Legalizing assisted suicide

For opponents of assisted suicide and euthanasia, the central creed of the Hippocratic oath – to “do no harm” – looms large. Because physicians are professionally and morally required to only do good for their patients, the argument goes, assisted suicide is categorically disallowed, as death is the greatest harm of all. There is a problem, however: the Hippocratic Oath never contained this phrase. Instead, it has a curious alternative: “I will keep them from harm and injustice,” or in Greek, “ἐπὶ δηλήσει δὲ καὶ ἀδικίῃ εἴρξειν.”

In all its definitions, the Greek word δηλέομαι means to harm through a destructive act, whether to physically hurt a person, to lay waste to a land, or to break a treaty with another. Beyond mere physical harm, however, the physician also has the potential to bring his patient into a state of injustice. He may publicize his patient’s illnesses, embarrassing them. He may fail to treat an illness adequately, even if he has the competence to do so. He may overestimate his level of skill, and undertake a procedure that is beyond his ken. The doctor, as Hippocrates conceived him, was far more than a healer of trauma or a salver of wounds. While he could heal the body, his greatest duty was as a guardian against injustice, and healing was but a part of this.

This points to a broader conception of what the doctor is, or could be. A rigid conception of “do no harm” ignores that perceptions of harm must shift over time in a patient’s life, for example. The adult in his prime would be seriously harmed by a lethal injection, naturally, but the senior in his twilight years, suffering from debilitating diseases and on death’s door as it stands, would perhaps reap a benefit from such an injection: the many days of pain ahead could be cut short, and the absence of pain would thereby outweigh the few days of living that were left to him. To accept this reasoning not only as rational, but as moral and true, is to also accept that life admits of a broader definition than existence or animation. It is also human flourishing, enjoyment, capacity for action, and when these things are taken away the real motive power of a fully realized human life is snatched away also. Allowing people to take their lives, with the assistance of a doctor, is not a position that is anti-life, but one that is against existence for the sake of existence. The doctor who helps his patients take their lives is not acting against life, but is helping these people live – and die – in the way they find most advantageous.

This is not a new position to take, either. For an ancient perspective, witness Seneca’s letter to a friend:

You may consider that the same thing happens to us: life has carried some men with the greatest rapidity to the harbour, the harbour they were bound to reach even if they tarried on the way, while others it has fretted and harassed. To such a life, as you are aware, one should not always cling. For mere living is not a good, but living well. Accordingly, the wise man will live as long as he ought, not as long as he can.[3] 5. He will mark in what place, with whom, and how he is to conduct his existence, and what he is about to do. He always reflects concerning the quality, and not the quantity, of his life. As soon as there are many events in his life that give him trouble and disturb his peace of mind, he sets himself free. And this privilege is his, not only when the crisis is upon him, but as soon as Fortune seems to be playing him false; then he looks about carefully and sees whether he ought, or ought not, to end his life on that account. He holds that it makes no difference to him whether his taking-off be natural or self-inflicted, whether it comes later or earlier. He does not regard it with fear, as if it were a great loss; for no man can lose very much when but a driblet remains. It is not a question of dying earlier or later, but of dying well or ill. And dying well means escape from the danger of living ill.

While some may find the comparison distasteful, this is the sort of mindset most pet owners take when preparing to euthanize the family dog. Fido has lived a good life, loved by his family, played with, adored, yelled at a few times but not excessively, but alas – a cancerous tumor has erupted on Fido’s right lung. Expensive and invasive surgery could give him another month, perhaps, but it would be a month of unremitting agony followed by a painful death. Why put a beloved creature through such needless agony, when a short and painless procedure can end it all immediately?

Many people have a disconnect between their lucid response to the pain of a family pet and their unhinged response to the pain of a human loved one. I would contend that this tension, while often cloaked in an appeal to rational arguments or religious tenets, is largely based on instinctual emotional distaste for death, and the fear of the unknown that it represents. That is not to say that there aren’t clear reasons to oppose it, but that empirically and rationally, there are stronger reasons in favor of it. I’ll go through some of the common arguments below:

  • Assisted suicide will destroy the trust patients have in their doctors. The physician Leon Kass wrote in the 1990s, “the patient’s trust in the doctors’s wholehearted devotion to the patient’s best interests will be hard to sustain once doctors are licensed to kill.” Fellow physician Mark Hall countered in the 2000s “Our study shows that only about 20% of people believe they would trust their physician less if euthanasia were legalized… The empirical support is weak for those who confidently assert that legalizing physician-assisted death would undermine trust in physicians for most people in the United States.”
  • Allowing doctors to legally kill their patients will provide a perverse incentive for insurance companies to encourage these practices. Like the other arguments, there is conflict on this point: one fact sheet states “It is well documented that the legal option to choose aid-in-dying is not related to finances. End of life choices are relevant only AFTER all curative or other treatments have been tried.”
  • Related to this, legalizing assisted and voluntary suicide will inevitably lead to involuntary suicide. According to the head of the Euthanasia and Guidance Organization, “In the Netherlands we have a living laboratory in which the euthanasia experiment in being conducted, and it is claimed that active non-voluntary and involuntary euthanasia are openly practiced there, exactly as predicted by the slippery slope argument. But the claim of the open and common practice of involuntary euthanasia has been often repeated but has never been substantiated, and indeed has been repeatedly challenged.”
Quote sources:

Beyond the empirical evidence that assisted suicide is not the bugbear it is purported to be, there is also the moral argument in its favor: the human being, by virtue of having a ruling reason, is entitled to dispose of himself in the same way he disposes of his property or his time. While there are clear and logical restrictions that must be placed on this freedom, such as against harming others, or harming oneself in a state of mental unbalance or insanity, this is certainly not the case for most assisted suicides. People at the end of their lives are not mentally unbalanced when they want to end their miserable time on earth, but acting completely rationally.

In full disclosure, I went through several drafts of this post attempting to justify my instinctual reaction against the very idea of suicide, before I realized I could not do so on rational and consistent grounds. It would be in tension with my other beliefs, in personal liberty and freedom of choice, and also – don’t tell anyone – my belief in the ultimate dignity of the human being, in life and in death. Assisted suicide is an intellectual and moral no brainer.

L’Anarchisme et la recherche de la liberté: recommendations des Déserts du Nouveau Monde.

Je suis vieux mais j’ai quand même un copain lycéen à Paris. Je l’ai rencontré un Quatorze Juillet justement, en Californie où je vis depuis déjà longtemps. Ugo a quinze ou seize ans. Il me dit par courriel qu’il lit Bakounine et Kropotkine. Cela me fait plaisir à deux titres. D’abord, cela signifie qu’il aéchappé à la malédiction du relent de totalitarisme collectiviste qui habite toujours de nombreux Français comme une croûte en Octobre colle encore aux lèvres des revenus de la colonie de vacances du mois d’Août.

La deuxième raison de ma réjouissance c’est que de telles lectures ne peuvent qu’allonger l’aune à laquelle Ugo mesurera la liberté. (J’allais dire la “liberté individuelle” mais, il n’y en a pas d’autre, c’est une mauvaise manie verbale.) Il me semble en effet que quand on vit dans le brouillard d’une societe étatique comme la France il doitêtre difficile seulement de reconnaitre le simple fait de liberté. Dans une telle société, on doit être menéinconsciemment à une mesure de la liberté étriquée pour la simple raison que les nombreux “droits” des autres ne peuvent que limiter naturellement, automatiquement les siens propres.

L’un de ces soi-disant droits est le droit de vivre correctement sans avoir jamais à s’efforcer, c’est-à-dire aux crochets d’Ugo et d’autres qui ne rechignent pas à travailler ou à inventer.

Mais, je souhaiterais qu’Ugo complète son éducation d’une manière spécifique. Il n’y a pas de vraie liberté là oúl’existence même dépend du bon vouloir d’un seul employeur, soit-il une grosse entreprise minière (comme dans Zola) ou l’Etat lui-même, ou encore, une entreprise formellement de statut privé mais menottée pas la réglementation.

En fin de compte, la liberté est garantiee par la possibilitéd’entrer librement dans des contrats entre égaux. Pour ce faire, il faut commencer par comprendre ce qu’est un marché. Or, mon observation des media français et mes conversations assez fréquentes avec des membres de la classe hexagonale instruite me font soupçonner qu’il est pratiquement impossible à un jeune Français d’aujourd’hui de se familiariser avec le concept de marché à travers uneéducation normale.

Je prescrirais donc bien à Ugo le grand document d’origine:La Richesse des nations, du philosophe moral Adam Smith mais je crains qu’un ouvrage publié en 1776 lui soit un peu rebuttant par son language. Je lui préconise, à la place, de lire n’importe quoi de l’économiste Autrichien et lauréat du Nobel (1976), Friedrich Hayek. .Cela pourrait etre La Route de la servitude ou presque n’importe quoi. (“La Route….” est le livre que tous les totalitarismes on hai et interdit.) Ceci,après, peut-être, une courte introduction par le Français Fréderic Bastiat (que les idéologues bêtes et méchants ont réussi à pratiquement éliminer des programmes scolaires français.)

Bien sur, j’attends qu’en retour, Ugo m’envoie ses propres conseils de lecture, qu’il contribue à m’ éviter d’être trop ringard, par exemple.

Is the European Union Collapsing?

Lately, the European Union (EU) stumbles from crisis to crisis. After a long hot spring dominated by the financial crisis in Greece, we now see the collapse of the system based on the Schengen Treaty, which secures the free movement of people within most countries of the EU. The upheaval is the result of the huge numbers of refugees entering the EU, mostly from Syria, Eritrea and Sudan. It is expected that Germany alone will offer asylum to approximately 1 million people this year. With no end of the refugee wave in sight more and more countries are either closing their borders, building fences, or reintroducing border patrols. The situation in Hungary seems worst, especially in the temporary refugee camps. This weekend we saw footage of guards throwing food into the hungry crowds, just like zoo keepers do when feeding the wild beasts. An absurd lack of civilization.

Both crises have at least two factors in common, namely issues of sovereignty and property rights. Sovereignty is claimed back by European politicians, who previously made arrangements at the European level, yet are now confronted by their electorates who want to end the infringements of their property rights. In the case of Greece it was about (mostly) Northern European leaders who were pressed by public opinion to stop paying for the support of what was seen as an almost bankrupt country. Certainly in Germany and The Netherlands it was seen that Greece made a mess of things which itself needed to sort out (this was the dominant perception, I underline that I do not say this is also the right presentation of all relevant facts). In the current refugee crisis public opinion also welcomes large numbers of people who –again as it is widely perceived- are seen a poor sods fleeing from a terrible war. Yet at the same time the people understand that the refugees, no matter how well educated some of them are, also need to receive all kinds of welfare arrangements and will go through an often hard process of integration into society. This against the background of more than a decade of heated debate about immigration and integration in most (Western) EU countries.

In both questions the politicians eventually tend to back out, by reclaiming national sovereignty. Not directly, as this would be embarrassing. So Greece got its third support package, and in the refugees crisis it is underlined that ‘temporary border patrols’ and even ‘border closings’ are still within the letter of the Schengen Treaty. There is also talk of centralizing the intake of refugees at the European level, instead of the current principle of ‘first country of entry is the country where asylum should be requested. This may well be a good idea given the fact that refugees will  arrive (as the US experience also makes clear). Yet it is hard to predict how the negotiations will end, because there are large objections against the European Commission spreading refugees among the EU member states at its own peril.

The bigger picture however could well reveal that both events mark the end of the movement towards ‘ever closing union’, the old purpose mentioned in the Treaty Of Rome (1957), the most important founding treaty of European integration. That is significant, because if I am right in my assessment it means we are experiencing a real turning point. There are a number of contributing factors, most of which have been identified before, but that does not make them less significant, such as a lack of European identity among the European people, and the desire to accept only a minimum amount of European policy, due to the much stronger desire to make national decisions, which are easier to correct by the electorates. This, by the way, is fully in line with classical liberal thinkers such as Hayek, Hume or Smith.

Does this mean the EU is about to collapse? Hardly likely. The economic basis is still strong and while large the current problems can be paid for and sorted out eventually. Yet if integration stops here it will also mean that the EU will never get a serious common foreign policy or a common defense policy either, both of which have been tried –and failed- over the past decades. So the EU will then only be a ‘super free trade zone’, with a common trade policy, and strong legal apparatus also spreading out over many non-economic issues.  This raises many more issues, but that goes beyond the purpose of this contribution. For one thing: these are once again exciting times in Europe!

The Poverty Of Democracy

I have been a strong proponent of democracy until the Spring of 2012 when I picked up Hans-Hermann Hoppe’s Democracy: The God That Failed. Since then, I have never looked at democracy with the same warm feelings again. Now, in this post, I would like to explore why democratic political representation is an impossibility and why it deals poorly with value pluralism – the fact that society holds various fundamental values that are in conflict with each other. In addition, I would like to urge that we should look for other political possibilities and stop maintaining that democracy is the end of all forms of social organization.

What most people find attractive about democracy is its underlying idea that the electorate is an embodiment of the general will of the public as if the public has reached some kind of general agreement on public policies and legislation. It is believed that with regular elections, the rulers are in power for a limited time and they “will be compelled by the threat of dismissal to do what public opinion wants them to do” (Popper, 1963, p. 345). Gerard Casey writes in Libertarian Anarchy (2012) that “[T]he central characteristic of representation by agency is that the agent is responsible to his principal and is bound to act in the principal’s interest” (Casey, 2012, p. 125). It is however questionable to what extent the electorate can truly represent the constituency and to what extent the public voice can be considered univocal. We must also beware of attributing “to the voice of the people a kind of final authority and unlimited wisdom” (Popper, 1963, p. 347). When society holds a vox populi vox dei attitude, it can easily slip into a tyranny of the majority. A society ruled by public opinion by no means guarantees social justice.

It is important to realize that the notion of representation is highly questionable. According to public choice theory, political agents cannot possibly truly represent their constituencies when members of a society have different comprehensive doctrines, hold different values, and have different interests. Public choice theory applies economic methods in the field of political theory and provides some interesting insights that are relevant for political philosophy. It maintains that politics is ruled by clashing opinions among policy makers and clashing opinions among members of the constituency. One may for example desire to build new roads with public funds, another may want to use public funds for the modernization of the military and defense, a third may desire to spend more on social welfare, a fourth on education etc.

Given that we live in a world of value pluralism, it is difficult for policy makers to pursue and represent the ‘public interest’. Furthermore, special minority interest groups may have incentives to organize themselves in order to influence public policies through lobbying. When the expected gain of lobbying of such minority interest groups is greater than the cost of lobbying efforts, they have greater incentive to influence legislators. Large interest groups, such as taxpayers in general, have fewer incentives to campaign for particular legislations, because the benefits of their actions, if they are successful, are spread much more widely among each individual taxpayer.

When the principal believes that the cost of being politically active – keeping oneself up-to-date with political actualities and being involved with political campaigns – is not worth the benefits, the principal may become ‘rationally ignorant’ of politics. This gives representatives more incentives not to pay attention to the public interests. Rationally ignorant principals do not know who their representatives are or what they do. This consequently discourages the politicians’ feeling of accountability for their actions and it encourages the politicians to sell themselves to donors and to pursue personal agendas. Different interests, incentives, and ideologies among principals and political agents therefore result in unequal representation.

I believe that Casey is right when he asserts that there is

“no interest common to the constituency as a whole, or, if there is, it is so rare as to be practically non-existent. That being the case, there is nothing that can be represented” (Casey, 2012, p. 125).

Imagine that there is a piece of legislation that our representatives can either pass or not with 35 per cent of the public in favour of the legislation and 65 per cent who oppose it. If our representatives pass the legislation, they will represent the 35 per cent and ignore the interests of the 65 per cent. If they do not pass the legislation, they will represent the 65 per cent and cease to represent the interests of the 35 per cent.

“In this very normal political scenario, it is not that it is difficult to represent a constituency – it is rather that it is impossible” (Casey, 2012, p. 125).

A representative democracy is therefore actually quite inadequate in dealing with a pluralistic society as it cannot fulfill its promise: representing the will of the peoples. Democracy is moreover a system that is inherently violent, because it divides people along the lines of their comprehensive doctrines. People with similar political thoughts organize themselves into groups to campaign against people who hold conflicting ideas. In a democracy, these people then vote for their preferred ruler to rule over people who may have contrasting views or who may be indifferent to political issues at all. It has never happened that the turnout at elections is 100 per cent. According to, the average turnout rate in Europe is around 43 per cent. Nonetheless, the 43 per cent are choosing political agents who are expected to represent the 57 per cent of the non-voting constituency. The violent nature of democracy is that with every vote the voter attempts to enforce their preferred rulers or legislation unto others. This basically makes it a system in which people lose their political autonomy to other voters.

I believe that in order to deal more adequately with value pluralism we have to look for political possibilities that lie beyond a representative democracy. Instead of considering democracy as the end of all forms of social organization, we should ask ourselves how we could discover better forms of social organization.

Popper, K. (1963). Conjectures and Refutations. London: Routledge.

Casey, G. (2012). Libertarian Anarchy: against the state. London: Continuum International Publishing Group.

Myths of Sovereignty and British Isolation XIX, Charters and Constitutions

The last post discussed the historical role of law. This post finally delivers the promise to discuss constitutions and charters. The sovereigntist Eurosceptic position in Britain standardly includes an elevation of Magna Carta into the greatest document ever in human liberty or, in more moderate versions of this position, certainly the greatest since it was issued in 1215 and the fount of all worthwhile liberties ever since: blessing Britain and countries which might be considered off shoots, like the USA, Canada, Australia and New Zealand (the ‘Anglosphere’), with a unique appreciation of liberty and parliamentary democracy.

While Magna Carta is of course a remarkable document and the moment it was issued was a remarkable historical moment, these claims are a distortion. It was a Latin document issued under duress during civil war conditions, the duress applied to the king by barons, at a time when the the English aristocracy and monarchy was distinguished from the great body of English by use of the French language and holdings in France.

Magna Carta has nothing to do with parliamentary democracy, it refers to a council of 25 which barons might form if they found the king to be misbehaving, and does not refer to a standing representative body but rather something more like a right of insurrection against a ‘tyrannical’ monarch. This has no more to do with parliamentary democracy than a variety of councils and assemblies existing across Europe at this time, and rather less than some.

Though Magna Carta is dressed up in the language of reasserting traditional rights, this does not make it the expression of a distinctly English or British love of rights based in tradition rather than innovation as the sovereigntists standardly claim. All demands for rights across Europe were expressed in that way at that time, and for centuries before and centuries after. The French Revolution itself started as a demand for ‘restoration’ of rights. The language of restoration is of course frequently a cover for innovation, an attempt to justify innovation by denying what it is.

Magna Carta was the innovatory product of political struggle, not the writing down of the unchanging liberties of old England. The same goes for the struggles for parliamentary power in the seventeenth century which frequently took on the deceptive form of ‘restoration’ of a Magna Carta which was already supposedly a restoration. It is even more fantastical to see the US Constitution as the outcome of Magna Carta, which does not stop many Anglosphere sovereigntist Eurosceptics doing so.

The history, or histories of liberty, is the accumulation of many interacting events, charters and theories in many countries. The growth of British parliamentary power took place in that context as did the US constitution and the Declarations of the Rights of Man and Citizen, which took place during the French Revolution. Like the French Declarations, Magna Carta exists in different versions so there is no pure origin text of liberty in either place. Rival French and Anglosphere attempts to proclaim the priority of either are particularly absurd. These are documents separated by hundreds of years and many other factors.

We cannot imagine modern liberty without either source, though both sources are flawed and open to challenge. The last thing thought and politics based on liberty needs is some sacred unchallengeable text as foundation, inevitably distorting understanding of the varied contexts and sources of liberty, and inevitably distorting our understanding of how ‘sacred’ documents had a source in power politics and political economy. There is no immaculate liberty born outside of struggles over power and appropriation of wealth.

The writing down of liberties in a legal document itself, particularly one that has a special, difficult-to-overturn foundational status, places some constraint on liberty, on how some people now and even more in the future might have some different ideas about liberty and see the earlier document as constraining.

It is certainly the case that a strongly entrenched document like the US Constitution deprives later generations of the liberty to re-imagine liberty and it is certainly the case that such a Constitution conflicts with the common law tradition exalted by British sovereigntist-Eurosceptics, according to which law progresses through the way judges build gradually on earlier cases to interpret statutes and formulate principles of justice.

Clearly a strongly entrenched Constitution with a Bill of Rights added does not come from common law, though it may try to capture some of the principles supposed to be widespread in common law, and must heavily constrain common law judges. The idea of a Constitution standing above politics, constraining it according to pure justice, has at least in the United States made the membership of the Supreme Court and its decisions a matter of constant political contention.

No attempt at a system of liberty can avoid tensions between different sources and understanding of liberty. Unfortunately the Eurosceptic-sovereigntist position largely tends to overlook this, or like someone looking at the Sun, cannot have it directly in its gaze without serious damage. The elevation of common law tradition, Magna Carta, and parliamentary democracy is the elevation of different things which in some sense must always be part of liberty, thinking of the general principles of judicial independence, institutional harmony, and representative government. However, as they conflict there can be no perfect version and no reason to think English, British or Anglosphere solutions can be regarded as above all others and with nothing to learn from the law-governed democracies of mainland Europe.

Next week, the end, a final summary.

Cultural Adaptation to Climate Change? Requesting Feedback

I am currently working on adaptation to climate change and would appreciate a bit of feedback. I find feedback can be useful, if only to get me out of the ivory tower.

A brief background: When addressing climate change the popular idea is to reduce carbon emissions through a carbon tax, cap-and-trade or regulations. However focusing on emission reductions alone:

  1. Ignores the political difficulties of trying to reduce emissions. Regions that rely heavily on coal use are not going to be in favor of reducing its use or paying extra to use it, see the chart. Notice that states like California or Washington, which are trying to reduce their emissions independently, don’t use much coal anyway to meet their energy needs and would be minimally harmed by a carbon tax.
  2. Reductions today would not address the climate change that will occur even if we stopped all emissions today. Even if

We therefore need to adapt to climate change. We can adapt:

  • Individually by adopting technologies (e.g. air conditioning) or migrating to locations we expect to have better climates.
  • At the urban level by investing in the necessary infrastructure (e.g. seawalls to counter sea level rises), or by allowing cities to ‘move’ by letting old buildings deteriorate and focusing new development inland or building up near the coasts depending on local conditions.
  • At the (inter)national level by sharing technical information.

Economics, my home field, has plenty to say about the above three forms of adaptation. It is however lacking in discussing cultural adaptation.

For example, in Spain and other Mediterranean countries, it is customary to take a long mid-afternoon break to take a long lunch at home or take a nap. To compensate for this break work may end later than is customary elsewhere, and family-friendly social life is active well into the late evening. This custom was transplanted, to varying degrees, in Latin America; I am most familiar with the Mexican version due to family stories and personal experience. This custom helps to avoid working during the hottest time of the day and shifts activity towards the cooler part of the day. My understanding is that a similar custom exists in the warmer southeast Asian countries, but my personal knowledge is limited.

Are there any other examples of cultural adaptation to climate change that my fellow note writers can think of? Examples don’t need to be in regard to contemporary climate change and can be adaptations that took place during the Medieval Warm Period, the Little Ice Age, etc etc.

US States by % of Electricity Produced from Coal.
Source: The U.S. Energy Information Administration, 2013.
Note: Rhode Island, Vermont, and D.C. excluded due to minimal coal use for electricity production.

WV 95.28% KS 61.41% NC 37.38% HI 13.67%
KY 92.83% IA 58.76% TX 34.47% MA 12.04%
WY 88.48% MT 53.74% GA 33.26% AK 9.61%
IN 83.94% MI 53.40% AL 31.25% NH 7.40%
MO 83.06% AR 52.86% SD 28.19% OR 6.28%
UT 80.64% MN 45.85% VA 27.52% WA 5.90%
ND 78.46% MD 43.34% SC 25.62% NY 3.45%
NE 72.14% IL 43.31% FL 20.84% NJ 3.12%
OH 68.88% TN 40.78% LA 20.43% CT 1.91%
NM 67.31% OK 40.72% DE 19.90% ID 0.60%
CO 63.67% PA 39.00% MS 16.48% ME 0.45%
WI 61.62% AZ 38.38% NV 14.42% CA 0.41%
US 38.89%