Is a real debate on physician-assisted dying possible?

Although almost unknown in Scotland, Professor Alasdair MacIntyre is an interesting chap. Born in Glasgow, his philosophical career has taken him across the old, weary face of Europe, before vaulting the Atlantic and settling down in Notre Dame University in the United States. His intellectual orientations are an interesting blend. In the lingo, he is something of a Marxist-Thomist. A doubter of liberal credo, MacIntyre has been an elemental force in reinvigorating the idea of virtue ethics, a shade of which was first promulgated by Aristotle, and was taken up by subsequent Catholic scholars. None of which is terrifically important for what is to follow, but it gives a bit of context for my remarks.

In the most popular of his books, After Virtue, MacIntyre suggests something quite provocative. Glance about the contemporary world, he says. Heed the debates which rage. Note the concepts employed. The whole process is charged with a sense of its meaningfulness and significance. Free speech facilitating verbal fencing where both participants carry gleaming rapiers, the conceptual kit donned by each warring party having its materiality, authenticity and even coherency. In resolving public disputes, in brief, arguers assume that their words and conceptual schema are significant. MacIntyre, cheekily, suggests that perhaps we moderns are mistaken about this confidence.

Rather, he suggests, we are in the aftermath of a cataclysmic fracturation of moral discourse. We play around with bits and pieces from past traditions – a flash of utilitarianism there, emphasising the morality of consequences, a selective deontology, a flutter of virtue, a crumb of Christianity. All of these bits and pieces are mushed together in discourse without coherence, without the organising hand of a shared tradition, which might make our arguments meaningful. For MacIntyre, we shout past one another. We cant agree enough to disagree meaningfully. Our discourses are vacuous and empty.

Don’t worry. I haven’t just set out to be dreary and abstruse. Rather, I think we can see an example of the problem teased out by MacIntyre in contemporary Scots life. Whether or not one would agree with MacIntyre’s general characterisation of moral discourse doesn’t signify here, or is a dispute for another day.

The contemporary problem I’m referring to is Margo MacDonald’s Bill to sanction physician-assisted dying in Scotland, and the arguments which will supposedly resolve that controversy. Of course, labelling the Bill in that way is also contestable. What interests me is, what sort of debate can we have about the subject? How are we to resolve aye or nay, or determine who is in the right or in the wrong? How are advocates of different conceptual starting points to meet meaningfully with those who do not share the same preconditions?

All of which probably sounds a bit obscure. Exploring some of the arguments actually made about physician-assisted suicide is probably the best way to make the problems involved in having any meaningful debate on the subject plain as day. Indeed, it probably affirms MacIntyre’s thesis – amid the broken bits of shattered moral traditions – we’re ragbag moral tramps.

Start with the Scotsman’s letter page. One communicant suggests that “as rational adults they feel strongly about their right to make informed decisions about their lives and deaths”. Here we have ideas of rights, autonomy, choice, and the elevation of the individual. Each of us has private dignity of conscience. I am allowed to choose how I live, why am I not allowed to choose how to die? At the foremost here are conceptions of rationality and choice. Death is subject to human willing and life can be alienated without reproach. Killing of an unwilling subject, however, not able rationally to chose, would remain excluded.

Consider the Maximum Eck’s remarks which I’ve quoted previously – he suggests we must be concerned with the “sanctity of life”. He doesn’t mention God, so who the author of this sanctity is isn’t wholly plain. Nevertheless, it is easy enough to recognise two different positions are possible here – godless or godful sanctity. And yet more conceptual divisions. Salmond’s sanctity of life clearly contains some categories of exclusion. One can kill in self defence. Abortion within a particular time frame. Clear exceptions. In short, a different sort of sanctity. But frame the debate in these terms, and his position is apparently incoherent. Murder is wrong. Murder is intentionally killing of an innocent person. A foetus is a person. A terminally ill person is a person. Dying at the hands of a physician whether by abortion or the administration of drugs is intentional killing of an innocent. Hence is murder, consent or no. Alex Salmond’s position is clearly different from this. What the exact dimensions of the conceptual sanctity he envisages is difficult to say.

A third argument, made by subrosa below my last post on the subject. She said that “Let's be honest here, physician assisted suicide has been going on for generations Indy, but to have it written in law would be wrong”. So, in addition to the other potential arguments for or against assisted dying as such, we must also take into account the idea of legislation, and legislating as an area for disagreement. This introduces norms of public acceptability – norms which are nothing to do with the act of assisted suicide – but seem to address themselves to the idea of the consequences of legalisation. The quality of the act is thus, not in debate, but a position with an eye to the social engineering of the issue is being taken. Worries along the lines of “what will happen if …”, “thin-end of wedge…”, “slippery slope” &c &c &c.

And these are just a handful of the sort of points people will make. How are we to decide, or even talk about it meaningfully? How can godly sanctity of life argue with godless sanctity? How can arguments suggesting rights to autonomy deal with those who recognise no such rights? Can we argue them into existence, one convincing the other? I doubt it. Are proponents of either position actually talking to one another at all? It’s a painful tangle of incommensurable assertions.

Which returns us to a point I made the other day about the matter of Scott Rennie. Social choices in contexts where this incommensurability prevails are always the consequences of an overlapping consensus, where there is no single conceptual basis among consensus-builders for the reasons why one ought to pursue one policy or another. There is agreement on material ends, but not conceptual means. In this sense, those hostile to Margo’s Bill will include those who propose a religious sanctity of life, as well as those like Salmond who favour a muddier sort of selective sanctity, allied with arguments deriving from consequences – predicated on very different presuppositions about the moral quality of the act itself.

Those who favour individual autonomy, by contrast, have nothing to say to their opponents, and vice versa. All they can do is assert, and trust that they can accumulate more asserters on their side than on the other. Conceptualisation, as this level, is itself a profoundly political act. I suggested last week that there is a risk of binarising responses to Margo’s Bill. In terms of the debate itself, matters are far worse. While the overlapping consensus will favour one side of the pairing – for or agin – the reasons our representatives will give for doing so will be infinitely divided, largely meaningless. Conscientiously torn, certainly, morally grim-faced, undoubtedly – but without the sort of conceptual agreement necessary seriously to have that debate, and to seriously disagree.