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The Case For Voluntary Physician
Assisted Suicide
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The
following introduction is from
Derek Humphry
who is the author of the ground-breaking book on assisted
suicide entitled
Final Exit and the founding father of the Hemlock Society
- now known as
The Euthanasia
Research & Guidance Organization
(ERGO) - the world's premier right-to-die organization.
ERGO is a nonprofit educational
corporation based in the State of
Oregon, U.S., and was founded in 1993 to
improve the quality of background
research and information for hastened
dying for persons who are terminally or
hopelessly ill and wish to end their
suffering. ERGO holds that voluntary
euthanasia, assisted suicide,
physician-assisted suicide,
physician-assisted dying and
self-deliverance, are all appropriate
life endings depending on the individual
medical and ethical circumstances. In the following paragraphs, Humphry presents a very simple
and powerful case in favor of the right-to-die position.
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Table of Contents |
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1.
Introduction by Derek Humphry |
While it is true that we have no
control over our births, at least we ought to have control
over our deaths. How can we claim to be free people if someone
else's morals and standards govern the way we die? Physician-assisted suicide for an adult who is
in a rational state of mind, whose terminal suffering happens
to be unbearable despite the best medical efforts, is an
idea whose time has come. I'll explain why. We
die differently today from our forebears. In this century,
medicine has made tremendous strides towards keeping us
healthy and living longer, for which we are all grateful.
But modern medicine has not entirely solved the problem
of terminal pain, and it certainly never will be able to
answer the very personal question of an individual person's
quality of life. Some people can stand more
pain than others. Some patients in their dying days suffer
distressing symptoms, like loss of bowel control, hemorrhaging,
bedsores, permanent hiccups and so forth. So psychic pain
is added to the rest of the problems. Take
note that I have liberally used the word some. Most people
die quickly, peacefully, and painlessly. Of that there is
no doubt. Physician-assisted suicide is needed for very
few dying patients - probably two percent or less of total
deaths. But, two points:
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a. |
You or I could be in that two
percent; |
b. |
If we're not included, then
we should have the decency to speak up for those
who unluckily are.
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As I said, we die differently nowadays.
There is the scourge of AIDS, which in some cases is a terrible
death. More of us die of degenerative diseases like A L
S (motor neuron disease), Parkinson's, Multiple Sclerosis,
Alzeheimer's Disease, and Osteoporosis. These wasting diseases
take years to run their course - sometimes 10 to 15. Our
grandparents knew very little of such diseases because they
died earlier. Two out of every five of us is
going to die from a degenerative disease. Knowledge gives
choice. At my present age of 69, I can remember when as
a young man we took the word of doctors and nurses as gospel.
They knew better. We had almost no medical informational
sources. But you've probably noticed that things are different
nowadays. Television and radio programs graphically describe
health matters; books and magazines on medical and psychological
affairs are big sellers; and non-medical persons can attend
conferences and workshops about their special subject. With the empowerment of better knowledge, we nowadays
make more decisions for ourselves. Of course, working intelligently
with our medical advisors to come to the best decision for
our case remains important. But we live in a more autonomous
age; gone are the days when the doctor played God.
Some terminal pain is managed well, but the medical
literature is full of examples where it is not. Sometimes
it is medical ignorance through sloppy training, occasionally
carelessness due to overwork, and in a few cases indifference
by second-rate doctors. There are rare instances where a
request for physician-assisted suicide is justified in being
made because of intractable pain, and that's why an appropriate
law is necessary. Sometime in the next century,
laws will be altered to permit voluntary euthanasia and
physician-assisted suicide -- at least in western countries.
In my view, supporters of this concept should constantly
work in whatever way they can for such important reforms.
- by Derek Humphry
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2.
End-of-Life Political Terminology |
Before delving into the issues it is
important to first understand the terminology involved.
The following is a glossary of terms to help you better
understand end-of-life issues.
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Right to Die |
The belief that
end-of-life decisions should be
an individual choice and that everyone
has a fundamental right over their
own life and death |
Right to Life |
The belief that
death should only come about by
the will of a god or gods, or the
belief that life is the prevailing
value, regardless of medical conditions
or desires to end it for whatever
reason. |
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3.
End-of-Life Death Terminology |
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Murder |
Unlawfully ending the life of a
person who wished to be alive |
Kill |
Lawfully or unlawfully ending the
life of a person |
Mercy Killing |
Ending the life
of a person without their explicit
request in the belief that it is
the only compassionate thing to
do (this term is loosely used to
describe all acts of euthanasia) |
Suicide |
Deliberately ending one's own life |
Assisted Suicide |
Providing someone
else with the means, such as drugs
or other agents, for them to take
their own life (assisted suicide
differs from euthanasia in that
it is only assistance) |
Physician-Assisted Suicide |
A doctor providing
the lethal drugs with which a dying
person may end their life |
Euthanasia
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Literally means "good death." Helping yourself
or someone else have a good death
(euthanasia differs from assisted
suicide in that it is actively participating
- rather than assisting - a person
end their life) |
Passive Euthanasia |
Deliberately
disconnecting life support equipment,
or stopping any life-sustaining
medical procedures, to permit the
natural death of the patient ("passive"
refers to an act that indirectly
causes death) |
Active Euthanasia |
Deliberately
taking action that directly end
the life of a dying patient to avoid
further suffering ("active"
refers to an act that directly causes
death) |
Active Voluntary Euthanasia |
A lethal injection
by a doctor into a dying patient
when the patient has consented to
it |
Active Non-Voluntary Euthanasia
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A
lethal injection by a doctor into
a dying patient when the
patient's consent is unknown (usually
a patient who is no longer able
to communicate) |
Active Involuntary Euthanasia |
A lethal injection
by a doctor into a dying patient
when the patient has refused (this
is so-called "Nazi euthanasia") |
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4.
End-of-Life Medical Terminology |
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Hospice |
A program of
care for a person in the last six
months of life, providing pain management,
symptom control, and family support
(palliative care is the medical
term for hospice) |
Heroic Measures |
Medical procedures
which are pointless because the
patient is certain to die shortly |
Double Effect |
Giving large
amounts of opiate drugs to a patient
to relieve pain while at the same
time recognizing that these will
hasten death |
Slow Code |
The deliberate
slow response to a medical alert
of heart or breathing stoppage which
is designed to make resuscitation
impossible (also known as "blue
code") |
Negotiated Death |
A formal agreement
between family, physicians, hospital
management, etc., that life support
systems to an incompetent person
are better disconnected in the best
interest of the patient (all parties
agree not to bring lawsuits) |
Snow |
A slang word
which means administering heavy
doses of opiate drugs to completely
sedate a person who is dying painfully
(person dies whilst unconscious) |
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5.
End-of-Life Diagnostic Terminology |
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Terminally ill |
A person dying from an illness which
has no known cure |
Irreversibly ill |
Same as terminally ill but more
likely to be a lengthier dying process |
Hopelessly ill |
A person with
a disease that has no known cure
but is not immediately life-threatening |
Vegetable |
A crude but popular
way of describing a person who is
in a long-term coma (the correct
term is persistent vegetative state) |
Persistent Vegetative State |
A severely brain-damaged
person in a permanent coma from
which they will not recover (the
person is almost always on life-support
systems) |
Coma |
Prolonged unconsciousness
from which a patient may or may
not recover |
Brain dead |
Complete cessation
of cognitive function - life support
systems could keep the body operating
but pointless - the point of death
is defined by what is known as "the
Harvard criteria" |
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6.
End-of-Life Ethical Terminology |
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Ethics |
A system of moral standards or values |
Bioethics |
A study of the moral problems which
face modern medicine |
Rule Ethics |
Obeying the moral standards dictated
by a religion |
Situation Ethics |
Moral standards as dictated by the
prevailing circumstances |
Medical Ethicist |
A person with
philosophical and/or legal training
who offers opinions on the moral
dilemmas which face physicians and
psychiatrists |
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7.
End-of-Life Legal Terminology |
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DNR |
(Do
Not Resuscitate)
an order on the patient's medical
chart advising health professionals
that extraordinary measures should
not be used to attempt to save this
person's life |
Advance Directives |
The legally accurate
name for the next two documents
dealing with passive euthanasia |
Living Will |
The popular name
for an advance directive by which
a person requests in writing a physician
not to connect, or to disconnect,
life-supporting equipment if this
procedure is merely delaying an
inevitable death |
Durable Power of Attorney for Health
Care |
An advance directive
by which a person nominates another
person to make health care decisions
if and when she/he becomes incompetent,
thus allowing by proxy decision
a treating physician to obtain informed
consent to a medical procedure or
withdrawal of treatment |
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8.
The Case for Voluntary Physician Assisted
Suicide in General |
The following
are excerpts from a 1994 executive summary on assisted
voluntary euthanasia and other end-of-life decisions of
The
British Columbia Civil Liberties Association.
Modern medicine has been enormously successful
in saving and extending lives. No one can reasonably regret
this, but it exacerbates a problem which has always been
with us, namely, how to treat those patients who are alive,
but not living lives they think worthwhile, and have no
prospects for anything better. Under current law, patients who want
to die can either commit suicide, or, if they are competent,
refuse all treatment necessary for life. But patients do
not always have the ability and opportunity to do the former,
and the latter does not always bring about a gentle and
easy death for either them or their loved ones. The question
thus arises as to whether we should make legal provision
for assisted suicide - providing the means of suicide -
and active voluntary euthanasia - killing patients on request.
There is a strong case for allowing persons
who are facing intractable pain or indignities in the final
stages of their lives to determine for themselves when life
is no longer worth living, and, where necessary, receive
assistance in ending their lives. This case is constructed
from the principles of liberty, autonomy and equality; from
the value of preventing unnecessary suffering and preserving
the dignity of the individual; and from the inconsistency
between legally allowing suicide and passive voluntary euthanasia
while denying legal space to assisted suicide and active
voluntary euthanasia. If we are to continue legally to bar
these practices, there must be a compelling reason for doing
so. None of the reasons that have been put
forward for continuing the current absolute ban on assisted
suicide and active voluntary euthanasia is compelling. We
consider separately each of these arguments, which include:
the sanctity of life and the moral wrongness of killing;
the possibility of an incorrect diagnosis or a miracle cure;
the alleged inability to know that voluntary informed consent
has been obtained; the "slippery slope" argument;
and the ability of modern medicine to control pain.
Since none of the arguments against prohibiting assisted
suicide and active voluntary euthanasia is compelling, the
strong case for the legalization of these practices must
prevail. We note that, although the objections are not compelling,
they do raise concerns which must be addressed in making
legal provision for aid in dying. The logic of the debate is this: There
is a case for legalizing assisted suicide and active voluntary
euthanasia. There is a long list of objections to doing
so. If all the objections can be answered, the pro-legalization
case will be left in sole possession of the field, and governments
should act accordingly. On the other hand, if any of the
objections is good, that case will be cancelled, and governments
should keep the legal door to the practices in question
shut. We will argue that none of the objections is good. Our rejection of the objections to legalizing these
practices does not mean that the objections cease to function
at all. This web page will spell out more explicitly our
belief that some of the objections function as limits on
access to these practices, and form the rationale for procedural
requirements designed to ensure that access to these practices
is not abused.
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9.
The Case in Favor of Assisted Suicide and Active
Voluntary Euthanasia
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a. People
Should Be Free to Control Their
Life and Death |
The first and simplest argument appeals
to the value of liberty. Freedom is a good. Restraint is
an evil. This forms the basis of the common view that individuals
can do as they want unless there are weighty reasons which
dictate otherwise. Restrictions on liberty are certainly
sometimes justifiable, but the onus of justification always
lies on their defenders. Thus, given that prohibiting
assisted suicide and active voluntary euthanasia are restrictions
on liberty - patients are prevented from getting what they
want, and physicians from providing it - there is a good
case for legalizing those practices, and it is up to their
opponents to show why they should be forbidden.
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b. People
Should Be Allowed to End Their Suffering |
This case can be strengthened by appealing
to two other equally uncontroversial values: the prevention
of suffering and the dignity of the individual. Patients
sometimes are in medical conditions for which there is no
relief, and awaiting them is a future filled with suffering,
or the indignity of the disintegration of their bodily and
mental functions, or both. They often want to avoid these
evils, and shield loved ones from their sight. It is also
sometimes the case that the only way to do this is to die,
and the only way to do that is to receive some assistance
in the form of help in committing suicide or active voluntary
euthanasia. If we now grant that people have a right
to preserve their dignity and minimize their suffering and
that of others, we again get a strong presumption in favor
of making some kind of legal allowance for assisted suicide
and active voluntary euthanasia.
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c.
Some People are Physically Unable to End Their
Lives When the Option is Open to Others |
The principle of equality supports another
argument. The prohibition against assisted suicide creates
an inequality since it prevents persons physically unable
to end their lives unassisted from choosing suicide, when
that option is open to others. Although the blanket prohibition
on assisted suicide appears to treat all persons equally,
its actual effect is to deprive persons who are unable to
commit suicide without assistance of the ability to commit
suicide in any way that is lawful.
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d. Voluntary
Euthanasia is Legal |
Finally, we turn to a pair of arguments
which proceed by alleging there is an inconsistency between
what the law permits and prohibits, and since it is right
to permit what it does, the prohibition should be removed. The first of these begins with the fact that passive
voluntary euthanasia is allowed by the law: a competent
and fully informed person may, for whatever reason, appropriately
refuse any treatment necessary for life. Thus, if active
voluntary euthanasia is to be legally proscribed, there
must be some relevant difference between killing and letting
die. It is, however, not clear there is: if
both the intention - to bring about a death - and the certainty
of outcome - death coming about - are the same in each,
it is hard to see how there could be any morally relevant
difference between killing patients and letting them die. It does not follow that we can appropriately aid persons
in securing death whenever they can refuse treatment, for
they may refuse treatment for bad reasons, and while there
may be nothing immoral or properly preventable about them
harming themselves, there is something wrong in our assisting
them in doing so. However, it does follow that if they have
a good reason for refusing treatment - if, say, their future
is brief and only holds pain and indignity - there is a
presumption that there is nothing wrong with our assisting
them, and the law should not stand in our way either to
help them kill themselves or to kill them on their authority.
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e.
Suicide is Legal |
The next argument runs along exactly
similar lines, and begins with the fact that suicide is
not a criminal offence. This does not mean we should not
prevent suicide when we can. In most cases we certainly
should, for suicides typically have very bad reasons for
wanting to die, and need our help. But suicide cannot be
properly prevented in all cases. If persons have a good
reason for death - if, for instance, they are elderly and
terminal and suffering - it would be unspeakably meddlesome
to interfere. But if so, we get the presumption that in
just those circumstances in which we should not prevent
persons from bringing about their own death, we can appropriately
help them do so by either assisting their suicide or delivering
active voluntary euthanasia. If persons have
a good reason to die, and do not have the means to commit
suicide, they should be legally allowed to request and receive
those means from those willing to provide them, and if they
are too weak to swallow a pill or inject themselves, to
authorize others to deliver the fatal dose. Thus under certain
conditions the right to suicide entails the right to assisted
suicide and active voluntary euthanasia.
This completes
the case for the legalization of assisted suicide and active
voluntary euthanasia. Insofar as we value liberty, the prevention
of suffering, and dignity, and admit that sometimes people
have a good reason for wanting to die and need help to do
so - all surely uncontroversial claims - there is no avoiding
the conclusion that the burden of proof lies on those who
wish to oppose legalizing the practices in question. But
this is also a burden which opponents have taken up, and
they have provided a formidable list of obstacles to those
practices. It is to these that we must now turn.
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10.
The Case Against Assisted Suicide and Active
Voluntary Euthanasia
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a.
Life is Sacred and Killing is Wrong |
One objection to assisted suicide and
active voluntary euthanasia is that they involve killing,
and all killing is morally wrong. This principle may be
based on religious views (e.g., the sixth commandment) or
maintained on purely secular grounds. But whatever its basis,
we cannot appeal to this unqualified principle to condemn
the practices in question unless we are prepared to condemn,
for example, the killing of steers for food, fish for sport,
trees for paper, weeds to beautify a garden, mosquitoes
for comfort, and so forth.
Few are prepared
to accept such consequences. But if we are not, our task
is find some version of the sanctity of life principle which
will allow instances of killing we want to allow, while
at the same time excluding assisted suicide and active voluntary
euthanasia. However, this is not easy to do.
One might try to avoid the above repugnant consequences
by restricting the principle to human beings. The question
immediately arises as to whether this is an arbitrary restriction,
but we will not pursue that here. It is sufficient to notice
that the restricted principle still excludes too much, prohibiting
as it does killing in self-defense and to protect the defenseless.
Nor would it help to stipulate that it is the killing of
innocent human beings which is morally prohibited. For not
only is it strained to morally proscribe assisted suicide
and active voluntary euthanasia because they involve "taking
an innocent life", the principle itself is problematical.
We do not want to disallow killing insane (and therefore
presumably innocent) attackers, and it is highly controversial
to condemn bombing enemy civilian populations in wartime
when not doing so would result in the heavier bombing of
our own. One could continue doing moral carpentry,
and tack further qualifications onto the sanctity of life
principle to secure just the conclusions one wants. For
example, one could specify further that killing innocent
but insane aggressors and innocent civilians in wartime
are not absolutely prohibited, but that assisted suicide
and active voluntary euthanasia nonetheless are. But then
the principle starts to appear to arbitrarily exclude those
practices, and we must ask what reason there is for excluding
them at all.
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b.
It Violates Our Duties to God, Ourselves and
Others |
There are three possible
reasons: assisted suicide and active voluntary
euthanasia violate some duty to God, or to
ourselves, or to others. We will take each in
turn.
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I. |
It violates our duty
to God: There exist both strongly held and intellectually
coherent religious reasons for a demand on the part of some
people that the current legal prohibitions on assisted suicide
and active voluntary euthanasia be retained or even strengthened.
However, in American society we do not use the criminal
law to enforce the religious views held by some people on
others who do not share these views. This is not a denigration
of those religious views, but an assertion of the principle
that a state which respects the right of its citizens to
choose their own religious values cannot use the criminal
law to enforce such views. |
II. |
It violates
our duty to ourselves:
The claim that we have duties to
ourselves is conceptually incoherent.
Because to say that I have a duty to
myself is to say that I have a right
against myself. And since I can always
waive my rights, but can never release
myself from a duty, it is contradictory
to speak of duties to oneself: I have
something from which I both can and
cannot release myself. |
III. |
It violates our duty to others:
It is hard to see what duties to others
could be exacted from realistic
candidates for assisted death. Such
patients are not typically going to be
in a position to render very many
services to others, and even if they
were, it is plausible to suggest that
their medical distress cancels any duty
to provide them. |
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Much more could be said about
all these grounds for claiming that assisted suicide and
active voluntary euthanasia are immoral. But we need not
dilate on them. For even if assisted suicide and active
voluntary euthanasia were shown to be immoral in any of
the above senses, it would not follow without considerable
further argument that they should be illegal. We might view
them as many currently do homosexuality and adultery: immoral,
perhaps, but nonetheless not the law's business.
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c.
An Incorrect Diagnosis is Possible or a New
Treatment Might Be Discovered |
There is always the possibility of an
incorrect diagnosis or the discovery of a treatment that
will permit either survival or recovery.
Rebuttal: While these things
cannot be ruled out as absolutely impossible, they can often
be ruled out as impossible for all practical purposes. It
is frequently beyond all reasonable doubt that the diagnosis
is mistaken or some cure will not be discovered in time
to help, and it is not clear why this should not be sufficient.
The law has never taken a "pigs might fly" attitude towards
the risks attendant on any activity. We only need to establish
"guilt beyond reasonable doubt" to send a person to prison
or even to his execution, and it is not possible to require
more without making the enforcement of the law impossible.
Why a more stringent standard should be demanded in the
cases of assisted suicide and active voluntary euthanasia
needs to be explained. Moreover, when the likelihood
of being restored to what one would regard as a worthwhile
life is small, and that of enormous pain and degradation
relievable only by death great, no one can plausibly say
that the decision to die is an unreasonable one. But if
so, respect for the autonomy of the individual requires
that we not prohibit him from authorizing others to help
put it into effect.
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d.
Voluntary and Informed Consent Can Never Be
Absolutely Sure |
We can never be absolutely sure that
we have voluntary and informed consent. If the request is
made prior to patients' coming to be in a desperately bad
way - say in the form of a living will - it cannot be considered
binding because it is insufficiently informed. On the other
hand, if the request is made when patients are in a bad
way, then the pain and drugs prevent them from making a
fully rational decision. In either case, it is not possible
to secure a death-request which would justify the deed.
Rebuttal: The demand for absolute
certainty with which this objection begins is too strong.
But even if we purge the complaint of that feature, it is
still not good. It is indeed true that prior request ought
not always be considered binding. Certainly it should not
be if individuals subsequently renounce their decisions.
Again, if individuals alternately reaffirm and renounce
their decisions we may be in a quandary about what to do.
But it cannot reasonably be claimed that a prior request
can never be binding because it is always insufficiently
informed. If individuals reaffirm their decisions under
pain, after the first shock of it has passed, we have very
good grounds for claiming to know their fixed and settled
desires. Again, if individuals fall into a
state which does not permit them to either reaffirm or renounce
their decisions, and are not expected to recover from that
state, then we have the same reason to act on their prior
death-requests as we would subsequently have to distribute
their estates in accordance with their wills. In both cases,
such decisions are momentous, irrevocable, and ones that
might not have been made if the persons could have foreseen
their futures. But to deny the bindingness of such requests
is to say that persons should not be permitted to make such
decisions, and that is surely unacceptable.
Where the individuals make the death-requests in pain
and under the influence of narcotics, it must be admitted
that they are not in the best condition to make a fully
rational decision. But it must also be granted that they
are in an excellent position to say whether or not they
wants to continue living in such a state. It
may also be that such an existence is the best they can
expect, and there will come a time when it is quite unreasonable
to tell patients that they will adjust to their condition,
and a time when it is unreasonable to hold out any hope
for any improvement. It is hard to see why the appropriate
facts of this sort, conjoined with the patients' judgment
that their present state is intolerable, should not yield
a request for death that is sufficient to justify action.
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e.
Terminal Patients May Feel Obligated to End
Their Lives to Prevent Being a Burden to Others |
The chronically and terminally ill are
often vulnerable and feel themselves to be (and often are)
a burden to others. Many of the ill, however, are not tired
of life and do not want to die. But if assisted suicide
and active voluntary euthanasia were readily available,
they might feel obligated to opt for death, and relatives
or others in whose care they are, who often would just as
soon be rid of the burden, may consciously or unconsciously
exert pressures, in a way difficult to detect and avoid,
to request assistance in committing suicide or active voluntary
euthanasia.
Rebuttal: It is unrealistic
to suppose that some such tragedies will not occur. But
that should not be taken as a decisive objection to the
practices in question. We allow policemen to carry guns
and young people to choose their marriage partners, and
tragedies result from these too. But we accept such tragedies,
however regretfully, as a part of the price of policies
which are on the whole beneficial, and a similar line is
plausible in the case of assisted suicide and active voluntary
euthanasia. It is a mistake to think that if
we do not liberalize the law no tragedies will occur. The
pain and degradation which euthanasia laws address will
continue; the sick will continue occasionally to attempt
suicide in ways which are neither painless to themselves
or others nor always successful; friends and relatives will
be faced with the terrible choice of either standing by
and watching the suffering and disintegration of a loved
one, or acting in a way which is contrary to law and for
which they have no expertise. We must also
be careful not to exaggerate the susceptibility of persons.
Persons who are competent to make a legally binding death-requests
will also typically be able to resist the pressures in question;
if they cannot do the latter, they will not typically be
able to do the former. Nor should we presuppose that the
pressures in question cannot be adequately counteracted
by informal means such as counseling and discussion. If
they can be - and there is no reason to think otherwise
- it would certainly be more appropriate to so control them,
for we do not thereby deprive everyone of the right to death
in order to protect a few who could be protected in some
other way.
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f.
Voluntary Euthanasia Will Eventually Lead to
Non-Voluntary Euthanasia Tomorrow |
Legalizing assisted suicide and active
voluntary euthanasia today will lead to active non-voluntary
euthanasia tomorrow, and that will lead to active involuntary
euthanasia the day after: the antisocial, the ethnically
unattractive, the politically deviant, the aged, etc., will
all become potential victims. Thus if we do not draw the
line where it is, we will not be able to prevent substantial
harm to others. This is the famous
slippery slope argument.
Rebuttal: This argument is singularly
implausible if one who makes it means that there is a logical
connection between the killings in question such that one
who endorses the first cannot without inconsistency refuse
to endorse the last. The fact that in one case a person
is killed in his own interest because he requests it, whereas
in the other a person is killed in the interest of others
without (or contrary to) his consent, is surely a morally
relevant difference. Since this is so, the question "How
can we draw the line?" should not perplex one for long.
No one thinks that making killing in self-defense an exception
to criminal homicide starts one on a slippery slope which
logically must end in the abolition of the crime of murder;
no one should think the same about legalizing voluntary
euthanasia.
A more common and plausible way
of understanding the objection is to take it as alleging
an empirical connection between the killings in question.
If, however, the claim is an empirical one, it stands in
need of evidence. What is the evidence that a policy of
allowing death on request, begun in good faith and motivated
by compassion, will lead to unwanted killings? Two items of evidence are commonly alleged. The first
is the Nazi experience. However, there is no parity between
the cases; all they have in common is the name euthanasia.
In these cases, the name stands for quite different policies.
The Nazi program of euthanasia was neither voluntary nor
based on compassion; it was, rather, motivated by the desire
to remove useless eaters and preserve the purity of the
Volk, and hence was the result of a vicious and racist ideology
already firmly in place, not the unwanted and unexpected
upshot of an intrinsically desirable social reform. The second, which is currently attracting the most attention,
is the Netherlands experience. In the Netherlands we have
a living laboratory in which the euthanasia experiment in
being conducted, and it is claimed that active non-voluntary
and involuntary euthanasia are openly practiced there, exactly
as predicted by the slippery slope argument. But the claim
of the open and common practice of involuntary euthanasia
has been often repeated but has never been substantiated,
and indeed has been repeatedly challenged. To begin
with, to say that a slippery slope has taken place is to
make a causal claim to the effect that legalizing assisted
suicide and active voluntary euthanasia caused an increase
in the incidence of active non-voluntary euthanasia. But
a high incidence rate does not, in itself, establish causation.
Nor can one argue for causation on the ground that legalizing
assisted suicide and active voluntary euthanasia was followed
by an increase in active non-voluntary euthanasia. To establish
causation, it is necessary to show that if assisted suicide
and active voluntary euthanasia were not legalized, then
there would not have been an increase in incidence of active
non-voluntary euthanasia. However, there is no evidence
to support this, and hence no evidence for a slippery slope
having taken place in Holland. Moreover, even
if a slippery slope were demonstrated, the wrongness of
legalizing assisted suicide and active voluntary euthanasia
would not follow without considerable further argument.
Two defenses are open to defenders of legalization. First, one can argue that the occurrence of that incidence
of active non-voluntary euthanasia is a regrettable but
acceptable consequence of an on-balance beneficial policy.
This is the argument which accepts the downside alleged,
but contends that there is a countervailing upside. Second, one can take the line that the incidence of
active non-voluntary euthanasia is acceptable and not regrettable.
The cases of active non-voluntary euthanasia which comprise
the bulk of those which occurred in Holland involved severely
defective newborns or debilitated elders (many of whom had
made a prior request for euthanasia, but not in a way which
satisfied the stringent consent requirements laid down in
Dutch law). Further, some Dutch physicians argue that active
non-voluntary euthanasia is more humane and dignified for
all concerned than the alternatives of keeping the patient
alive or letting nature take its course.
But
let us now suppose that all the above is mistaken; let us
suppose, that is, that slippery slope has taken place in
Holland, and that this is unacceptable. The question still
remains whether this provides compelling evidence that a
slippery slope would certainly or likely occur if assisted
suicide and active voluntary euthanasia were legalized in
America. There is a difference between the
two cultures which makes that inference problematic. There
also may be ways of making legal space for those practices
- say with greater safeguards or stiffer penalties - which
will prevent unacceptable results. Even if Holland's way
of legalizing assisted suicide and active voluntary euthanasia
led to active non-voluntary euthanasia there, that provides
no evidence for saying that other means of legalizing those
practices will lead to that consequence elsewhere. The upshot of the above is that we do not have convincing
evidence that legalizing assisted suicide or active voluntary
euthanasia will certainly or probably lead to unacceptable
consequences. Thus the empirical version of the slippery
slope argument fares no better than the logical version.
There is one final version of the slippery slope argument
to be considered. It is sometimes argued that while there
is no evidence for a slippery slope taking place, it is
something which everyone must admit is possible, and do
we want to take that chance? This argument
assumes that things are just fine now. The problem with
the argument is that the assumption is false. We know that
legalizing assisted suicide and active voluntary euthanasia
will help. We do not have any evidence that bad consequences
will ensue. Put this way, which we submit is the accurate
way, the gamble seems eminently reasonable.
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g.
It Could Be Used as a Cover for Committing
Homicide |
The proposed legislation would make it
easier to commit malevolent homicide. Many people want,
and badly want, to be rid of others, and the deaths of those
persons could be brought about under the cover of voluntary
euthanasia.
Rebuttal: This objection applies
with equal force to allowing killing in self-defense as
non-criminal homicide. So, insofar as it is not used to
advocate the repeal of that classification, its application
to the case of voluntary euthanasia is unsound and discriminatory. With certain safeguards, it would also be difficult
to pass off murder as euthanasia. Certainly that would be
no easier - and probably a good deal harder - to do than
to pass of murder as self-defense or suicide. Since this
is so, it is unlikely that legalizing voluntary euthanasia
will cause an increase in the incidence of murder or of
undetected murder.
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h.
It Will Create a Decision-Making Bureaucracy
That Will Just Prolong Their Agony |
Patients seeking assisted suicide or
active voluntary euthanasia clearly do not wish to prolong
their agony, but seeks a quick end to their suffering. Yet
any proposal for the legalization of these practices must
necessarily include some process of ensuring that their
decision is voluntary and informed. Any such procedures
would have to be carefully followed and the results painstakingly
confirmed. All this would demand time, and by wrapping the
decision-making process in red tape, create the very delays
which those who advocate the practices seek to avoid.
Rebuttal: To ensure that assisted
suicide and active voluntary euthanasia are not misapplied,
time consuming procedures must be followed. But to conclude
from this that these practices should not be legalized is
like arguing that no one should get a driver's license or
unemployment benefits, because it would be irresponsible
to hand them out without verifying the information, and
that means that people cannot get them as speedily as they
wish. The unavoidable necessity of delaying
assisted suicide and active voluntary euthanasia is no reason
for denying them altogether. We must also not exaggerate
the time and red tape that need be involved in following
procedures which are reasonable safeguards against misuse
and abuse.
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i.
Physicians Don't Want to Be Nor Should Be
Involved in This Kind of Activity |
The medical profession exists to provide
important professional services, and neither wants to be
nor should be involved in the kind of bureaucratic activity
involved in responsibly administering the delivery of assisted
suicide and active voluntary euthanasia.
Rebuttal: This objection begs
the question by assuming that assisted suicide and active
voluntary euthanasia are not "important professional services."
But that is false. It is important to most people to die
painlessly and with dignity, and engineering such a death
by way of assisting suicide or delivering active voluntary
euthanasia is a matter calling for medical expertise. Grant
this, and the objection that we should not legalize the
practices because of the paperwork involved - which could
not be any greater than that involved in determinations
of competency - is embarrassingly lame.
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j.
Hospice and Pain Control Has Advanced in Recent
Years and is a Better Option |
The extraordinary development of palliative
care and pain control in recent years is a more positive
and safer response to the problems than assisted suicide
or active voluntary euthanasia.
Rebuttal: The hospice movement
and advances in pain control are certainly welcome developments
which do something to reduce the need for legalizing assisted
suicide and active voluntary euthanasia. But they do not
remove it altogether, and we should not view these things
as alternatives. There are indeed drugs which,
if properly administered, can control pain. Nonetheless,
insofar as the patient remains conscious, there are other
forms of distress such as the terror of breathlessness,
uncontrollable vomiting, paralysis, incontinence, inability
to swallow and sheer weakness and helplessness which cannot
always be adequately controlled. We must also remember that
it is often difficult to arrive at and maintain the correct
dosage of drugs under the most conscientious surveillance
of patients, and the practical realities of contemporary
medical care mean the patients often get less than this. However, even if pain and distress were not a problem,
there is frequently a strong fear on the part of patients
of the abject dependency and degradation involved in the
loss of bodily and mental functions which often accompany
the dying process, and no amount of care services can remove
these.
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k.
It Will Discourage the Search for New Cures and
Treatments for Terminal Patients |
The legalization of assisted suicide
and active voluntary euthanasia will discourage the search
for new cures and treatments for the terminally ill patient.
Rebuttal: There is no difficulty
in showing any policy to work ill if we conjoin idiocy with
it; and if we suppose that people will accept assisted suicide
and active voluntary euthanasia as substitutes for treatments
and cures, there is no difficulty in showing a serious problem
with their legalization. But if one is to look askance at
these practices for this reason, one must do so at a host
of other things as well, such as improvements in palliative
care, fire and theft insurance, and airbags in automobiles. But this is surely absurd. There is no reason to think
these mitigating measures have that effect, and it remains
to be shown why we should think that legalizing assisted
suicide and active voluntary euthanasia would have it either.
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l.
It Will Encourage Patients to Give Up and
Significantly Decrease Their Chances for
Recovery |
Patients who struggle to recover have
better recovery rates than those who have given up hope.
The availability of assisted suicide and active voluntary
euthanasia will encourage patients to give up, and so significantly
decrease their chances for recovery.
Rebuttal: On the face of it,
this argument applies with equal force against allowing
people to divorce, drop out of college, or refuse medical
treatment, for removing those options would likewise make
people struggle with sometimes good effect. But even if
we limit the scope of the argument to assisted suicide and
active voluntary euthanasia, it is not a good one. One cannot argue that the struggle would be beneficial
in all cases. Nor could one realistically argue that medical
prognoses are so fallible that it may be valuable in any
given case. The prohibition must therefore be based on the
claim that it would be beneficial on the whole. There is,
however, no evidence to suppose that this is so. But even
if there were, criminalizing the conduct for this reason
relies on a questionable theory of interference. Certainly, society may interfere to prevent individuals
from harming others. It is more problematical, but also
arguable, that it may interfere to prevent unencumbered
individuals from harming themselves. This argument, however,
depends on the still more controversial view that society
can prevent some unencumbered individuals from acting in
their interest in order to prevent other unencumbered individuals
from acting to their detriment, and this principle seems
impossibly strong.
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11. Conclusion |
This brings us to an end of our review
of the arguments for and against assisted suicide and active
voluntary euthanasia. Two things are evident: the arguments
against these practices are very weak, and each applies
with equal force against some other entrenched practice
or practices, most notably passive voluntary euthanasia
and killing in self-defense. Given the latter, if we do
not allow the arguments to rule out those practices, we
should not let them rule out assisted suicide and active
voluntary euthanasia. And, given the former, we should not
allow the arguments to rule out those practices. Thus we
have failed to find any objection sufficient to cancel the
case in favor of assisted suicide and active voluntary euthanasia.
Unless some such objection is produced, legal provision
should be made for those practices.
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12.
Links to Voluntary Physician Assisted Suicide
Sites and Articles |
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