Tuesday, January 29, 2013

What’s wrong with assisted suicide?

The following was published in the Nov./Dec. 2012 issue of MCCL News.

On Nov. 6 the state of Massachusetts narrowly rejected a ballot measure to authorize physician-assisted suicide, which is already legal in Oregon and Washington. The Minnesota law prohibiting assisted suicide has recently been challenged in court by Final Exit, a euthanasia advocacy organization. How should we think about this emotional and ever-looming issue?

Physician-assisted suicide—euphemistically called "aid in dying" and "death with dignity"—is when a doctor helps a patient intentionally take his or her own life, usually by prescribing a lethal dose of medication. It is both morally wrong and practically dangerous. And none of the arguments offered for its legalization are successful.

Morally wrong

Suicide is morally wrong because it is the intentional killing of an innocent human being. The norm against killing is grounded in the inherent dignity and right to life of the human person. Human life is a profound good. Life is better than death, and caring is better than killing. Suicide is always a gut-wrenching tragedy because it is the wrongful loss of something precious, of someone who mattered. It should never be sanctioned or encouraged by the medical profession or by the state.

This does not mean that a patient's life must be sustained by all means in all circumstances. Allowing death—e.g., by withholding artificial treatment from a terminally ill patient—is not the same as intending death. Nor is it necessarily wrong to hasten the end of life through treatment aimed at controlling symptoms. In either case it is the underlying disease or injury that causes death, and the doctor's actions are intended only to allow the natural dying process to continue or to comfort the patient. (Of course, these decisions should be made in accordance with the patient's wishes.)

Assisted suicide, however, is a case of intentional killing. It is, as Hippocrates taught, contrary to the very nature and purpose of the medical profession.

Practically dangerous

Assisted suicide is dangerous in practice for a variety of reasons. Consider the following:

  • In places where assisted suicide has been approved, psychiatric evaluation is not required, almost certainly leading to the deaths of many depressed patients who would have wanted to live had they received appropriate treatment. Suicide is a cry for help, and we should help such people, not facilitate their deaths.
  • The legal availability of suicide opens the door to pressure and even coercion to not be a "burden" on family or finances. When death is accepted as a rational choice, it may seem to be the only choice. Continued existence must be justified. The right to die becomes a duty to die.
  • Terminal diagnoses sometimes turn out to be wrong; some patients have received such a diagnosis only to live happily for many more years. But patients are denied any chance when they are aided in killing themselves.
  • Assisted suicide is unlikely to remain limited to the terminally ill. That restriction is not recognized in the Netherlands, where the circumstances in which killing is deemed appropriate have continued to expand. The arguments for suicide (see below) do not apply only to the terminally ill.
  • The acceptance of assisted suicide leaves little rational basis for rejecting active euthanasia—when a doctor directly kills a patient (usually via lethal injection) for the patient's alleged benefit. For the only difference between the two is who (the patient or doctor) performs the final act; sometimes a patient is unable to do it himself. And the acceptance of voluntary euthanasia can easily lead to non-voluntary euthanasia, including the killing of disabled newborn babies, as it has in the Netherlands.

Compassion, autonomy

Advocates of legalizing assisted suicide offer two main arguments. First, they argue that assisted suicide should be legal to relieve patients of unbearable pain and suffering. Compassion requires it.

But the data show that very few patients who seek suicide do so because they physically suffer. They seek suicide because they are depressed or fear losing autonomy or becoming a burden. Regardless, modern palliative and hospice care can treat pain in virtually all circumstances. The solution to suffering is to improve access to quality pain management—to end the suffering, not the sufferer. That is what true compassion requires. Finally, all of us experience forms of suffering during our lives; it is presumptuous to think that suffering has no value or purpose, and it is dangerous to think that it makes life less worth living.

Second, advocates of assisted suicide contend that suicide must be allowed as a matter of personal autonomy. Patients have a "right" to choose the timing and manner of their deaths.

But many suicidal patients are influenced by anxiety and depression (which should be treated) and are not acting rationally. And suicide is rarely just an individual choice; it affects the family members and friends left behind, not to mention the physicians who are made complicit. Legalization would confer social, governmental and medical approval of the act of suicide. This is far beyond mere "personal autonomy."

It is also clear that personal autonomy, while important, is not an absolute principle. Since morality is real—right and wrong, good and bad—we may not do just anything we want. The value of a life doesn't disappear because someone decides or feels that it does.

Everyone matters

Suicide in general is widely recognized as a tragic mistake. We raise awareness and create emergency hotlines. We do all we can to prevent someone from making that fateful decision. But advocates of assisted suicide think one class of people should be excepted from such concern and allowed—indeed, helped—to kill themselves. This is a rejection of the equal and intrinsic value of all human beings, irrespective of age, illness and disability.

Suicide is not the way to deal with the difficulties of life. And society is to blame when we enable killing rather than provide protection, care and treatment for those in need. Everyone matters.