The choice illusion

We have an established routine in our family for the purchase of a used car. It's been honed over the last quarter decade and seems to work quite well.

My role is to find the right vehicle and talk to the car salesman. Once I've established a few facts and signal a desire to purchase, I tell the salesman that I'll need to talk it over with my wife and get back to him.

Anne is a bit more hard-headed than me. Returning to the car yard and agreeing to the purchase, I leave her to negotiate the price. It's a bit of a tag-team, good-cop, bad-cop routine, but it works for us.

Or does it? I guess we'll never really know; but it does feel good to be able to say that we knocked the price down and made more on the trade-in. I suppose it is possible that the salesman may well have the last laugh, but at least we felt like we were in control and made a good choice.

Choice is an integral part of our sense of well being. This is particularly so in this era where personal rights dominate the public discussion and where 'full disclosure' and 'informed consent' are now the expected norm for every transaction from an insurance policy to a medical procedure.

Full disclosure of information affecting a transaction certainly makes for the possibility of better choices. Marketing gurus have exploited what I would call this 'choice mantra' (as I imagine sales people have done since the birth of commerce) to the point where the word 'choice' is even integrated into business names these days.

Exercising choice can contribute to a sense of well being; essentially because in making a choice we feel in control of our circumstances and 'on top of things'. Conversely a sense of not being in control of one's circumstances can produce the opposite effect.

When my mother-in-law moved to a nursing home I think we all sensed that her short-lived reluctance was really about a loss of the sense of control over her affairs. 'Just hit me on the head, dear,' she said more than once. In somewhere like the Netherlands or Belgium and absent a loving family who knew the reality, maybe this would have been interpreted as a wish to die. It wasn't. It was a crie de coeur to be listened to, for affirmation and acknowledgement which we gladly provided.

Hardly surprising then that this matter of control is recognised in surveys as the primary concern of those approaching their twilight years and not, as one might imagine, the possibility of a painful death.

The spectre of the possibility of a lack of control (or choice) is promoted by the pro-euthanasia and suicide lobbies as its strongest sales pitch. They know that, like the snake oil salesmen of Wild West fame, you can create a need (whether real or imagined) and then provide the answer. But their answer lacks credibility because choice, in terms of euthanasia and assisted suicide, is an illusion.

Unlike buying a used car or with any other service, the ultimate choice in making a request to die lies with another – the doctor. In my used car purchase, this would be akin to us choosing a car and then being told by the salesman that he will have a think about whether or not he's willing to sell and get back to us after the weekend! There's no real sense of control here, and also the very real risk with legalized euthanasia & assisted suicide that what in fact may be a cry for help (or real control) might easily be interpreted wrongly.

Then there's the slippery slope. While once scoffed at as something akin to the Loch Ness Monster, the data now emerging from places like the Netherlands and Belgium confirms what most of us saw as simply common sense: that once the genie is out of the bottle, any vestige of restraint or restriction (upon who may qualify for state-sanctioned-killing) soon evaporate or are simply ignored.

This makes a mockery out of the pro-euthanasia lobby's choice mantra. Newborns, teens and, most recently dementia sufferers are now euthanased in the Netherlands. What started out as a regime for so-called 'hard cases' is now extended to those who could never consent (children) and those who have lost the ability to consent (dementia sufferers).

Canadian Oncologist, Jose Periera recently observed that, whereas the Dutch experiment with euthanasia was once seen as a 'last resort' it is now, in his opinion, an 'early intervention'. Where is choice in the Dutch experience? It stands to reason that if euthanasia & assisted suicide is now an 'early intervention' that the real choices for primary care and palliation simply aren't made available. Choice, as my title suggests, is an illusion. Our salesman might decide to sell you a car from a limited range on the front lot while he's hiding others from view out the back!

But what if you never wanted to buy a car in the first place?