Compassion or compromise? The ethics of assisted suicide

“Death is inevitable, but suffering doesn’t have to be,” says Tennessee native John Jay Hooker, who has devoted his life to fighting for civil liberties, and hasn’t let his deadly cancer stand in his way. This past summer, he filed a lawsuit against his state to sue for the right to die on his own terms.

If you found out that you were going to die from a progressive, painful, and debilitating disease–say Huntington’s disease, Alzheimer disease, Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig disease) or cancer, would you want someone to tell you that you couldn’t end it all? Even when you could not face the pain and suffering anymore? As long as the decision was truly yours and made while you were mentally competent, before the progression of disease may have made this impossible, would you want some governmental entity telling you that you couldn’t?

Swift, dramatic progress in science has given us the ability to save lives and treat disease more effectively than ever before. However, this same technology has provided the power to prolong the lives of those whose physical and mental conditions are irreversible, and who experience intractable pain.

Just days ago lawmakers in California passed legislation to allow physician-assisted suicide (PAS), pending the signature of the governor. It is modeled after Oregon’s Death with Dignity Act, and would give mentally capable people with terminal illnesses the option of obtaining a physician’s prescription for drugs to end their lives painlessly and with dignity. States with comparable laws include Washington, Montana and Vermont.

Supporters of assisted suicide argue that all individuals have the right to choose what they will do with their lives, as long as they don’t harm others. For most people, the right to die is one they can easily employ. But for some, their disease or condition makes them unable to exercise this right in a dignified way. Physician-assisted suicide is often confused with euthanasia, in which the doctor provides the means of death, usually using a lethal drug. PAS is always administered by the patient, after he/she requests it and consents to it.

One who opposes measures to allow assisted suicide may argue that we as a society have a moral obligation to respect, protect and preserve life. To take it a step further, one might feel that society must oppose any threat to the lives of innocent people. If assisted suicide is permitted based on mercy and compassion, the argument goes, what will prevent us from extending this to anyone whose life may be considered worthless, undesirable, or inconvenient? Brittany Maynard, a 30 year old American woman with terminal brain cancer who decided that she would end her own life, recently became the face of the right-to-die movement. She and her husband moved from California to Oregon so that she could die with dignity, on her own terms. In her final Facebook post, Maynard wrote “Goodbye to all my dear friends and family that I love. Today is the day I have chosen to pass away with dignity in the face of my terminal illness, this terrible brain cancer that has taken so much from me … but would have taken so much more.”

Arthur Caplan, a medical ethicist from NYU, wrote that because Maynard was “young, vivacious, attractive … and a very different kind of person” from the average patient seeking assisted suicide, she “changed the optics of the debate” and inspired people in her generation to think about this issue.

Many health care professionals object to PAS because they feel that certain vulnerable populations may be negatively impacted. This assumes that once PAS is initiated for the terminally ill, it will be offered to or even forced upon other vulnerable groups, such as the disabled or the poor. Further concern surrounds the issue of whether these populations may be assisted to their deaths without actually consenting to them.
State legislators around the country tend to look at the Oregon Death with Dignity Act as a guide, because it has been in effect since 1997, and data since that time has shown that the law has been utilized the way it was intended. In other words, there has been no evidence of a slippery slope for individuals deemed vulnerable or “undesirable.” Similar results have been seen in Washington and Vermont, which have had this type of legislation since 2008 and 2013, respectively.

The conflict has waged over decades; in the 1990s, Dr. Jack Kevorkian assisted in the suicides of over 100 terminally ill patients, with much public protest, and for which he was imprisoned. In 2009, the debate was over a clause in the Affordable Care Act having to do with end-of-life discussions to help regulate health-care costs. Critics of PAS called these “death panels,” as it was felt that these consultations were for the purpose of coercing terminally ill patients to ask to die.

The case against physician-assisted suicide is powerful, as it addresses the fundamental reverence for life, our ability to respond to suffering with true compassion and the risk of slipping down the slope toward minimizing respect for life. But the counter-argument is equally powerful, as it appeals to our empathy and our wish to support individual self-determination; it is saying that allowing a patient to decide when he/she is ready to die and to do so on his/her own terms is the most compassionate thing that we as a society can do.

Featured Image: Courtroom gavel by Joe Gratz, Public Domain via Flickr.