When is death the right answer?
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 should be a legal right to it.
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). It is criminalized in some of the states with perennially loathsome governments: 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 be killed by another (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, this additional right will not be recognized. 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.
Stephen Kershnar is a State University of New York at Fredonia philosophy professor. Send comments to firstname.lastname@example.org