A doctor, a lawyer, and Death walk into a bar...

my Trade Tripper column in this 31 July-01 August 2015 weekend issue of BusinessWorld:

Got invited to Makati Medical Center’s bioethics forum last Tuesday.

I accepted quite eagerly as it provided an opportunity for me to dwell on topics that have been of interest to me for some time and that is not only the matter of euthanasia but also that of allowing death (with or without the patient’s consent).

The stated objectives of the forum were “to present a case of an AIDS (Acquired Immune Deficiency Syndrome) patient with a life-threatening complication; and to discuss the bioethical issues in the care of the AIDS patient who has refused further medical management.”

Needless to say, my obsession with natural law (and how it is woven into the fabric of our Constitutional system) served as the practical framework with which I approached the subject.

“Legal reasoning”, so says John Finnis, “is broadly speaking, practical reasoning. Practical reasoning moves from reasons for action to choices (and actions) guided by those reasons. A natural law theory is nothing other than a theory of good reasons for choice (and action).”

In this case, as was stated in the Protocols of the discussion handed to me, in the final stages of the patient’s life “additional sedative was given... in which the relatives were informed of possible side-effects.”

On the last day, the “patient became hypotensive but relatives deferred all further diagnostics, feeding, fluids and medications (except for the pain medications). The infectious disease service signed out of the case. He was then pronounced expired on the same day.”

The issues of “do not resuscitate” or “do not intubate” did not come into play here. Neither did “double effect”. Medication was ongoing and a determination was made to stop it, regardless of any discussion whether the treatment was ordinary or extraordinary.

The most apparent issue for me (as a working assumption) was the decision to defer “feeding, fluids” made by the relatives. Granted, the patient himself signaled a few days before he died that he apparently preferred “mercy killing.” But even that gives rise to further issues.

The protocols did ask whether an “HIV/AIDS patient with possible clinical depression was still competent to decide for himself.” But that is something for psychologists and medical doctors to determine. However, even granting that he was indeed competent, would such patient have the right in the first place to ask for “mercy killing”?

Because this was indeed a killing, albeit under the cover of “charity” or “good intentions”. But charity and good intentions for whom?

And to say that the relatives and doctors were merely following the wishes of the patient only leads us again to the question of whether the patient had the right to ask that he be killed.

Constitutionally, I would say no. And my grounds are based on the “common good” and “human dignity” clauses of the Constitution, as well as (perhaps) the “right to life” subject to due process and equal protection.

But the patient has his freedom, progressives ask. His individual autonomy. The offshoot of a liberal US Supreme Court that would invoke “emanations and penumbras” (as per Grisworld) or “the right to define the meaning of life, of one’s concept of existence, of meaning, of the universe, and of the mystery of human life” (from Casey). Both of these cases, incidentally, would find their “reasoning” in the recent lamentable Obergefell.

But individual autonomy has limits.

Nobody is allowed to sell himself into slavery or prostitution, or to sell body parts even for the most altruistic of reasons. And for all the talk of individual autonomy, the patient in this case still placed himself not within his exclusive powers but within the structure of the medical profession, as well as the framework of society itself (with all the concomitant norms, knowledge, and values).

In other words, for all his talk of individual autonomy, the patient still needed others, including society, to kill himself. And this desire to kill himself is pointedly regardless of society. And, frankly, regardless of the patient’s condition.

For one thing I realized is how utterly random the standards the medical profession put into place to give themselves the power to kill others: the definitions of extraordinary/ordinary treatment, of terminal conditions, of medical treatment from human necessity/hospitality.

And so while progressives struggle to deal with the quite indefensible position of autonomy, the nature and value of human dignity needs to be posited.

Our Constitution, drawing from the Enlightenment and the development of natural law and natural rights, speaks of protecting human life from the moment of conception. Outside that, Kant tells us of suicide’s unacceptability: for employing a choice that ultimately destroys the ability of choosing. Schopenhauer tells us that to harm oneself is ultimately harming all.

In the end, science has limits.

And try as they might to avoid it, people will always be faced with the need to make non-relativistic moral choices, knowing fully well that such choices have inevitable far-reaching consequences.