In a submission to the Health Select Committee, Bishop Jim White has argued that terminally ill New Zealanders should have the right to choose medically-assisted suicide.

His submission, which follows in full below, challenges the moral definition of suicide when the options are not life or death, but whether to end life with greater or lesser suffering.

Petition of Hon Maryan Street and 8,974 others

Submission on Medically Assisted Dying

In the name of the Right Reverend James White, Bishop of the Anglican Church.

Summary

The submission maintains that the key principle at stake in the moral evaluation of medically assisted dying is the moral evaluation of suicide and that this the proper frame for debate. It also holds that it should be legally available to any individual who is terminally ill who makes a rational and sustained decision that they want to end their life.

Moral Principles

It is the submission that every life is of moral worth and deserves the utmost respect and care. Fundamental to this is that every individual shall be permitted to determine their own life course in so far that they do not harm others and this includes evaluating the value of their own life to themselves and others. It also holds that if we deny reasonable assistance to someone wanting to pursue their life aims, we unjustly discriminate against them.

Argument

One of the hardest tests for the basic moral principle occurs when an individual judges that their own life is not worth continuing and decides that she/ he wants to end their own life.

The submission is that this choice can be a rational choice and the right to exercise the choice needs to be preserved and reasonably assisted.

Because suicide involves killing (killing oneself) we tend to immediately adjudge this to be wrong – a violation of the absolute sanctity of life. However, this is misguided. Intentionally killing another human being (as in war, or to prevent a certain and grave greater evil such as a police officer killing a criminal threatening others) is a moral matter of the greatest significance, however, it is, under certain circumstances, rational and the moral thing to do.

Here the argument is that one must always hesitate to say that killing per se is morally neutral because it is always the ending of a life. But it is the case that the circumstances that justify the killing are the most significant feature in any moral evaluation and sometimes the circumstances justify killing another. It is also right that we assist those doing the killing by, say, in case of the military, arming, training, and giving legal protections to them.

When it comes to the consideration of suicide we, likewise, always lament the loss of life but the moral evaluation of each suicide is located in the circumstances that surround it. 

Of course, it should go without saying that some individual suicides are deeply misguided acts for reasons of mental illness, drugs, impulsiveness and so on. Everything should be done to prevent these suicides. Other individual suicides are just as surely adjudged as right and even honourable acts. Thus, the soldier, who throws herself in the way of certain danger and dies preventing harm to her comrades, is lauded.

 Or, in Christian terms and to use an actual historical instance, Maximilian Maria Kolbe (8 January 1894 – 14 August 1941), who volunteered to die in the place of a stranger in Auschwitz, is considered a saint and a martyr of charity. That is, a witness (martyr) to a greater good.

 Such deaths, when the individual freely chooses them, are lauded. Such a death, if another ordered it, receives a quite different (even the opposite) moral evaluation.

Thus, on occasion, a person, choosing for themselves and according to the weighing of their own values, who commits suicide can be not only be adjudged to have acted rationally but in a morally commendable way.

It is of note that some might consider the above cases are not suicide because the intention was simply to save others (doctrine of double effect). However, this is not correct. They are cases of self-determined and self-caused death albeit obviously chosen ‘for the good of others.’

(It also is of note here that within the Medically Assisted Dying debate, often cause for greatest concern is that people might choose to die for the good of others (as adjudged by themselves).  While we want to be certain that there has been no coercion in this decision it can be a legitimate reason for committing suicide.

Even if we set the above cases to one side as not being cases of suicide because the saving of lives of others was the intended consequence, not the death of the individual, we might consider other cases. For instance, many witnessed on live television those who leapt to their deaths from the burning Twin Towers in the September 11 attacks. There was only compassion and understanding for those suicides.

Or consider the aged, terminally ill person, who uses one of the many methods of painlessly bringing about their own death. We have compassion and understanding for such an individual. Of course, the obvious retort is that in these cases the person did not intend their death, only to avoid anticipated suffering of some kind. But this is a key point for advocates of the right to assisted suicide; very few people actually want to die, many want to avoid suffering.

At this point it is important to state that ‘suffering is both physical and psychological’ and the estimation and evaluation of what kind or extent of suffering and individual can bear belongs to that individual alone and is a matter over which we should exercise the greatest respect. We might counsel people and assure them of utmost care but in the end, it is for the person to judge for himself or herself.

In sum at this point it is important to see that while we once held suicide with opprobrium – they were buried outside the consecrated ground of church graveyards - today we have rightly ceased such negative judgment. Rather we greet such deaths with compassion and ‘understand’ the suicides of many - that is, we view such deaths as entirely rational. (Let me say again for the sake of clarity, we also view many suicides of the young or mentally ill as tragic and terrible and we rightly want to do everything we can to prevent such deaths.)

It is, then, the submission here that any person who has a terminal illness, who is of sound mind, having made a sustained request for assistance in obtaining a safe, sure, and certain method for ending his or her own life, should receive that assistance. Measures need to be in place such that we can determine, not just the soundness of mind and the fact that it is a sustained wish, but that it is the case that the person is not being coerced in any way.

There is a real risk that ‘Do-it-yourself’ methods and kits create a detrimental subculture in our society and it is altogether better for the well-being of all that assistance to die be legally available.

That assistance should go further than that offered in the State of Oregon. That is, it should go beyond the mere prescription and supply of appropriate lethal drugs leaving the individual to physically take the drug him/herself. Such a measure falls short of a just provision of reasonable aid for all – that is, it discriminates against those who are not physically able to carry out the wish themselves. It also risks that individuals will end their own life earlier than they might otherwise do for fear of being physically unable to implement their wishes.

Thus, medical assistance should be legally available to any individual who is terminally ill who makes a rational and sustained decision that they want to end their life.

 The Rt Rev Jim White is Assistant Bishop of Auckland.