Wednesday, October 20, 2010

“Mentally competent” and “asking for death” – can I rationally choose death?

"Mentally competent" and "asking for death" – can I rationally choose death?
Torrey Orton
October 20, 2010

Decisionmaking and death – irritated reflections on Ahmed, Gray and others.

"balance-sheet" suicide and "rational" suicide – way stations in the argument about how a choice to die can be justifiable. This argument hangs partly on an undiscussed dispute about what a 'rational' decision is. It swings back and forth because rational thinking is persistently misunderstood as affect free thinking. The standard model is reflected in Ahmed's (TheAGE, Oct 7, '10) discussion, which leaves him stuck and indecisive.

I've been stuck for two weeks in this misunderstanding, too, which from my present perspective is no problem because I cannot influence it. I am clear myself where I stand on my own access to effective self-destruction. The details matter some. Nigel Gray's in THE AUSTRALIAN, Oct 6, 2010 alternatives, for example, are quite attractive to my needs to pre-empt an unfortunate death. But a well refined approach to what a good argument for my euthanasia should be will not increase my access to it. That portal is blocked now by a few others' (lifer kooks and gutless pollies) beliefs that I should not have it. By the way, by their default to inaction, the gutless pollies of course cast themselves as supporters of the kook believers. The pollies are a very special class of banal believers – swaying in the intemperate breezes of the various kooks (individual and institutional) for fear of losing something. That fear costs them their integrity and legitimacy, and the rest of us our representation.

Two rationalist fantasies
There are two rationalist fantasies employed in the euthanasia debate: both to the detriment of my rights.
1- that we can and should be able to make rational decisions about our deaths, unclouded by irrational affect; and,
2-that we can only make irrational decisions about euthanasia, because all reason on matters of death is always clouded by 'mental problems' about being close to death – feeling down about being ill, fearing our decline and tormenting ourselves with our pathetic state(s); that is, we are mentally ill if dying, and so unable to decide.

The emotional factors are not understood within the range of normal human emotions. So, the depression, sadness, etc., felt by the dying and the-in-danger-of-dying are treated as pathological rather than normal responses to perceived (and objectively real) dangers. Ahmed acknowledges this implicitly by referring to dialysis research where personal control emerged as a key determinant of patient depression and connecting it to related Oregon findings about euthanasia choosers and oncologists' observations of cancer patients. He then confuses his discussion by calling this mix of feelings and needs "personality factors". While his personal position on patient decision-making is never made explicit, it is suggested by his use of the term "saved" in discussing suicide by aged, near terminal patients.

Rational decisions = ?
What do we know about decision-making by everyday humans (not rats or undergraduates, please)? Simply, that rational or logical decisions mainly exist in digital systems like ICT, positivist economics and its social science affiliates, and the foundations of classical physics and chemistry. The latter have been withdrawing from the fantasy that a number is a discrete item, that data are clearly discernible from each other, since Einstein. And data clear or foggy do not, it is generally agreed, have feelings or thoughts except perhaps in some delicate metaphysics (electrons feel their neighbours and scurry off to a safe place at a nano-distance; planetary attraction is a species of elective affinity?).

Behavioural economics is the belated acknowledgement that Adam Smith was right about economy – it's not the numbers that matter, except to bankers and even not to them when they consider their "quality time". There's a place in human development where an increase in quantities of livelihood produce no gain in quality of living. Many of us are there now.

Judgment = intuition
Decision-making is making judgments. These are integrating intuitions, summarising whole experiences into actions. They do not follow iterative, additive pathways except in expostfacto reconstructions of the sort used in "evidence-based" medicine and its allied affiliates. Try mapping the decision steps in a serious life issue on a decision mapping system like this: . You will still end up with a judgment which cannot be rationally explained except by reference to supposedly non-rational, emotive factors. Judgments express values in relation to important facts. Important facts are the valued ones.

Individual rights only available fully to a group
If our rights were pure universal truths they would just be. When they are contested, as with euthanasia, abortion and just war, for example, their limited claims are made apparent in the act of their dispute. If they were pure and universal they would be substrate, assumptions, of our life processes. The pointy end of the rights stick these days is individual rights. The upshot of the contest in matters socio-economic, so far, is that a few get to monster the many in the name of the many's right to choices they cannot make.

Nigel Gray argues for euthanasia from a personal choice perspective. He stretches his case just as egregiously as he claims the pro-lifers do theirs, but maybe not for the same effect. He proposes a pure right of individual choice on the basis that "..this is one's own business, no one else's." He certainly has a right to think this, but that does not constitute a right to die with no consideration for the effects on others. It's an irritated right with which I sympathise but cannot honour as any more rational than those who say I do not have it (because it belongs to God for instance.)

Putting my hand up for certainty
A string of ways of dying from self inflicted euthanasia to physician assisted euthanasias – the actually occurring choice-based deaths - sit inside the over-arching fact that (so far) we will all die if we live. Euthanasia already exists de facto in physician assisted deaths, either by legally mandated turning off life-support or providing assured decline into death with family-agreed terminal palliations (morphine comas). This is where the individual choice wheels meet the highway of life – namely, with a hand-up if you want it, and sometimes if you do not. I could do with a bit more certainty in my hands.

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