This is the final of three Ethical Musings' posts on death and assisted suicide. The first post discussed the issue of life expectancy; the second post explored the morality of assisted suicide. This post delineates proposed criteria that laws regulating assisted suicide should incorporate (the presumption, of course, is that readers and legislators have found the case for assisted suicide persuasive).
First, a person requesting assistance with suicide should be terminally ill and have a life expectancy of less than six months. Assisted suicide is not an ethical option for the depressed, the disappointed, or the despairing. Assisted suicide offers a positive option for the person whose suffering—in the individual's own estimate—exceeds whatever value s/he may find from living longer.
Second, the law should require a physician approve a person's request for assisted suicide after discussing the mechanics of assisted suicide and the person's illness together. Only a physician is competent to assess whether a person is terminally ill and to offer an expert estimate of life expectancy.
Third, the person should make the request on more than one occasion. The law in all four states that have legalized assisted suicide stipulates that the terminally ill person must make the request twice orally and once in writing. This seems reasonable. On the one hand, it avoids whimsical, spur of the moment decisions. On the other hand, the requirement is not excessively onerous.
Fourth, a person making the request must be a mentally competent adult, i.e., over eighteen years of age. Establishing an age is somewhat arbitrary, but not allowing a four year old to decide whether to commit assisted suicide is clearly reasonable. Although one might argue for setting the age of consent at sixteen or twenty-one, eighteen seems a reasonable compromise. I invariably think that the age at which a nation is willing to send someone into harm's way as a member of its armed forces represents a reasonable age for other significant choices, such as voting, consuming alcohol, entering into marriage, etc. Mental competence (sanity) is also a reasonable requirement. The mentally ill and incompetent require our assistance rather than our complicity in making difficult choices.
Fifth, assisted suicide laws should specify that suicide occur through a lethal dose of legally prescribed drugs, in as painless a manner as possible, and, if possible, the terminally ill person should take a decisive role in administering the drug(s), even if that consists simply in pushing a button or flipping a switch. Legalizing assisted suicide without making it legal for physicians to prescribe the requisite drugs and pharmacists to fill those prescriptions is wrong. Having the person take an active part in her/his own death both helps to ensure that the person wants to die and that the death is truly assisted suicide, not murder.
Individuals should have the right to die with dignity. Choosing to die rather than to endure suffering that has no value is inherently part of dying with dignity. When a terminally ill person has had an opportunity to say goodbye or otherwise end important relationships, when that person is at peace with her or himself, and when that person is at peace with God, then choosing to die may represent taking a step forward toward the goal of abundant living.
I have never understood Christianity's condemnation of suicide. In my experience working with suicidal individuals (sadly, I have worked with more than a hundred of them, several times intervening decisively to prevent an unnecessary death), people turn to suicide out of desperation, believing that their only hope—no matter how slight—for a better life consists of trusting in God's mercy. For the terminally ill who are in great and sometimes unmanageable, death may in fact be their only real hope of a more abundant life.