Written evidence submitted by Professor Anthony Clifford Grayling (ADY0202)

Assisted Suicide and the Right to Die: The Ethical Case.

Professor A.C. Grayling CBE MA DPhil (Oxon) FRSL

Professor of Philosophy and Principal of the New College of the Humanities at Northeastern University, London.

(Note: the expression ‘assisted suicide’ will be used also for ‘assisted dying’ and ‘assistance to someone seeking voluntary euthanasia’: but see Appendix on terminology and important conceptual distinctions.)

At the heart of the case for assisted suicide is the argument that says (a) individuals have a right to choose the time and manner of their deaths, subject to the latter not causing unreasonable harm or inconvenience to others, and (b) that if they cannot themselves administer the means of ending their lives, they have a right to assistance to do so.

Arguably, the decriminalization of suicide in the Suicide Act of 1961 implicitly recognized a right of individuals to terminate their own lives. Such implicit recognition is inconsistent with refusal of assistance to individuals who cannot themselves administer the means to ending their own lives. This refusal is discriminatory.

The argument for the legitimacy of assistance to die in voluntary euthanasia does not rest on the point in the preceding paragraph, however. It more powerfully rests on the entailments (that is, not merely the implications) of three rights enshrined in the European Convention of Human Rights and the effect given to it in the UK by the Human Rights Act 1998, as follows.

The three pertinent articles of the ECHR are 2, 3 and 8. respectively the right to life, to protection from inhumane and degrading treatment, and to privacy.

Article 2

A ‘right to life’ cannot mean a right to merely bare existence. It must at least mean a right to a certain minimum experienced quality of life. For example: if someone were confined in a small cage and provided with nothing more than bread and water in perpetuity, this would scarcely be to accord him a life in any acceptable sense.

The conception of a ‘right to life of a certain minimum experienced quality’ entails that when a life of suffering or disability has come to be experienced as below that level of quality – a level that an individual feels and society can rationally recognize as minimally acceptable – then in the light of the individual’s right to terminate his life, he should be accorded assistance if he cannot himself implement the means of doing so.

Dying is an act of living. In the process of dying, an individual’s rights are as fully engaged as at any other time in normal life. The right to a minimum quality of life, that is, to a minimum quality of experience in any living act, ipso facto applies to the experience of dying. Shortening the dying process, and making it easy and peaceful, expresses consideration for what is meant by a ‘right to life’ in the fullest sense of ‘a right to a minimum experienced quality of life’.

Article 3

To deny assistance to someone with a mature, considered and settled wish to die but unable to implement the means himself, is to subject that individual to inhumane treatment. To require that such an individual should exist in conditions of e.g. pain, incontinence, dependence and/or indignity when he does not wish to do so, is to subject him to degrading treatment.

One understands that article 3 is intended to apply principally to prisoners or those at the bar of law, but if these are to be protected, the more so are the rest, and chiefly anyone suffering so intolerably as to have a settled and considered wish to die.

Article 8

Whereas the right to privacy is intended to protect individuals against undue surveillance and interference by public or private agencies, it likewise carries a more general entailment: to a sphere or margin of essential self-determination and autonomy. Such matters as choosing one’s domestic partner, having a family, enjoying privacy in one’s affections and sexual life, are integral to selfhood. Among these key self-determining liberties, and arguably the most fundamental of them, is that of choosing whether one continues to live or not. If an individual (a) has the ultimate right to decide this, (b) chooses to end his life and has the implicit right to do so, but (c) is unable to enact the means of doing so, it is a denial of his right to self-determination, as entailed by the privacy right, to deny him that assistance.

The foregoing should be understood as applying to cases where an individual has what is rationally recognizable as a considered case for ending his life which fully engages our sympathy and understanding. Terminal illness, intolerable suffering, a profound contrast between a life enjoyed before catastrophic injury or disease and afterwards, identify cases where it is not merely transient depression or emotional upset following less severe life events such as divorce or business failure. We understand that a clear-minded and settled intention to end life must be present, and must survive careful examination by those from whom help is solicited.

Appendix

A note is required on definitions of terms, in light of the systematically misleading definitions of euthanasia standardly offered.

As its strict etymology from the Greek shows, euthanasia literally means ‘a good death,’ though more strictly it should be construed as ‘a good dying,’ given that death is a state that follows life and is not part of the experience of living. By sharp contrast, dying is an act of living, and everyone hopes for a lived experience of dying that will be ‘good’ in sensu painless, easy and peaceful.

It is of significance to grasp what is therefore contrasted to a ‘good dying’; examles are a process of dying marked by unrelievable chronic pain, severe pain or agony, anxiety or terror, choking or struggle for breath, incontinence and other loss of control, and like known attendants on the body’s reluctance to cease functioning. In cases of e.g. hospice treatment these ‘dysthanasic’ (coined from dysthanasia, ‘bad dying’) symptoms can be masked by drugs, which for some people is a deprivation of the chance to take rational farewell of loved ones and of life itself, which they would prefer to do, with a chosen exit from life which is prepared, peaceful and graceful, before the difficulties of the dying process and the need for the ‘psychological euthanasia’ of the drugged condition supervene.

The first of the pair of terms ‘assisted dying’ and ‘assisted suicide’, viz. ‘assisted dying’, should be restricted to cases of what is standardly now called ‘involuntary euthanasia’ as in cases where life support for an irremediably comatose patient is ended. All cases of chosen death requiring assistance from a third party are literally suicide, as much as cases where the suicide is by the agent’s own hand; use of the term marks the elective nature of the act. As at least implicitly a right of individuals, ‘suicide’ should always denote chosen termination of life, and so ‘assisted suicide’ is the appropriate term.

Professor A. C Grayling

January 2023

Disclosure: Professor Grayling is a Patron of Dignity in Dying, and a member of Dignitas, Switzerland.

Jan 2023