Stephen VasciannieCONSIDER, FIRST, the case of Miss B. Miss B (this is a court-ordained name) was born in Jamaica 43 years ago. At age eight, she was sent to Britain, and there, in keeping with wider social trends which attest to the social progress of Caribbean women, she flourished. She earned a Master's degree in public policy and administration and, professionally, rose to become the head of training and development at a British hospital.
Then the cruel and mysterious hand of fate intervened, striking Miss B so viciously that now she lies hospitalised, physically at the point of death; she still has, however, a mind that remains clear, attentive and perceptive, and her soul continues to embrace Christianity, dignity and sensitivity. Miss B now survives physically with the assistance of a ventilator; she is paralysed from the neck down; she has virtually no chance of recovery; and she wants to be allowed to die.
Miss B's final wish - Lord, let now your servant depart in peace - has created a moral and legal quandary for her doctors in London. Specifically, Miss B wants her doctors to switch off the ventilator that is keeping her alive. In her view, she should have the right to die on her own terms, and there is no point in artificially prolonging a life which exists with paralysis from the neck down, and without the prospect of remission. But the doctors are reluctant. Here, to them, is an articulate, thoughtful woman: what right do they have to take steps that will knowingly lead to her death? First, do no harm, they recall from the Hippocratic Oath.
Should Miss B have the right to force her doctors to switch off the ventilator? At the legal level, the matter was decided last Friday by Dame Elizabeth Butler-Sloss, president of the Family Division of the High Court in England. At risk of some degree of oversimplification, the legal proceedings turned essentially on a question of fact: does Miss B have the clarity of mind to make rational decisions concerning her treatment (including the decision to die)? The judge has found that she does, and, accordingly, upon Miss B's word, the ventilator will have to be switched off.
Is this right? Again from the legal point of view, the question is one of applying a statutory provision that does, in fact, recognise personal autonomy in respect of medical treatment. And, this is consistent with the English legal perspective on suicide: you may take your life if you are of sound mind, and you decide it is time to go.
But in moral terms, the issues are not as straightforward. In support of the legal result, it may be argued that Miss B, more than anyone else, should know whether she can bear the indignity and suffering inherent in her condition. And, with that in mind, it is difficult to suggest that the State should have a greater moral right than Miss B to her own life. Also, if we start from the assumption that life in society is part of a contract we all make with each other, then it is plausible to suggest that the State has a right to interfere with our lives only when this is necessary to prevent us from harming other people. Miss B's harm, if that is the appropriate word, will be inflicted upon herself, and therefore, this is not really the business of the State - it is perhaps the most intensely personal decision a human being may be called upon to make.
On the other hand, it is not altogether clear that, morally, Miss B's decision is exclusively personal. Remember, in particular, the doctors who will ultimately be called upon to switch off the ventilator. They may, in some senses, be acting as the agents of Miss B, but, for a matter concerning life and death, I rather doubt that they can be mere conduits for the implementation of Miss B's will. Switching off the ventilator involves a positive act that will knowingly lead to death: personal conviction may lead some doctors to the view that this action is morally indistinguishable from the taking of life. And, if they do, it ought not to be within the power of the State to force them to contribute to the passing of Miss B.
Consider, now, the case of Mrs. Pretty. Mrs. Pretty, like Miss B, is terminally ill; and like Miss B, she wishes to die with dignity. Mrs. Pretty is also of sound mind, but, one effect of her ailment is that she is now unable to speak very clearly. Mrs. Pretty's physical condition is quickly worsening, and, in the circumstances, she too wishes to take her life. In her case, however, the question is not whether doctors should be required to switch off a ventilator. Rather, it is whether Mrs. Pretty's husband may legally be allowed to take her life, upon her request.
In Mrs. Pretty's case, the courts, from first instance through to the House of Lords, have given a negative answer to this question. Mrs. Pretty may have the legal right to take her life by herself, and she may have the legal right to require doctors to terminate life-saving treatment; but no, she does not have the right to assisted suicide, even if undertaken by a husband willing to ease the pain of his long-suffering wife. Faced with the decision of the House of Lords, Mrs. Pretty took her case to the European Court of Human Rights last week, and now awaits final word.
Is Mrs. Pretty's case morally distinguishable from that of Miss B? In one case, the victim of fate will die when the ventilator is switched off, while in the other, the victim will die after a slow, painful and traumatic process. Both women have concluded that at a certain point personal autonomy must override the State's collective desire to preserve life, and both have felt strongly enough about this to pursue the matter in court. In neither case is there now a serious question about the clarity of mind of the women involved.
Also, in both cases, an external agent will be needed to fulfill the desire for death: doctors in one instance, a husband in the other. In the latter case there may be the unspoken fear that if relatives can take your life upon your request, then the right to life may be seriously undermined not only by unscrupulous relatives, but also by loving relatives so stricken with grief that their judgement is impaired. But there is no apparent evidence of this in the case of Mrs. Pretty's husband; for, at all relevant points in the case, Mrs. Pretty has been clear that the proceedings are being driven by her desire to die with dignity.
So perhaps the cases cannot be distinguished. They do, however, raise painful questions for individuals, and pressing issues for the broader society. As technological means for prolonging life develop, these issues will become more prevalent: I doubt that any of the answers will be altogether satisfactory.
Stephen Vasciannie, a UWI lecturer, is currently a Visiting Fellow at Wolfson College, Cambridge University in Britain.
