Specious arguments advanced by Sydney psychologist

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The opinion piece in The Age.

In today’s Fairfax press, Sydney woman Mary Ticinovic advances a number of reasons as to why she believes that assisted dying is not merciful. The by-line identifies her as a “clinical psychologist”. But her arguments are not founded on the basic tenets of psychology. How so?

Read Mary’s opinion piece in The Age

All life is precious

Mary argues that to support assisted dying is to go “against the principle that all life is precious.” She offers no substantive explanation, invoking the notion of ‘human worth’, stating that it exists regardless of the health state or suffering of the person, and complaining that assisted dying promotes the idea that “your life is no longer worth living”.

These are not psychological arguments. We can agree that life is precious. But reluctantly deciding to hasten one’s death in the face of intolerable and unrelievable terminal suffering doesn’t negate that preciousness. Indeed, to some people, choosing assisted dying can evidence the preciousness of one’s very capacities and values as a human.

Whose standards?

Mary further muses over “by whose standards would we judge if life is not worthwhile any more”, as though this is only some vague theoretical argument amongst philosophers or doctors. This is not a psychological argument, either. Under assisted dying law reform, it is only the dying individual’s world-view and circumstances that determine whether he or she feels life is worth living: not anyone else. General philosophical theory doesn’t come into it.

She further argues that assisted dying “promotes a utilitarian view of humanity”. This is not a psychological argument, either. Nor is it valid. Indeed, legalised assisted dying respects the very nature of the diversity of humanity by enabling the world-views many people hold most dear: that of making rational choices consistent with their own beliefs, values and circumstances. Some patients, for example in Oregon, are deeply religious and believe that their God is compassionate and understands and respects their choice to avoid intolerable suffering. That’s not utilitarian at all.

Harm and the Hippocratic Oath

Mary invokes the Hippocratic Oath said by her medical friends to oblige doctors to “do no harm” and that the medical role is “in healing and helping the patient to be restored to health.” This is simplistic nonsense, not a psychological argument.

Firstly, doctors do harm all the time: think of surgical procedures or chemotherapy. Many medical interventions do harm, but we accept the harm because we expect there to be a commensurately greater good as a result.

Secondly, medical practice cannot always “restore the patient to health” as Mary exclusively puts it. What then? The dying patient may judge that the unrelievable suffering they will experience along the path to death is a greater harm than dying a little earlier. And, doctors also have a primary duty to relieve suffering, which Mary doesn’t mention. What is under review is whether a doctor may participate in the relief of intolerable and unrelievable suffering— by hastening death—if the patient believes this is the lesser harm.

Thirdly, the Hippocratic Oath is around 2,300 years old. It requires doctors to swear allegiance to ancient Greek gods. It forbids women from becoming doctors. It requires current doctors to train the next generation free of charge, and it forbids surgery. Contemporary doctors don’t take it, and it’s certainly not “part of training” as Mary mistakenly states.

None of these are psychology arguments.

'Sucker’s choice'

Mary then argues that requiring dying patients to endure until the end promotes—and that assisted dying prevents—“fostering gratitude”, “reconciling hurts or differences with family members or friends” and “showing them strategies or different ways to approach their pain and suffering”.

But, in jurisdictions where assisted dying is legal, for example in Oregon in the USA, these are precisely things that are encouraged under assisted dying. Doctors are required to inform applicants of available medical and palliative interventions. Family gathers on notice of an anticipated death, music and poetry is shared, and expressions of love, devotion and gratitude are exchanged.

If a dying patient has no intention of reconciling with family or reflecting on approaches to dealing with their pain and suffering under an assisted dying law, precisely the same intention applies to the current regime that requires the patient to endure until the end. To assume a difference is a false dichotomy.

Obligatory compassion

Mary also argues that assisted dying ought to remain outlawed because “nursing a sick loved one is a way to give back”. This is yet another specious non-psychology argument. It promotes the ‘right’ of the ‘nurse’ to express love and devotion through ‘caring interventions’ at the expense of the dying patient’s own world view and deeply-held wish for a hastened death. Now who’s being utilitarian?

The upshot

I ran Mary’s opinion piece past an experienced psychologist, who described it as little to do with psychology. Note that neither of us has experience of or is commenting on Mary’s expertise as a clinical psychologist: she may indeed be a very good one.

My associate wondered out loud if Mary’s arguments were based more on underlying religious views than anything else. I agreed: they seemed to me remarkably consistent with the arguments advanced by religious opponents, even though they avoided directly religious words. So I did a little research.

It turns out that Mary is a committed and active Sydney Catholic.* Evidence abounds of her devotion to the Catholic tradition, and I commend her for her conscientious reflective practice and participation in it.

However, I argue that neither the stated psychological qualification nor the unstated religious affiliation make the offered arguments valid.

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* By way of fairness, I place on the record that I am agnostic.


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Comments

The Catholic Church is a major opponent to the introduction to VE laws in Australia, but it has well and truly lost the 'moral high ground' when talking about the dignity of life.  Senior Catholic clergy protected the priests who abused children, and did not report such criminal behaviour to the Police.  The Catholic Church has completely forfeited the right to tell people that they should suffer with dignity rather than request medical assistance to die.  It continues to improperly respond to decades of mistreatment of the very children it should have been protecting.  It did not ensure that such victims enjoyed their childhood with dignity. 

No Church (or anybody else) has the right to tell others how they should die when facing a terrible end-of-life existence.  The vast majority of Church goers (including myself) are in favour of terminally or incurably ill patients being given the choice of a quick and dignified death if their suffering cannot be alleviated sufficiently by Palliative Care.  The Churches are out of touch with the parishioners who fill their pews!

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