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Euthanasia and Narcissism

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Q&A: Dr. Sam Vaknin Talks Euthanasia and Narcissism
Dr. Sam Vaknin

by Anita Asabe Isioma Vincent-Otiono

Dr. Sam Vaknin is the author of Malignant Self-love: Narcissism Revisited. The 53-year-old Israeli, has written several pieces on Narcissism Personality Disorder. In one of his pieces he linked Euthanasia to Narcissism. In a interview, He detailed the relationship between the two, and shared his opinion on Belgian extending its right to die laws to children.

Q. What prompted you to study Narcissistic Personality Disorder and what is it?

SV: What prompted me is my compulsive need to garner attention and the constraint of having to make a living out of my own freakishness.

Pathological narcissism is a life-long pattern of traits and behaviors which signify infatuation and obsession with one’s self to the exclusion of all others and the egotistic and ruthless pursuit of one’s gratification, dominance and ambition.

As distinct from healthy narcissism which we all possess, pathological narcissism is maladaptive, rigid, persisting, and causes significant distress, and functional impairment.

Patients with Narcissistic Personality Disorder (NPD) feel injured, humiliated and empty when criticized. They often react with disdain (devaluation), rage, and defiance to any slight, real or imagined. To avoid such situations, some patients with Narcissistic Personality Disorder (NPD) socially withdraw and feign false modesty and humility to mask their underlying grandiosity. Patients with Narcissistic Personality Disorder (NPD) are either “classic” (meet five of the nine diagnostic criteria included in the DSM), or they are “compensatory” (their narcissism compensates for deep-set feelings of inferiority and lack of self-worth).

Some narcissists are covert, or inverted narcissists. As codependents, they derive their narcissistic supply from their relationships with classic narcissists.

Q. What is the relationship between narcissism and euthanasia?

SV: It is tenuous, but it is there. Narcissists tend to gravitate towards occupations, which allow them to yield power over others. Consequently, they are over-represented in the medical professions. Modern medicine seems to be preoccupied with delusions of omnipotence and the need to avoid the narcissistic injury to the doctor’s ego that death constitutes. This preference of the profession’s image over the patient’s welfare and quality of remaining life is patently unethical. But, to my mind, passive euthanasia is equally immoral. The abrupt withdrawal of medical treatment, feeding, and hydration results in a slow and (potentially) torturous death. It took Terri Schiavo 13 days to die, when her tubes were withdrawn in the last two weeks of March 2005. Since it is impossible to conclusively prove that patients in PVS (Persistent Vegetative State) do not suffer pain, it is morally wrong to subject them to such potential gratuitous suffering. Even animals should be treated better. Moreover, passive euthanasia allows us to evade personal responsibility for the patient’s death. In active euthanasia, the relationship between the act (of administering a lethal medication, for instance) and its consequences is direct and unambiguous.

Q. What is your stance on euthanasia?

SV: Voluntary active euthanasia is morally defensible, at least in principle. Not so other types of euthanasia. But terminating the life of a person depends on how we define a “person” or “human being”. The definition of personhood must rely on objective, determinate and determinable criteria (for instance: is a comatose person – a person at all?)

The anti-euthanasia camp relies on bodily existence as one such unambiguous criterion of personhood. The pro-euthanasia faction has yet to accomplish the same.

Euthanasia is a form of suicide. Though legal in many countries, suicide is still frowned upon, except when it amounts to socially-sanctioned self-sacrifice. Assisted suicide is both condemned and illegal in most parts of the world. This is logically inconsistent but reflects society’s fear of a “slippery slope” which may lead from assisted suicide to murder.

We all have a right to sustain our lives, maintain, prolong, or even improve them at society’s expense. Public hospitals, state pension schemes, and police forces may be needed in order to fulfill society’s obligations to prolong, maintain, and improve our lives – but fulfill them it must.

Still, this implies that each one of us can also implicitly or explicitly abrogate this right. One can volunteer to join the army, for instance. Such an act constitutes a contract in which the individual assumes the duty or obligation to give up his or her life.

Personal autonomy is an important value, but it is in conflict with other, equally important values. Hence the debate about euthanasia. The problem is intractable and insoluble. No moral calculus (itself based implicitly or explicitly on a hierarchy of values) can tell us which value overrides another and what are the true basic goods.

Furthermore, there is no right to have one’s life saved because there is no moral obligation or duty to save a life. That people believe otherwise demonstrates the muddle between the morally commendable, desirable, and decent (“ought”, “should”) and the morally obligatory, the result of other people’s rights (“must”). In some countries, the obligation to save a life is codified in the law of the land. But legal rights and obligations do not always correspond to moral rights and obligations, or give rise to them.

We must distinguish between four situations:

1. The patient foresaw the circumstances and provided an advance directive (living will), asking explicitly for his life to be terminated when certain conditions are met.

2. The patient did not provide an advanced directive but expressed his preference clearly before he was incapacitated. The risk here is that self-interested family members may lie.

3. The patient did not provide an advance directive and did not express his preference aloud – but the decision to terminate his life is commensurate with both his character and with other decisions he made.

4. There is no indication, however indirect, that the patient wishes or would have wished to die had he been capable of expression but the patient is no longer a “person” and, therefore, has no interests to respect, observe, and protect. Moreover, the patient is a burden to himself, to his nearest and dearest, and to society at large. Euthanasia is the right, just, and most efficient thing to do.

Society can (and often does) legalize euthanasia in the first case and, subject to rigorous fact checking, in the second and third cases. To prevent economically-motivated murder disguised as euthanasia, non-voluntary and involuntary euthanasia (as set in the forth case above) should be banned outright.

Counterintuitively, there is a moral gulf between killing (taking a life) and letting die (not saving a life). The right not to be killed is undisputed. There is no right to have one’s own life saved. Where there is a right – and only where there is one – there is an obligation. Thus, while there is an

As long as non-voluntary and involuntary types of euthanasia are treated as felonies, it seems safe to allow patients to exercise their personal autonomy and grant them the right to die. Legalizing the institution of “advance directive” will go a long way towards regulating the field – as would a new code of medical ethics that will recognize and embrace reality: doctors, patients, and family members collude in their millions to commit numerous acts and omissions of euthanasia every day. It is their way of restoring dignity to the shattered lives and bodies of loved ones.

Q. How does the U.S. differ from Europe on this issue?

SV: Europeans are far less prone to ostentatious and self-righteous religious zeal and, therefore, more amenable to reason and pragmatism. This is why euthanasia, within strict legal limits and specifications, is essentially either sanctioned or practiced everywhere in Europe.

Q. What is your opinion on the new addition to the Belgian Law (extending the right to die to terminally ill children)?

SV: Only adults (above an admittedly-arbitrary cut-off age) are moral agents. Children are incapable of making such decisions because, by definition, they can never be fully informed and, thus, can never grant informed consent. Parents, guardians, and custodians do not possess the right to take away a child’s life and to substitute their judgment and decision-making for the child’s for the simple reason that they are not the child whose life is under consideration.

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Mar/21/2014, 5:25 am Link to this post  

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