3 November 2010

On the social production of the "intolerable life"

The Committee room is quiet now. No more clerics or academics, campaigners agin or for Margo MacDonald's End of Life Assistance (Scotland) Bill will be heard from, at least at the first (and potentially last) stage of the Scottish Parliament's collective hesitation over her Bill. Today, the Committee meets in private to meditate on a draft report on the evidence  they've taken. Parliamentary rules define Stage 1 deliberation as:

Rule 9.5. 1(a) "consideration of the Bill’s general principles and a decision on whether to agree to them"

When they began listening to oral submissions and round-table discussions in September, I suggested that the Committee's task was unenviable, requiring "Herculean subtlety and open-mindedness" to try to fairly reconcile the diverse, incompatible epistemologies, moralities and systems of technical knowledge they were invited to consider. Even if they prove virtuoso cartographers, able to bracket their own particular attitudes to the landscape, better to track the rhetorical terrain of their witnesses, eventually the whole parliament will find itself slurped into mire of assessing just how these diverse, antagonistic claims to expertise and ethical insight ought to interact.

As those following my scribblings on the subject will be aware, I'm in general sympathy with the purpose of Margo's Bill and have been left deeply unconvinced by the insistence that if it passes into law, it will transform Scotland's metropoleis intro necropoleis and enthrone some sort of Aztecesque culture of death. In all honesty, even proponents of this view hardly seem convinced by it. It is reminiscent of debates one sometimes falls into with Christians, who suddenly, less than ardently, deploy the ontological argument for the existence of God to shore up their piety. They don't persuade, largely because they're not Christians because they happen to have convinced themselves one morning that the ontological argument was well founded. Regurgitating the contention is a form of backwards justification and by consequence, only tenuously relates to the foundational reasons for their faith in a higher power. So too with assisted dying. The whole culture of death line is an attempt, in my view, to escape from the cul-de-sac of personal piety and deflect the real difficulties assailing a Christian cosmology, attempting to squeeze into the theoretically egalitarian, Godless space of the public sphere. Its a bizarre transmogrification, but by transforming themselves into modernist sociologists, bustling with metrological metaphors, challenging questions about the imposition of religious values on a faithless public are slipped. Speakers are then able to claim they've identified eminently detectable law-like generalisations, which iron causality leads to social ruin, degeneration in the fundament and the corruption of the Scottish polity. And all that, without a breath of the Pentateuch.

While in general I don't find these arguments terribly convincing, I did want to raise one objection I find it far more difficult to dispense with, concerning what I'll call the social production of the intolerable life. The draft Bill includes eligibility requirements, proposing to limit who could lawfully request  and receive assistance to die. These are set out in section 4(2).  Specifically, "the requesting person" must have:

(a) "been diagnosed as terminally ill and finds life intolerable" or (b) be "permanently physically incapacitated to such an extent as not to be able to live independently and finds life intolerable".

The debate has tended to emphasise the subjectivity of assessments of intolerability. Some folk, day in day out, tolerate what other people imagine they can't endure, and lead lives full of interest and significance. Take the particularly challenging instance of Daniel James from 2008. Dying in a Swiss clinic at the age of only 23 years old, James was a rugby player who experienced severe spinal injuries in the collapse of a scrum. His mother explained:

“He couldn’t walk, had no hand function, but constant pain in all of his fingers. He was incontinent, suffered uncontrollable spasms in his legs and upper body and needed 24-hour care. While not everyone in Dan’s situation would find it as unbearable as Dan, what right does any human being have to tell any other that they have to live such a life, filled with terror, discomfort and indignity?”

While we're all embodied, its crucial to recognise that the experience and importance of physicality isn't the same for every person. However, the idea that assessments of intolerability are purely subjective, abstractly moral, ethical and only an expression of your particular ensemble of sensibilities and staminas seriously risks overlooking a brutal material truth. Resources matter. Poverty, abandonment, isolation and despair are acutely involved in the production of an intolerable life.  Pam Duncan of Inclusion Scotland emphasised just this point in her evidence to the End of Life Assistance Committee, arguing:

Pam Duncan: The issue of choice is really important. As we are absolutely against the bill, we have been asked by others, "What about choice?" The crucial point, however, is that we live in quite an unequal society in which not everyone has access to the same level of autonomy and choice as everyone else. Disabled people are disempowered and do not have the same autonomy as non-disabled people. They face huge discrimination and this disempowerment impacts on and limits their choices. I also argue that this is completely the wrong time for us to ask society to make such a choice, because with the current economic circumstances the very services that support independent living and make life tolerable are being cut. With those services being cut, we are at risk of again limiting people's choice—and when one's choice is limited it can sometimes be skewed.

Is it fair to accept that we all have equality of choice in a society with such deep-rooted inequalities? I say no and argue that disempowerment limits our choice. We also have to consider the value that society places on disabled people's lives. Only the other night I saw on television the cricketer—forgive me, but I cannot remember his name—

Sarah Wootton (Dignity in Dying): It was Chris Broad.

Pam Duncan: Thank you. The circumstances were slightly different, in that his partner took her own life, but, when asked about her choice in that respect, Mr Broad said that they had discussed what would happen and had agreed that she was not "the type of person who would be pushed and fed". Well, I am that type of person and I do not think that it is fair to place such limited value on my life or the lives of disabled people who need the support to live independently—support that, I should add, is under threat in the current economic climate. In that respect, we need to question the intention with regard to choice and autonomy.

This is no trite Mystic Meggery premised on woozy Durkheimian ideas about the social life of the community. It brings the debate crashing back to earth, to small places close to home and the  practical, material politics of disability in our society. It implicates all of us, through our politics and our parsimony, in the social production of intolerable lives.


  1. It's a bit off topic, but since you use the first half of your piece to question a view on this matter overtly based on Christianity, as a practising papist I feel entitled to reply! I know you have remarked before on what you call "the theoretically egalitarian, Godless space of the public sphere" but for many of us it isn't like that. The idea that there could be a space that is Godless is one we find really quite amusing. (The idea that we should conduct an activity so fraught with moral meaning as politics in this putative Godless space is not so amusing.) Suggesting there is this Godless space might be the non-believer's equivalent of a Christian deploying the ontological proof: an argument inadequately demonstrated to himself with which he cannot hope to sway others. However, Christian morality doesn't come out of nowhere, but out of 2,000 years of experience, including a great deal of experience of our own mistakes. If a society accepts, through its legal framework, that there might be some lives which aren't worth living, and that we may, in these circumstances, expunge others' existence - the "culture of death" - this really is a dangerous road to go down. Margo MacDonald's Bill might not lead to the slippery slope, but history is not devoid of warnings to the contrary, so we shouldn't take the risk.

  2. Not off topic at all, Am Firinn.

    I suspect you may not have read my earlier piece on this very issue of religion in the public sphere. I commend it do you. Aptly enough, it was inspired by the Holyrood session on assisted dying where religious figures (curiously excepting the Catholic representative) grappled with just this issue. In it, you may be surprised to find, despite my own godlessness, that I've a lot of sympathy for the position you're espousing. When I referred to taking the Christian cosmology and the difficulties of "squeezing into" the political sphere, I take that process and its tensions and ambivalences very seriously. More seriously, I'd suspect, than most of my fellow unbelievers.

  3. Thank you for your courteous response, LPW. Indeed I did read your previous piece at the time, and attempted to comment - but that was when the system was operating its own censorship on me! You certainly did recognise that we might be philosophically unable to examine issues other than in the light of what you call a "redemptive economy". You regard that, however, as a "cul-de-sac", presumably on the grounds that such a Weltanschauung prevents us discussing issues such as this empirically. But it won't do to suggest that putting considerations informed by that redemptive economy to Committee is an attempt to impose religious views on a faithless public, any more than it became Dr McKee, in what was far from his finest hour, of levelling that accusation at the assorted clerics before him. Presumably Dr McKee would angrily reject any suggestion that, by putting Nationalist views in Parliament, he is attempting to "impose" those views on the Unionist majority there. When we actually did attempt to impose our views on people, they knew about it, generally by the smell of black smoke and roasting flesh. But in the light of the 2,000 years of experience to which I alluded we have moved on: not out of any crisis of confidence, but because you can't actually burn some sense into folk!

  4. I don't think it is helpful to bring God into the debate. In fact it is completely pointless.

    On balance I am against Margo's bill. Religious beliefs have played no part in my arriving at that conclusion and I suspect the same is true of most people who have considered the arguments and decided what Margo is proposing.

  5. Am Firinn,

    To clarify a wee bit, I regard it as a "cul-de-sac" primarily because the faithful who gave evidence seem to have felt that way, scrabbling about for arguments which weren't premised on specifically religious values. The same goes for my observation about that panel's difficulty answering McKee's question.

    To my eye, it was a real pity that few of them seemed to have really given much thought to ways in which we might try to understand faith in the agora, or the dialogue between faith and reason, or however one wishes to style it. For myself, I think it is vital to understand the radical difference between a religious and non-religious worldview. This involves a serious effort to develop a reciprocal understandings of both positions. Without clarifying our understanding of these foundational issues early on, I don't see how dialogue is possible.

  6. Indy,

    There's no escaping from religion in this debate. Not least because many of the people who responded to the consultation did so with an explicitly Christian steer. While you may be right that most folk, like yourself, will weigh up the ethics and practice along unpious lines - I'd argue that it is certainly worth thinking about these issues along the central faultline of the parliamentary debate, as it has unfolded. Certainly, there is much, much more one can say about this Bill, beyond the religious dimension. Indeed, I've discussed many of those issues here before.

  7. "There's no escaping from religion in this debate."

    I don't see why not.

    This debate is not destined to be dominated by religion any more than a debate about homelessness, nuclear weapons or genetically modified foods. All those issues - and many more - are as subject to analysis in terms of faith and/or scripture as medically assisted suicide is. Equally it is perfectly possible to debate them with no reference to religion at all - as is the case with medically assisted suicide.

    I agree that the reason why it is seen as having particular importance to religious groups is because religious groups have mobilised to respond to the consultation.

    However the central faultline of the parliamentary debate is not one determined by religion. Only a very small minority of MSPs will approach this debate with their opinions framed by their religious beliefs. The vast majority of MSPs will be struggling with the practical issues of whether a. it is possible to reconcile medically assisted suicide with medical (not religious) ethics and b. whether there are sufficient safeguards in the bill to protect highly vulnerable people from possible abuse.

    I suspect most of them will decide a. no it's not and b. no there aren't. The bill will therefore fall - which will probably then spark off some debate about whether Scotland is still a country where conservative religious veiws can block progress when that is an irrelevant argument because that is not why MSPs will vote the way I believe they will vote.

  8. I will try again and hopefully this post will not disappear in the ether or be rubbed out.

    The presentations to the Committee have set the pace.

    The debate will inevitably be dominated by religion and perceptions based on the religious or irreligious persuasion of those taking part.

    Each will inevitably blame the other of trying to dominate the beliefs of the other. One a disrespect of their religion and faith and therein of its teachings, the other of seeking to control thought and advancement of humanity by the imposition of mediaeval doctrine.

    The Uppies versus the Doonies.

    Politicians are just that, Politicians. The seek to be re-elected and will do their utmost not to alienate what will be probably be seen to be the majority, the religious side. I say seen to be the majority but what I mean is the side that talks loudest and "menaces" their re-election chances more.

    The status quo is always an easy option for a Politician.

    The fact that the who motion got this far is due to Margo's condition and her realisation that she has nothing personally to lose as a Politician. She is also always up[ for a fight if she believes her position.

    Can a compromise be reached between the two poles? No, unless each accepts that the other's position should be respected and the view of one cannot and should not be imposed on the other.

    Thus can we think about two solutions, one for those who take a religious position, which would then have to be hammered out by that faction and the other for the group who does not believe in the religious based position. This second group may well include many those who profess a religion as the would what I term the religious grouping probably include those who profess no religion.

    As long as both sides exist there are bound to polarised views on this subject and even if religion withers on the vine, the irreligious side should not, for many reasons, seek to impose their position on the other.

    Is it beyond our ken to have a twin system where one group may go one way and the other the other?

    How we go about creating such a twin track approach and the ramifications of it would keep a Judge in Claret for a lifetime.

    This should make it a proposition that lawyers would be likely to embrace with open pocket books?

  9. Bugger,

    On your substantive point, arguably Margo's Bill does just that. Nobody is forcing the faithful to end their lives before they believe the Yahweh appears to claim them. By legalising the practice, whose who wish can avail themselves of it without fear of their relatives facing prosecution for furnishing assistance which might amount to a culpable homicide (or murder). Certainly nobody is proposing "death panel", compelling people to appear (and disappear into oblivion) before it.

  10. Indy,

    I'd argue that people will vote one way or t'other for a number of reasons, many of them likely to be perfectly incompatible with one another. There is a sort of "soup" of influences, if you like, some certainly more dominant than others, which bubble away and influence the way the Bill is talked, thought and decided on. Whether or not the MSPs consciously predicate their votes on the issues you mention - they at least have to make up their mind on what influence, if any, religious claims to ethical knowledge ought to have in their decision. If they decide to bracket those issues and focus instead on doctor-patient relations, that is not an insignificant choice.

    That said, at this stage in proceedings, they are simply considering the general principles of the Bill. Significant amendment across three stages being a parliamentary commonplace, the expanded details can be worked out. If MSPs vote to strike out, they'll be doing so at this level of conceptual generality.

  11. Thanks LPW

    I am aware that it is not compulsory but the level of open debate on this has been very polarised and the truth does not seem to be part of the language, form some sections of one side anyway.

    It has been presented as a way of bumping off granny who cannot make a rational decision anyway.

    I am minded that in an earlier piece you stated it was already possible for someone to assist someone else to take their own life? The laws of England don't apply in Scotland.

    Why then can it not be possible for someone just to leave a written note, presumable after taking a sanity test, that anybody who assisted them to take their own life is absolved of any criminality, be that person terminally ill or not. It is their life to keep or take and nobody else's.

    I am not a lawyer but often find that the law is unnecessarily complicated to the benefit of those who wrote it.

  12. Bugger illustrates the point I was making. People will interpret the decisions MSPs make through a religious prism when that is simply not the case. Opposition to Margo's bill does not mean that someone is taking "the religious side".

    The strongest opposition to medically assisted suicide actually comes from medical staff who work in palliative and geriatric care. Their opposition is not based on religion but on their experience of dealing with people who are terminally ill.

    This is the central point for me. I have no objection, moral or otherwise, to suicide. But if you want to kill yourself kill yourself. Do not ask a doctor to do it for you.

  13. Perhaps we are putting the cart before the horse here.

    Why should the debate not be the other way around?

    Most, I suspect, of us know fine well that assisted suicide, or speeding up of the terminal moment goes on all the time in hospitals. Many of us have had relatives in deep pain and all they wished, as we did too, was that the pain could go away and they be freed of it forever. I am certain that on one occasion a member of my immediate family was helped on their way in such a manner. I was told to go away and come back a few hours later and my relative had just died, peacefully they said.

    Having spoken to others of this I have found many more people who have had the same(ish) experience.

    I think the general public is way ahead of the legislators and lawyers on this one.

    If given a referendum on a particular premise, and the devil (sorry LPW) would be in the detail, I feel sure that the vote would be for assisted suicide under certain circumstances, including especially in hospital where before death people can be in terrible pain. Thus, doctors do have a place in assisting suicide unless you wish to create a class of medical technician who is licenced to do the deed.

    We pay more attention to welfare and well being of our pets than we do of our dying loved ones.

    Indy misunderstands my position or at least I did not make myself clear enough. Politicians will view this through a religious as they will probably conditioned by it, even from childhood and by definition humanists would also be conditioned by way of being just that. It is religion that has conditioned and defined many people's approach to atheism, mine included.

  14. I think you misunderstand my position. I, for example, do not have any moral or other ethical problem with the right of a person to take their own life - indeed, to have help from friends or family to take their own life if that is required.

    The issue is whether it is reasonable to ask doctors to take responsibility for killing their patients. Not easing their passing over in the last few hours or days of life but actually taking a decision which results in the premature and deliberate end of a patient's life. I don't think it is reasonable and that is why I am against Margo's bill.

  15. I very much agree with Indy’s comments on this.

    It’s rather unfair of LPW at one point to criticize religious contributors ‘scrabbling about for arguments which weren't premised on specifically religious values’ and at another for preparing submissions ‘with an explicitly Christian steer’. Mention has been made previously of MacIntyre’s claim that (broadly) modern ethical debate is undermined by the existence of competing and incompatible ethical traditions. But in his After Virtue etc those competing traditions are not straightforwardly between theism and non-theism but between a neo-Aristotelian ethics and other approaches. If MacIntyre’s analysis is anything like correct, any political debate is going to involve participants trying to convince others by translating their concerns into an idiom not entirely their own. That goes as much for non-theists as theists.

    It’s hard for me to see the conceptualization of the assisted suicide debate along the religious/non-religious divide as anything other than an attempt to regard religious contributions as based simply on faith rather than reason and thus immediately dismissible. Far better to take specific arguments as they come. Plausible versions of these will inevitably involve considerations of (eg) trust, harm, suffering and autonomy common to all ethical approaches. How these are to be balanced is essentially no clearer in the maelstrom of non-theistic ethics than it is in the wide variety of theistic ethics.

  16. Thanks for that comment Asterix. "Scrabbling" was probably an intemperate phrase which unhappily distorted what I was trying to argue. For clarity, it is probably helpful if I respond to the following comment first, and then return to your earlier objection.

    "It’s hard for me to see the conceptualization of the assisted suicide debate along the religious/non-religious divide as anything other than an attempt to regard religious contributions as based simply on faith rather than reason and thus immediately dismissible."

    I worry about this too - and as I hope was a bit clearer in my previous thoughts on assisted suicide and religion in the public sphere, this is absolutely resolutely not how I see the issue.

    You raise a familiar species of argument which others certainly do make, but I'm not looking to defend the distinction between legitimate reason and illegitimate belief here. However, I think the religious folk who addressed Holyrood were troubled by just this sort of argument - and as a result, found themselves making the sort of social predictions I discussed. I find this curious, understandable but not particularly convincing because it is not particularly honest. That said, my primary goal in the piece wasn't censure but more reflective on the fascinating interest and difficulty of ethical debate when argument is so fragmented, conceptualisations and basic axioms so diffusely founded.

    I should also add, I find the religious aspect of this discussion particularly interesting - and am not attempting to suggest that the great range of arguments on assisted dying which don't invoke Jehovah aren't equally significant, important, or straightforward. That I'm approaching it in this way is mostly reflective of my own bugbears, rather than an attempt to imagine the discussion wholly along religious/non-religious lines. Within the confines of a limited blog, where much is left unsaid, I can see how a different impression could be evoked.

  17. Thank you for your customary courtesy and reference to your earlier posting. I’ll take two quotes from that posting:

    ‘As Reverend Ian Galloway expressed it to the Committee, it is “a view of how life is.” The religious literally occupy a different world from those of us who don’t see the hand of the Lord at work in it.’

    ‘These seem to me to be wise thoughts which emphasise the double movement religious folk in the agora go through to put their views across. For those of us without faith, we would do well to reflect on the fact that our views suffer no comparable ordeal as they cross into the echo-chamber of the public forum - and have some sympathy for our religious fellow citizens.’

    The problem with this is that religious people don’t literally occupy a different world: we may have a different understanding of it, but we still encounter much of the same that others encounter. (Tables, suffering, blogs.) We may encounter some aspects under a different description (‘acts of God’; ‘redemptive suffering’) but that isn’t a problem mapped onto to the religion/non-religion divide (an Oxbridge educated atheist philosopher with background in Classical philosophy will probably see the world differently from an atheist who has a low IQ and low educational achievement), nor do those within religions share one understanding (a Thomist Catholic will not have the same understanding as a fideist member of the Salvation Army, let alone a Hindu).

    Certainly, religious believers do have an ordeal in putting forward their views in the public sphere. This, however, is not a problem particularly of religious belief, but of anyone, certainly of anyone with a well thought out position encountering a public sphere which is a mishmash of half-remembered Presbyterianism, New Age spirituality, Dawkinsism, selfishness, fear, altruism, a variety of attention spans (I could go on). Unlike MacIntyre, I don’t think this is a problem solely of the modern age, but is inevitably the problem of politics and morality in complex societies (ie anything bigger than Ancient Athens –and I’m not at all sure that similar issues didn’t arise then).

  18. Asterix,

    My apologies for my tardiness responding to your interesting and I think perceptive criticism. I've been hideously busy this week and want to respond properly. Will do so anon.