Monday, June 6, 2011

Till death do (I help) you part....

The past week has seen the passing of two major advocates of assisted suicide, Dr Jack Kavorkian in the US in failing health at age 83, and in Britain Dr Anne McPherson,  who died at 65 of pancreatic cancer.  Neither used assisted suicide in their exits as far as we know, nor did the stories say how they felt about that in regard to themselves (both must have known their end was nigh). However, there is no reason to think that the doctors had advance knowledge of their ultimate fate until the onset of symptoms.

Whether their choice to die in the usual uncontrolled way was made out of fear of death or hopes of recovery, or for whatever other reason is rather immaterial.  Both advocated the controversial idea that control over our own dying is basically a human right and that physicians should be there with expertise to help one's exit be peaceful, with as little pain and discomfort as possible, and with dignity.  They never suggested that anyone should be forced or pressured to die with assistance, so it's no issue whatever that they did not take their own medicine.  But society, for many reasons, resisted their view, and often quite strongly.

Assisted suicide is grim to think of, it contradicts some of the stronger religious views, and it could open the way to abuse by the doctors or--and there's plenty of precedence!--by the state, to remove those whose presence is inconvenient.  Others feel that the doctor's mandate was always and only to cure, and that this is a serious violation of that simple rule.

These incidents do raise a question that relates to MT's topics.  Only, or at most, humans are thought to understand the inevitability of death....indeed, some anthropologists have argued that some 'primitive' peoples do not understand that, and instead attribute every death to misadventure or hexing, etc.  Without written records and so on, perhaps it hasn't struck them.  Perhaps most have died before really dying of old age, so that the idea of inevitable wearing out is not in their general understanding.

But generally we know better. (Or do we?  Miracle anti-aging ideas, even perpetuated by scientists such as by promising telomere-lengthening and other miracle genetic remedies, abound even in our scientific society.)  For us, death has a cause, a bodily cause, not a spiritual one.  And if what we are is, as so many in science would like to promulgate, determined by our genes, then by tinkering with genes perhaps we really could immortalize ourselves.  For now that's science fiction, and evolutionary arguments (or just-so stories) have long been offered to show that darwinian evolution will have selected for mortality: get you and us out of the way so that a new crop of sprats, with new genotypes, can be sieved by the environment to make our species better (if you can believe we can be improved upon!).

That explanation is not so obvious, but is a topic for another day, but there's another that is more relevant.  If genes are as predictive as advocates for 'personalized genomic medicine' (PGM) would have you believe, and are directly causal in regard to disease and aging, then many or most of us could soon know from our DNA sequence what we're in store for.

If that is so, should society that allows for PGM also allow for the full range of action in response to one's genomic diagnosis?  That is, if you know you're in for a particular cause, and even roughly when it will arrive, should you be able to seek a narco-physician to assist you with a way out?  Would there be some probability cutoff--say, if the chance of a horrible death due to some disease was, say above 30% you could autonarcolize with doctor's help.  And if such things were legalized, could the doc do this even before your symptoms set in?  What would be the minimal age of consent for it, or could parents even decide it for their children (a modern form of infanticide, something widely practiced in other, especially pre-agricultural cultures)?  What kind of disorders would be sufficient justification?  A tendency to melancholy?

How reliable should the PGM diagnosis be for this to be allowed?  What regulations would protect one against false diagnosis, or other forms of mischief?  Will various social pressures for gerontocide, for example, arise as population growth presses heavily against resources, or as the new sprats tire of having to pay for our health care and rest homes?

Are such questions inevitable if we persist in the belief---or, contrary to our personal predictions, show the truth of the belief, that your future is writ in your genome?

No comments: