Against a Duty to Die for the Elderly and the Sick

Freedom absolutely implies the freedom to die: if you don't own your own life, then what do you own? If you wish to assign yourself a duty to die, because you feel a burden, or for whatever reasons you have, then go right on ahead. The people you're doing it for won't be anywhere near as moved as you'd like to think, but euthanasia of all sorts should have far more respect as a personal choice than is presently the case. One of the most offensive interventions enforced by most modern states is to make it next to impossible for a person to safely and painlessly end his life in the manner and time of his own choosing.

But that is choice. A duty to die in the other sense of duty, that of an obligation imposed upon you by an often nebulous collection of other people, folk who are not in fact signed up to die right now themselves, is a whole other outrage. It is a particularly banal form of evil that oozes through the broadening debate on medical costs and rationing. This debate will only grow while dysfunctional centralized medical systems persist: you can either have a near-as-possible free market in which people are responsible for their costs and providers have to compete ruthlessly for customers, or you can have terrible service, shortages, and waste. Pick one. No-one has to worry about the availability or fit of shoes in the US, but the current medical system bears more semblance to the provision of shoes in the old USSR than it does to the modern US shoe marketplace - and the consequences of that command and control structure are plain to see.

The growth in biotechnology and the concurrent need for radical new advances in medicine for a growing number of comparatively wealth elderly should be an unparalleled opportunity for researchers, businesses, and consumers alike, the incentive for a great leap forward in the same manner as the recent decades-long burn of accelerating computing power. Instead, via the dark alchemy of heavy government regulation, this opportunity has been transformed into waste and the standard issue tragedy of the commons that attends any trough of public funds, its battles argued in the language of entitlement.

So as the pigs root around the trough, their incentives are not to develop better means and technologies, not to expand the set of paying customers by better serving those customers, but rather to find ways to cut costs, to deliver less, to push some of the other pigs away from the feed. Perverse incentives lead to perverse outcomes, and hence we are back to the duty to die, and that rhetoric is usually explicitly linked with costs of entitlement, as in the "fair innings" argument that has been taking place in the UK for some years.

Against a Duty To Die

In a 2008 interview, Baroness Mary Warnock, a leading moral philosopher, said that people suffering from dementia had a duty to commit suicide: "If you're demented, you're wasting people's lives - your family's lives - and you're wasting the resources of the National Health Services". Warnock also claimed that there was "nothing wrong" with helping people to die for the sake of their loved ones or society. Well known for her support of euthanasia, Warnock expressed in the interview the hope that people will soon be "licensed to put others down" if they are unable to look after themselves.

While such claims are controversial, they are persistent and seem to crop up from time to time in public debates and scholarly literature. In the United States, former Colorado Governor Richard Lamm expressed a similar view almost 30 years ago. Referring to the elderly as "leaves falling off a tree and forming humus for the other plants to grow up," he told a meeting of the Colorado Health Lawyers Association, "you've got a duty to die and get out of the way" and "let the other society, our kids, build a reasonable life".

Social scientists have noted that the elderly often worry about being a burden on others, especially family members. In the period leading up to their deaths, elderly people who subsequently committed suicide reported that their lives had been lived and that they were now a burden on others. Little is known about the experiences of elderly people who live and die alone, but in one qualitative study of this population, participants characterized a good death as being able to die without becoming a burden to others. There is a small but growing body of evidence suggesting that worry about creating a burden on others is common among people of all ages who are near the end of life.

As is the case for most ethics viewpoints this quoted piece above takes the state of medical science as it is, and only asks how bad behavior might change for the better within this environment (while largely ignoring the regulatory causes of the economic incentives that lead to this behavior). This is woeful but widespread. In an age of change such as ours we should always ask first and foremost how technology might be developed to alleviate suffering, because the answer is usually that meaningful results can be obtained comparatively rapidly, in a handful of years given broad support.

The behavioral change that I'd like to see is for more people to wake up and support greater funding and development in the life sciences, as this is the key to eliminating the greatest causes of pain, suffering, and death. Along the way that would also steamroller the apparently thorny ethics issues that accompany that pain, suffering, and death, but that is hardly the point of the exercise. If you don't like the color of the wall, don't analyze it or work around it, but instead go out and buy some paint. The world is what we make of it.

But that point aside, it is hard to use technology to solve the consequences of regulation that slows progress and even diminishes the incentives to create progress in science - unless it is technology that helps you travel far enough away that regulatory bodies can't keep up. I think that medical tourism will the way in which most of the newest possibilities in medicine arrive over the next few decade. Not every region has yet become as hostile to progress in medicine as the UK or the US, and many of these regions also lack the steady stream of semi-officially propagated nonsense that there is a duty to die if you are old and in ill health.

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