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Lions Roar : July 2009
SHAMBHALA SUN jULy 2009 87 Adding death as a “treatment option” would surely intro- duce an ambiguity into the practice of medicine. patients who do not want assisted suicide might no longer have the same confidence that their doctor’s only interest was in keeping them alive. this might undermine public confidence in the medical profession, particularly among more vulnerable members of society. west’s parents were educated people, affluent profes- sionals who knew the medical system inside out. he was a law- yer. Not all families are as lucky, and not all sons are as devoted as west appears in this account. The Last Goodnights gives the impression that assisted sui- cide is purely a private matter, a personal choice, and nobody else’s business. however, dying raises complex psychologi- cal and spiritual issues, and is not perhaps as easy to micro- manage as some people assume. Contending that it is a private matter ignores the fact that individuals live in society, not in a vacuum. the legal, medical, and social ramifica- tions of permitting assisted suicide affect everyone, not just the tiny minority of patients who want it. significantly, expert committees that have con- sidered the arguments for changing the law have, overwhelmingly, recommended that assisting sui- cide should remain an offence, not least in order to protect the vulnerable. Caring for elderly relatives can be burdensome, both emo- tionally and financially, and death can offer a seductive way out. the economic attractions of assisted suicide would not be lost on healthcare funders or financially pressed relatives. this does not necessarily mean that patients would be killed against their wishes, but it could mean that the system had less incentive to spend resources on keeping them alive. there are also concerns about a “slippery slope” leading from assisted suicide to voluntary euthanasia, and from volun- tary euthanasia to nonvoluntary euthanasia. After all, if death is a benefit, why should it be withheld from those who cannot request it? Despite reassurances by right-to-die campaigners about legislative safeguards against such “creep,” the evidence from the Netherlands suggests that once the genie is out of the bottle, it’s very difficult to control. the Dutch started by per- mitting only voluntary euthanasia and physician-assisted sui- cide, but Dutch law now allows euthanasia for some patients who cannot request it. Although there is no mention of Buddhism in this book, and neither of west’s parents was religious, we may nevertheless take it as a point of departure for a discussion of Buddhist perspec- tives. the three values that west identifies as supporting the case for assisted suicide (autonomy, mercy, and dignity) have already been mentioned, and autonomy is the one most often cited. Autonomy is a concept derived from political theory, where it justifies the right of a state to enact its own laws free of outside interference. in an ethical context, it gains support from western philo- sophical views about the importance of the individual and comes to stand for the right to self-determination and free choice. it is reinforced by post- enlightenment notions about personal rights, and in modern times has been elevated by liberal theorists to the status of a quasi-supreme moral principle. one wonders, however, how well this quintessentially west- ern liberal notion fits with traditional Buddhist teachings. these do not lay such stress on individuals and their rights, and the doctrine of “no-self ” may be thought to undermine the con- cept of individuality entirely. the discourse of rights is absent from Buddhist literature, and what one finds instead is talk of duties and obligations to the community. Buddhism empha- sizes not so much that we have the right to choose, but that we are responsible for what we choose. Again, the law that is to be respected is not one enacted through personal choice, but the eternal law of dharma. indeed, far from stressing autonomy as a key value, Bud- dhism seems to tell us that we are not autonomous. A key Buddhist philosophical teaching is often said to be “dependent origination.” in most popular interpretations of this doctrine, things are seen as interconnected, rather than autonomous, in- dependent and self-determining. A Buddhist case for assisted suicide based mainly on autonomy, therefore, would seem to be on shaky ground. Does what west calls “mercy,” or what Buddhists call “com- passion,” provide a more secure basis? to accompany others in their suffering would seem to be a primary moral duty for all who follow the path of the bodhisattva. suicide, however, can represent a flight from suffering rather than an acceptance of it. perhaps the more compassionate response to suffering is to pro- vide medical care, comfort, and support, as opposed to termi- nating the life of the sufferer. we know, at least, that this is what monastic law says, and the case histories recorded in the vinaya, or monastic rules, reveal that monks who assisted the suicide of patients, even with the most compassionate of motives, were ex- pelled from the order. yet, there are also reports in the pali canon of monks who took their own lives, and some were even said to have attained arhatship. The legal, medical, and social ramifications of permitting assisted suicide affect everyone, not just the tiny minority of patients who want it. of the individual and comes to stand for the right to self-determination and free choice. it is reinforced by post- enlightenment notions about personal rights, and in modern times has been elevated by liberal theorists to the status of