission. autorisation. REVISITING EUMANASIA AND ASSISTED- SUICIDE: THE ISSUE OF SUFFERING BENOIT MORIN Ph.D. - 2001 Department of Philosophy / Joint Centre for Bioethics University of Toronto The purpose of this doctoral thesis is to revisit the debate on euthanasia and assisted suicide through an analysis of the issue of suffering, which is one important element underpinning most requests for voluntary termination of a human life. The thesis aims at making a contribution by analyzing a specific type of suffering, which is described as *overwhelming unpleasant experience", and by reflecting on its ethicai implications. Its contention is to develop a rationale supporting the view that there could be living States worse than death; to suggest criteria that could contribute to our understanding of how suicide may be rational and ethical; and to revisit why the legalization of voluntary termination of human life may be a reasonable option within the Canadian context, especially under the provisions made by the Canadian Charter of Rights and Freedorns, Chapter 1 gives a historical ovewiew of the debate on euthanasia and assisted suicide; reviews its status in other countries (especially the Netherlands and the US.); situates it within the Canadian legal context; and analyzes important events that occurred in the last decade. Chapter 2 develops an analysis of the suffering experience, which narrows the definition of suffering to an "overwhelming unpleasant experiencen. As a result, suffering's assertiveness on the sufferer's life becomes idiosyncratic and the implications of such an influence are analyzed. iii Chapter 3 discusses how the nanowed concept of suifering may be valued. It establishes that suffering may have three different values: intrinsically negative and instrumentally positive and negative. It is argued îhat suifering's instrumental value may be determineci according to how the state affects the sufferer's "personhoocl". Chapter 4 analyzes the ethical implications of chapters 2 and 3. The ethical analysis is articulated within a consequentialist framework and the theoretical issues stemming from such an approach are discussed. Chapter 5 argues that, within the specific context of the debate on euthanasia and assisted suicide, the possible opposition between the right to self-determination and the right to Iife embedded in the Canadian Charter of Rights and Freedoms could be mediated by a right to die, which is an idea that rnay be supported by the arguments that stem from this thesis. In the course of writing a doctoral thesis, many people play different roles at different levels and with vatying intensity. It would be fastidious to attempt to name everyone who helped me and I apologize to those who are not specifically named, but I trust that al1 people who have been supportive of my writing this thesis know how grateful I am for their support. Thank you all. I would like to extend specific thanks to my thesis supervisor, Wayne Sumner, and to my thesis advisor, Bernard Dickens, for helping me steer my work in the right direction; to the Director of the Joint Centre ior Bioethics, Peter Singer and to Kerry Bowman for heiping me aquire and finetune important professionai skills; and to Joyceline Wright for her efftciency, patience and kindness in helping me understand and survive the institutional demands. I would like to extend special thanks to the (former) Director of the Collaborative Program in Bioethics, Bill Harvey, whose personal and professional guidance was invaluable; to Barry Brown for believing in me; and to Margot Smith for her friendship and care. Iwouid also like to express my deepest gratitude to my family and friends for their constant support and encouragement. l would like to thank the Fonds pour les Chercheurs(ses) et pour l'Aide à la Recherche (F.C.A.R.), the Ontario Govemment, and the University of Toronto, its Department of Philosophy and its Joint Centre for Bioethics for their financial support. Abstract / AcknowIedgrnents / Table of Contents Revisiting Eutltanasia and Assisted Suicide: me issue of Suffering INTRODUCTION CHAPTER 1 EUTHANASIA AND ASSISTED SUICIDE: THE CANAO J LEGAL CONTEXT P.6 1.1 Preliminary Remarks 1.2 Canadian Law 1.3 The Sue Rodriguez Case 1.4 Final Remarks CHAPTER 2 FROM PAIN TO SUFFERING: A PRUDENTIAL PATH 2.1 Theoretical Background 2.2 From Pain to Unpleasant Experience: The Perceptive Level 2.3 Managing Unpleasant Experiences: The Responsive Level 2.3.1 Reflex: An Unmediated Response 2.3.2 Cognition: A Mediated Response 2.3.3 Individual Limits of Management Capacity 2.4 Suffering: The Assertive Level 2.4.1 Suffering as Overwhelming Unpleasant Experience 2.4.2 Suffering's Assertiveness CHAPTER 3 VALUING SUFFERING 3.1 Suffering's Normative Essence 3.2 Suffering's Value 3.2.1 Suffering's Intrinsic Value 3.2.2 Suffering's Instrumental Value 3.3 Nagei's Objective Tolerance 3.4 Valuing Suffering CHAPTER 4 A CONSEQUENTIALIST APPROACH TO SUFFERING 4.1 Theoretical Background 4.2 Virtue Ethics 4.3 Consequentialism 4.3. t Two Versions 4.3.2 Consequentialist Issues 4.3.3 Discarding RuleConsequentialism 4.3.4 Railton's Sophisticated Consequentialism 4.4 A Consequentialist Approach to Suffen'ng CHAPTER 5 REVlSlTlNG EUTHANASIA AND ASSISTED SUICIDE 5.1 Voluntary Death 5.2 Rationality of Voluntary Death 5.3 Ethics of Voluntary Death 5.4 Life's Worth 5.5 The Canadian Charter of Rights and Freedoms 5.6 Conclusion Ahtract / Acknowledgments / Table of Contents Revisiüng Euthanasia and AssrSted Suicider The Issue of Siifferhg INTRODUCTION 2 The mntemporary issue as to whether or not euthanasia and assisted suicide represent a rational and ethical option that should be legalized and offered to those who express the wish to voluntarily terminate their life has been debated for more than three decades and is still divisive. Alongside other core debates such as the one on abortion or more recently on cloning, the euthanasia and assisted suicide debate canstitutes an important arena in which Our society's core values reveal themselves. At the heart of the euthanasia and assisted suicide debate is out attitude and beliefs, as individuals and as a society, regarding Our finitude and the meaning of death. The progress brought about by modem medicine resulted in an increased control over Our Iives and on its counterpart: death. We now have the possibilrty of prolonging and sustaining life to a point where both signs of death and life cohabitate in the same human being for a period of time that ranges from minimal to significant, Conversely, the increased certainty with which medical science can predict the timing and conditions of a terminally il1 patient's death raised fundamental questions. Amongst them, an important one arose from Our increased ability to control life: Should we control death as well? This question is a difficult one especially since Our occidental culture has traditionally been resistant to include death as part of life. This cleavage between life and death translated into what could be called a strong "culture of life", which excludes death as a fundamental element of it. The Hippocratic oath that constitutes the foundation of modem medicine clearly contains allusions to the rejection of death as part of life and even less as part of medical practice: "1 wiil keep them [patients] Inttuduction RevisAing Eufhanasia and Assisteâ Suicide: The Issue of Suffering fmm ham and injustice. 1 Illneither give a deadiy dnrg fo anybody if asked for it, nor will 1 make a suggestion to Ihis effect. This somewhat frames death as the enemy and makes a sharp distinction between death and life. The underiying intention was probably to make sure that it is clearly stated that a physician should not kill, but the consequences of the Oath might have gone beyond this legitimate intention. It may have contributed to develop a medical and social culture that frames death as the denial of Me and thereby excludes death from the options that are available to us to serve and respect life. In other words, death became the negation of life instead of one of its essential components. Consider the words of Dr, E. Latimer, a palliativeare specialist with 27 years of experience: Our original goal in medicine, which was to conquer disease and illness, may have got sidetracked to fight death, which isn't really (..,) a possible goal in many cases, We are a deathdenying society and in medicine we embrace technoiogy to fend off cieath. But we now have to be challenged with the idea of when is death inevitable and how to adapt to that.