The future of euthanasia and suicide

Another extract from You Tomorrow, one that is very much in debate at the moment, it is an area that needs wise legislation, but I don’t have much confidence that we’ll get it. I’ll highlight some of the questions here, but since I don’t have many answers, I’ll illustrate why: they are hard questions.

Sadly, some people feel the need to end their own lives and an increasing number are asking for the legal right to assisted suicide. Euthanasia is increasingly in debate now too, with some health service practices bordering on it, some would say even crossing the boundary. Suicide and euthanasia are inextricably linked, mainly because it is impossible to know for certain what is in someone’s mind, and that is the basis of the well-known slippery slope from assisted suicide to euthanasia.

The stages of progress are reasonably clear. Is the suicide request a genuine personal decision, originating from that person’s free thoughts, based solely on their own interests? Or is it a personal decision influenced by the interests of others, real or imagined? Or is it a personal decision made after pressure from friends and relatives who want the person to die peacefully rather than suffer, with the best possible interests of the person in mind? In which case, who first raised the possibility of suicide as a potential way out? Or is it a personal decision made after pressure applied because relatives want rid of the person, perhaps over-eager to inherit or wanting to end their efforts to care for them? Guilt can be a powerful force and can be applied very subtly indeed over a period of time.

If the person is losing their ability to communicate a little, perhaps a friend or relative may help interpret their wishes to a doctor. From here, it is a matter of degree of communication skill loss and gradual increase of the part relatives play in guiding the doctor’s opinion of whether the person genuinely wants to die. Eventually, the person might not be directly consulted because their relatives can persuade a doctor that they really want to die but can’t say so effectively. Not much further along the path, people make their minds up what is in the best interests of another person as far as living or dying goes. It is a smooth path between these many small steps from genuine suicide to euthanasia. And that all ignores all the impact of possible alternatives such as pain relief, welfare, special care etc. Interestingly, the health services seem to be moving down the euthanasia route far faster than the above steps would suggest, skipping some of them and going straight to the ‘doctor knows best’ step.

Once the state starts to get involved in deciding cases, even by abdicating it to doctors, it is a long but easy road to Logan’s run, where death is compulsory at a certain age, or a certain care cost, or you’ve used up your lifetime carbon credit allocation.

There are sometimes very clear cases where someone obviously able to make up their own mind has made a thoroughly thought-through decision to end their life because of ongoing pain, poor quality of life and no hope of any cure or recovery, the only prospect being worsening condition leading to an undignified death. Some people would argue with their decision to die, others would consider that they should be permitted to do so in such clear circumstances, without any fear for their friends or relatives being prosecuted.

There are rarely razor-sharp lines between cases; situations can get blurred sometimes because of the complexity of individual lives, and because judges have their own personalities and differ slightly in their judgements. There is inevitably another case slightly further down the line that seems reasonable to a particular judge in the circumstances, and once that point is passed, and accepted by the courts, other cases with slightly less-defined circumstances can use it to help argue theirs. This is the path by which most laws evolve. They start in parliament and then after implementation, case law and a gradually changing public mind-set or even the additive effects of judges’ ideologies gradually evolve them into something quite different.

It seems likely given current trends and pressures that one day, we will accept suicide, and then we may facilitate it. Then, if we are not careful, it may evolve into euthanasia by a hundred small but apparently reasonable steps, and if we don’t stop it in time, one day we might even have a system like the one in the film ‘Logan’s Run’.

 Suicide and euthanasia are certainly gradually becoming less shocking to people, and we should expect that in the far future both will become more accepted. If you doubt that society can change its attitudes quickly, it actually only takes about 30 years to get a full reversal. Think of how long it took for homosexuality to change from condemned to fashionable, or how long abortion took from being something a woman would often be condemned for to something that is now a woman’s right to choose. Each of these took only 3 decades for a full 180 degree turnaround. Attitudes to the environment switched from mad panic about a coming ice age to mad panic about global warming in just 3 decades too, and are already switching back again towards ice age panic. If the turn in attitudes to suicide started 10 years ago, then we may have about 20 years left before it is widely accepted as a basic right that is only questioned by bigots. But social change aside, the technology will make the whole are much more interesting.

As I argued earlier, the very long term (2050 and beyond) will bring technology that allows people to link their brains to the machine world, perhaps using nanotech implants connected to each synapse to relay brain activity to a high speed neural replica hosted by a computer. This will have profound implications for suicide too. When this technology has matured, it will allow people to do wonderful things such as using machine sensors as extensions to their own capabilities. They will be able to use android bodies to move around and experience distant places and activities as if they were there in person. For people who feel compelled to end it all because of disability, pain or suffering, an alternative where they could effectively upload their mind into an android might be attractive. Their quality of life could improve dramatically at least in terms of capability. We might expect that pain and suffering could be dealt with much more effectively too if we have a direct link into the brain to control the way sensations are dealt with. So if that technology does progress as I expect, then we might see a big drop in the number of people who want to die.

But the technology options don’t stop there. If a person has a highly enhanced replica of their own brain/mind, in the machine world, people will begin to ask why they need the original. The machine world could give them greater sensory ability, greater physical ability, and greater mental ability. Smarter, with better memory, more and better senses, connected to all the world’s knowledge via the net, able effectively to wander around the world at the speed of light, and being connected directly to other people’s minds when you want, and doing so without fear of ageing, ill health of pain, this would seem a very attractive lifestyle. And it will become possible this century, at low enough cost for anyone to afford.

What of suicide then? It might not seem so important to keep the original body, especially if it is worn out or defective, so even without any pain and suffering, some people might decide to dispose of their body and carry on their lives without it. Partial suicide might become possible. Aside from any religious issues, this would be a hugely significant secular ethical issue. Updating the debate today, should people be permitted to opt out of physical existence, only keeping an electronic copy of their mind, timesharing android bodies when they need to enter the physical world? Should their families and friends be able to rebuild their loved ones electronically if they die accidentally? If so, should people be able to rebuild several versions, each representing the deceased’s different life stages, or just the final version, which may have been ill or in decline?

And then the ethical questions get even trickier. If it is possible to replicate the brain’s structure and so capture the mind, will people start to build ‘restore points’, where they make a permanent record of the state of their self at a given moment? If they get older and decide they could have run their lives better, they might be able to start again from any restore point. If the person exists in cyberspace and has disposed of their physical body, what about ownership of their estate? What about working and living in cyberspace? Will people get jobs? Will they live in virtual towns like the Sims? Indeed, in the same time frame, AI will have caught up and superseded humans in ability. Maybe Sims will get bored in their virtual worlds and want to end it all by migrating to the real world. Maybe they could swap bodies with someone coming the other way?

What will the State do when it is possible to reduce costs and environmental impact by migrating people into the virtual universe? Will it then become socially and politically acceptable, even compulsory when someone reaches a given age or costs too much for health care?

So perhaps suicide has an interesting future. It might eventually decline, and then later increase again, but in many very different forms, becoming a whole range of partial suicide options. But the scariest possibility is that people may not be able to die completely. If their body is an irrelevance, and there are many restore points from which they can be recovered, friends, family, or even the state might keep them ‘alive’ as long as they are useful. And depending on the law, they might even become a form of slave labour, their minds used for information processing or creativity whether they wish it or not. It has often truly been noted that there are worse fates than death.