February 24, 2015
Suicide is a nettlesome ethical problem. Moral objections almost invariably have their origins in religious belief, although some cultures (e.g., China) frown on the practice, but do not condemn it under all circumstances. While as a practical matter in the United States criminal proceedings are no longer brought against persons who attempt suicide (although they may be involuntarily committed by a Court for psychiatric evaluation), individuals who assist them, irrespective and familial or professional relationship, may face severe criminal penalties.1
Physician-assisted suicide (PAS) has been forbidden since antiquity. However, as a practical matter, physicians have likewise had a measure of latitude in the specific application. Thus, for example, an otherwise fatal dose of an opiate might be administered to counteract intractable pain in a terminal patient, with a not unexpected resulting death. (Indeed, anecdotal evidence points to such practices continuing even today, especially in cases of massive, third-degree burn victims whose kidney function has completely collapsed.) In much of northern Europe PAS has been legislated, albeit with varying limitations on both patient and provider. In the United States, only Oregon currently permits PAS. Washington enacted PAS legislation through voter initiative in the November 2008 election cycle, although the law remains to be formally implemented.
ARGUMENTS IN FAVOR OF LEGALIZED PHYSICIAN ASSISTED SUICIDE
Arguments in favor of legalized PAS extend from considerations of personal autonomy to those relating to precepts underlying a liberal democratic society.
Respect for autonomy: Voluntary decisions about the time and circumstances death are very personal. In a certain sense, the end of life—death—is a person’s most private act. Other factors in life—e.g., birth, sexuality—occur in conjunction with other persons. Death occurs alone. This, of course, raises the rhetorical question, “just whose life is it, anyway?” Understood in these terms, a competent individual should have the right to elect death as an option.
Individual liberty v. state interest: Though society has strong interest in preserving life, that interest must be balanced against a comparable requirement to respect individual autonomy. It appears obvious that state interest recedes and is overtaken by the demands of personal autonomy when a person is terminally ill and evinces a strong desire to end what has become an intolerable existence. A complete prohibition on assisted death excessively limits personal liberty. Therefore PAS should be allowed in certain cases.
Justice: Justice requires that we ‘treat like cases alike.’ Competent, terminally ill patients are allowed to hasten death through treatment refusal. For some patients, however, treatment refusal will not suffice to hasten death. In such cases the only option is active intervention that achieves the same goal. Justice requires that we should allow assisted death for this latter group.
Compassion: Suffering often extends beyond considerations of pain and its amelioration. There are other physical and psychological burdens (e.g. quadriplegia) that often involve unbearable suffering. Under such circumstances, the individual should have the right to call upon assistance to terminate it once and for all.
ARGUMENTS IN OPPOSITION TO PHYSICIAN ASSISTED SUICIDE
As in the case of arguments in favor of PAS, arguments in opposition extend from philosophical considerations to the specifics of medical practice and patient treatment.
Sanctity of life: American democracy and limited government rest to a considerable extent on religious traditions that, inter alia, find suicide morally objectionable. To act in a manner that fundamentally opposes such a broadly based moral precept may serve to undermine others upon which the nation’s principles