April 4, 2024

‘Terminalism’: discrimination against the dying is wrong

Unjust discrimination is a focal point of bioethics discourse. Bioethicists battle sexism, racism, classism, speciesism, ableism, and ageism. Do they really need another ism? Yes, says philosopher Philip Reed. He has declared war on “terminalism”, or discrimination against the dying. It is a concept that opens up a new front in discussions of euthanasia and assisted suicide. 

In an article in the Journal of Medical Ethics, Reed says that terminalism is “treating the terminally ill worse than they would expect to be treated if they were not dying”. He sketches four areas where this is relevant: hospice eligibility requirements, allocation protocols for scarce medical resources, right to try laws and right to die laws. 

In debates about the “right to die”, supporters normally allege that people who want to die are discriminated against because their wishes are being thwarted by existing legislation. But Reed turns this on its head. 

In denying that the terminally ill are committing suicide by accessing assisted death, the professional organisation most committed to preventing suicide has given up its responsibility of addressing suicidal ideation among the terminally ill. This is terminalist: purely on the basis of group membership, one group gets suicide prevention and another gets suicide assistance.

Moreover, the availability of the option of assisted death only for the terminally ill negatively influences the terminally ill who wish to live by causing them to doubt their choice. When assisted death is available only to the dying, a dying person may be prone to feel a need to justify his existence in a way that the non-dying, not having the option, need not do. This puts the dying at a disadvantage. 

The distinctions that Reed makes are subtle but very thought-provoking. 

… discrimination against the dying occurs regularly in high-capitalist Western cultures. I think terminalism is relatively easy to see, that it has been hiding in plain sight, and the fact that we have not yet confronted it reveals in part our blind spots and prejudices. We don’t want to think of ourselves as discriminating against yet another vulnerable group, yet we are plainly doing so. 

The reason that terminalism matters is that dying persons matter. Our willingness to treat such patients badly assumes a kind of fatalism—where we imagine that a life with very little future means a less valuable life.