A couple of weeks ago I wrote a post about my elderly mother’s Alzheimer’s. Then last week, in the discussion threads following my post on “secular zealotry”, the issue of euthanasia and its moral dilemmas was raised. And now this week Terry Pratchett has weighed in to the debate on assisted suicide and mercy killings, topics which were themselves brought again to public attention through some well-publicised and possibly contradictory decisions in the courts. This week’s Moral Maze on Radio 4 also debated and dissected the complex and difficult issues which these matters bring into sharp relief. So it feels as if my internal world and the external world are both conspiring to make me think through these painful problems a little more explicitly.
In the face of these juggernauts of seemingly absolute moral positions, the notion of bringing the techniques of risk management to bear might seem akin to digging a grave with a teaspoon. What can bureaucracy bring to a debate in which the main protagonists are slugging it out using weapons of mass ideological destruction; the one camp bellowing that life is a sacred gift from God, whilst the other retorts that one group’s intellectually bankrupt and scientifically ridiculous imaginings should not be permitted to condemn the more enlightened to suffering and infantilism? When you’ve finished reading this post you might well feel that the answer is, “Nothing!”, but undaunted I’m going to give it a shot.
For those lucky enough to have avoided risk management thus far, the briefest of explanatory notes. In matters such as financial planning, health and safety, human resources and the like, it is usual practice to set out the risks associated with a range of possible scenarios. Each risk is then given a score to indicate how serious or damaging it would be for an organisation were that risk to “crystallise” in risk-speak jargon – for you or me, that means that the bad thing actually happens. Then the risk is given another score, indicating the probability of the risk crystallising. The two scores are multiplied together to give a total. The person responsible for managing that particular risk then sets out what defences they intend to put in place both to reduce the severity of the risk should it crystallise, and also t0 reduce the likelihood of it actually occurring. The risk is then scored again for severity and probability, and another total calculated. This is the score of the “mitigated risk”, which will hopefully be substantially lower than the unmitigated one. An example before I return to the real substance of this post. Take the risk of a fire in an organisation’s head office. Such a fire could effectively destroy the company and kill many of its employees. Hard to think of a more serious risk, so for severity this would score 10 out 0f 10. What about the chances of it happening? Let’s assume for the moment that no mitigating defences have yet been put in place. A fire is not inevitable, but without action it’s hardly inconceivable. So let’s score it 7 out of 10 for probability. Overall unmitigated risk score would thus be 70, which means that it’s pretty bad. The mitigating actions might be to ensure that fire drills are regularly carried out, that escape routes are clear and safe, that all important company information is copied and kept also at another location. These would all mitigate the seriousness of the consequences, which might now score 7 out of 10 (a fire is always going to be serious). If additional actions, such as installing sprinkler systems and other fire fighting equipment, removal of inflammable materials, etc are undertaken, these will also reduce the likelihood that a fire will either occur, or take serious hold. So the probability score might now be 3 out of 10. The mitigated risk now scores 21, a marked improvement on the original 70.
OK, so what on earth has this to say about assisted suicide, or mercy killing? Simply this. The problem about the entrenched and absolute positions taken in this debate is that it seems you have to pay your money, and take your choice. Black or white. Sacred or “don’t talk bollocks”. The problem with this is that it assumes one of these positions can somehow be proven to be correct, and that once that’s been done, all the losers have to accept defeat. It also assumes that the “correct” position will be free of difficulty, once the choice has been made. But that is ridiculous. If you take the life is sacred position, you have to concede that without mitigation, you will condemn many people to appalling suffering. If you take the utilitarian position you have to accept that there is a risk that decisions to kill others, or to assist their suicide, might be wrong. So yes, it’s about risk. And all risks can be managed and mitigated, even if they can’t be removed. I’m not going to go through all the many potential risks implicit in these difficult issues and how they might be mitigated, but rather, by taking a couple of examples, to show how the approach might take the sting out of the seemingly intractable arguments that swirl around this problem.
It will come as no surprise to those who read my “Secular zealotry?” post that I am broadly sympathetic to the position which flows from the concept of life being sacred. But I know that this starting point brings serious risks with it (not counting the risk that it might be a load of old crap.) I’ve mentioned one already: that individuals might be condemned to appalling suffering. There are others, of course. Most notable is the risk that someone’s autonomy will be denied. Imposing the will of one person over another in such a situation hardly seems to me to be the best way of respecting the sacredness of the victim’s life. Let me try and submit just these two examples to the risk management technique. The seriousness of these risks would both seem to me to be high. To have to suffer intolerably is not a trivial thing. To have one’s wishes denied or overruled is likewise a serious affront. So let’s score them 10 and 8 respectively. How might their seriousness be mitigated? In the former case, presumably by some kind of pain-relief therapy. Many experts say that no-one any longer needs to suffer, at least in terms of physical pain, if adequate analgesia is provided. Pain is not the only form of suffering – there’s also loss of dignity, for example. But for many people it is the fear of uncontrolled pain that frightens most. So perhaps a mitigated score might be 6. In the latter case, it’s probably not possible to mitigate it much, if at all. Either one’s wishes are denied, or they’re not. So perhaps its score stays at 8. What of the probabilities? Since there are lots of ways to die that do not involve prolonged suffering, and not everyone will have their wishes ignored, let’s score the probabilities at 7 and 4 respectively. A lot of the suffering that people fear at the ends of their lives is the result of excessive medical intervention. By thinking about this in advance, individuals can set out the limits of intervention that they are prepared to consent to, even if when it comes to it they are no longer able to express that removal of consent. So this might mitigate the probabilities of both suffering occurring, and of autonomy being denied. For the purposes of this example, let’s assume these mitigations of probability reduce the scores to 5 and 3. The unmitigated risk scores were 70 and 32, but after the actions to limit these risks, the mitigated scores are 30 and 24. In this rough and ready way we can say that suffering is a greater risk than loss of autonomy, but that we can do more to mitigate the former than the latter.
Please don’t get obsessed with the numbers since they’re only for illustration. The point I’m making is simply that with careful analysis, and honest thought, we can start to get a handle on the relative degrees of risk, and the extent to which we can reduce them by taking action of one kind or another. Remember that these are the risks that pertain to a particular starting point. In this case it was the starting point that life is sacred and ought not to be actively taken. If the starting point is that life has no absolute status, but can be taken when some tipping point is reached, then there would be a different set of risks and mitigations. Both positions have many risks, and all the risks pose grave problems in scoring both their seriousness and their likelihood. The mitigations will likewise be challenging to think about and to score. However, if a given risk that flows from my starting point becomes intolerable, then I have to accept either a mitigation, or perhaps even an exception to my starting principles. But the same applies to those who deny the sacredness of life. So I think that if we are prepared to descend from the heights of our respective moral absolutism to embrace this more pragmatic and perhaps even bureaucratic territory in the valley, we might find both that we have more to agree about than we thought, and that there is value in both starting points even if we cannot personally endorse one or other of them.