Stephen
Kershnar
Physician-Assisted Suicide: Who Owns You?
Dunkirk-Fredonia Observer
October
8, 2019
The
right-to-die movement argues that terminally ill people have a right to die via
physician-assisted suicide, refusing life-saving medical treatment, or voluntary
euthanasia. Their argument is sound. There is a moral right to die in these
ways and there should be a legal right to it as well.
Physician-assisted
suicide occurs when a physician provides a patient with the knowledge or means (drugs)
to commit suicide. Physician-assisted suicide is legal in nine states
(California, Colorado, Hawaii, Maine, Montana, New Jersey, Oregon, Vermont, and
Washington) and in part or all of some advanced countries (Australia, Belgium,
Canada, Luxembourg, Netherlands, Switzerland, and United States). Some of the
states with perennially loathsome governments criminalize it: Connecticut, Illinois,
and New York.
In a
pair of cases, Washington v. Glucksberg
(1997) and Vacco v. Quill (1997), the
Supreme Court held that there was no constitutional right to physician-assisted
suicide. In an earlier case, Cruzan v.
Director, Missouri Department of Health (1990), the Supreme Court recognized
a constitutional right to refuse life-saving treatment and tried to distinguish
this right from a right to physician-assisted suicide.
Voluntary
euthanasia occurs when a person consents to have another kill him (for example,
a physician). It differs from physician-assisted suicide only in terms of who
acts last to bring about the patient’s death. There is no moral difference
between physician-assisted suicide and voluntary euthanasia as nothing rests on
who acts last. In both cases, the physician and patient act with the same goal,
use the same means, and bring about the same result.
Physician-assisted
suicide has safeguards. The patient must have a terminal illness, be competent,
notified of an alternative to suicide (palliative care), and repeatedly
authorize the drugs. One study in Oregon found that the most common reasons
given for seeking physician-assisted suicide are the loss of ability to
participate in activities that made life enjoyable, loss of autonomy, and loss
of dignity. In a Washington study, the majority had terminal cancer or a neurodegenerative
disease (consider, for example, ALS and Huntington’s disease).
The argument
for physician-assisted suicide is straightforward. A person owns himself. That
is, he has a fundamental right to control his body. If a person owns himself,
then he may shape his life as he sees fit. If he may shape his life as he sees
fit, then he may end his life. This is especially true when he has a terminal
illness that would otherwise make his future degraded, miserable, and short.
If a
person has a moral right to end his life, then he may get others’ help in doing
so. Thus, there is a moral right to physician-assisted suicide. In helping a
person end his life, the physician does wrong the patient, himself, or a third
party. In general, the state should allow people to exercise their moral rights
except when doing so prevents catastrophic loss. Hence, there should be a legal
right to physician-assisted suicide.
Self-ownership
explains why the state grants people other legal rights. Consider rights to think
and say what you want (for example, free speech and religion), determine your relationships
with others (for example, sex, dating, and marriage), and be free of
interference (for example, battery, unreasonable search and seizure, and
trespass). It also explains fundamental legal rights in the medical context
such as rights to abortion, contraception, and refusal of medical
treatment.
Legislators
opposed to a legal right against physician-assisted suicide argue that there is
good reason to criminalize it. First, they argue, the practice would endanger
vulnerable people, particularly the disabled and mentally ill. For example,
they note, some of the degraded-and-terminally-ill people who want to die are clinically
depressed.
This
reason is unconvincing. There are procedures to lessen this risk and the burden
is on those who want to block a fundamental moral right to show that the
procedures aren’t working. Even if they could show this, and the evidence doesn’t
support them, free societies find ways to protect incompetents that are less
restrictive than trampling on the rights of competent adults.
Second,
opponents argue that criminalizing the practice prevents people from being
pressured into suicide. Such pressure might come from loved ones who struggle with
the crushing financial and psychological burdens of supporting someone who is
dying in an expensive, painful, and slow manner.
This
argument is paternalistic. It tells dying people that they are too much like
children to decide what is and is not a good reason to die. Dying people are
not children. They can decide for themselves whether being a burden is a good
reason for dying, especially in the context of an otherwise degraded,
miserable, and short future. Trampling on the fundamental rights of competent adults
hardly seems a permissible way to prevent undue pressure in some families.
Third,
opponents argue, allowing such a practice will eventually lead to legalizing euthanasia,
perhaps even involuntary euthanasia. Others argue that it might lead to
legalizing suicide by people who do not have a terminal illness.
The
first slippery-slope argument is neither conceptually nor empirically justified.
Conceptually, there is a big difference between letting someone die who
consents to it (via physician-assisted suicide) and killing someone who doesn’t
consent to it (via involuntary euthanasia). Empirically, I cannot find any evidence
of a slide into involuntary killing in states and countries that allow physician-assisted
suicide. In addition, as noted above, the distinction between
physician-assisted suicide and voluntary euthanasia is insignificant.
The
slippery-slope claim that the self-ownership argument for permitting this
medical practice also justifies permitting competent individuals without a
terminal illness to commit suicide is correct. A person is not owned by his
church, country, family, or government. Rather, he owns himself. Free countries
permit people to shape their own lives, even if they do so poorly. As an
empirical matter, the state will not recognize this additional right. Sadly. Americans
just don’t love liberty that much.
In
summary, the right-to-die movement is correct. Terminally ill people should have
a legal right to die.
