Thursday, October 16, 2014

Assisted suicide

An Ethical Musings' reader sent me a link to Ross Douthat's recent Op-Ed piece in the New York Times, "The Last Right" (October 11, 2014), soliciting my thoughts on assisted suicide.

What is right? How do we know?

First, life is good. For the religious person, life is not only good but also a gift from God, directly (e.g., for a creationist) or indirectly (e.g., for someone who accepts the theory of evolution). For the non-religious person, the good of life is manifest in the desire to live and, in many people, the desire to perpetuate life by procreating.

Second, life is transient. In the large scheme of the cosmos, an individual human life is ephemeral. In the small scheme of a human existence, the span of a human life can seem short (an infant who dies within a month of birth) or lengthy (the life of a centenarian). In either case, a human life is like a lily, beautiful in the moment and then gone.

Third, for people who believe in life after death (regardless of whether one imagines the next life as a blissful eternal existence or a form of reincarnation), death is not an end but a moment of transition. The common euphemism for death, "passing," connotes death as a transition, passing from one life to another. If death is a transition, then lingering too long in a stage may retard development, growth, arrival in a more blessed state, etc.

Fourth, for people who do not believe in life after death (and for many who do believe in life after death), the quantity of life may not be the only value. Quality of life may be at least important as longevity. The tradeoff between quantity and quality is observable in the lives of individuals who sacrifice self for the well-being of others, such as the warrior who dies in defense of country, the healthcare worker who becomes infected with a terminal disease while aiding others, etc.

Fifth, the desire to die is sometimes misguided or wrong. Many depressed people contemplate the possibility of suicide; some plan a suicide attempt as a means of calling for help; a relatively few depressives actually want to die. Depression is a mental illness. The symptoms, including the desire to die, are usually treatable; much depression is actually curable. For the depressed, suicide is a permanent solution to a temporary problem and therefore misguided. In other cases in which the person committing suicide is not depressed, suicide is wrong, e.g., a jilted lover wanting to make the former lover feel guilty for having preferred another.

Sixth, God does not control when or how an individual dies. That statement is obvious to persons who do not believe in God. For persons who believe in God, to posit that God controls when and how every individual dies is to make God responsible for great and numerous evils. These evils range from the holocaust to the victims of mass murder. The deaths of innocent infants, famine victims, those who die from natural disasters, cancer deaths, and those killed by drunk drivers are all among the deaths for which God is responsible. Evil deeds are incompatible with the concept of a good God. Attributing control of how and when every individual dies is a form of fatalism that few contemporary theologians find palatable.

Seventh, if God alone is not in control, then humans have some measure of responsibility for how and when people die. Sadly, that control is often apparent in tragic deaths from war, avoidable manslaughter (e.g., the parent who leaves a child unattended in a sweltering vehicle), needless homicide (e.g., crimes of passion), and the spread of infectious disease (e.g., parents who do not have their children vaccinated). Human control is also apparent in the deaths averted from people who feed the hungry, heal the sick, prevent crime, and end fascism.

Eighth, since life is good but finite, and the goodness of life is not measured by longevity alone, and since humans do exercise some unknown measure of control or influence over life's duration, the question is not whether assisted suicide is ethical but under what circumstances or conditions assisted suicide is ethical. To oppose assisted suicide depends upon one of three arguments: that God, not humans, determine the number of a person's days; that longevity is the sole determinant of a good life; or, that a state cannot legalize assisted suicide in a way that effectively avoids abuses, i.e., avoids wrongful suicide, manslaughter, and homicide. I've already rejected the first two of those arguments (points three, four, six, and seven above).

Ninth, the practice of assisted suicide in the four states where it is currently legal has not resulted in allegations of criminal or ethical abuses. In the United States, physician assisted suicide is currently legal in four states (Oregon, Washington, Vermont, and Montana). In Montana, a court must approve the request. In the other three states, the person must be a resident of the state, at least eighteen years of age, within six months of dying from a terminal disease, and have made the request to the physician at least twice orally (minimum of fifteen days apart) and once in writing. In other words, laws and practices in those four states are substantial evidence that legalizing assisted suicide is possible without creating a great potential for abuse or crime.

Tenth, de facto assisted suicide now happens on a widespread basis. Assisted deaths occur with some frequency in all states under unregulated conditions. Most often, well-intentioned healthcare providers administer large doses of narcotics to ease severe pain in the terminally ill. At some point, a dose meant to end the pain has the unintended consequence of permanently ending the person's pain. Unassisted deaths are also widespread: many individuals have signed advance medical directives to prevent healthcare providers from using emergency procedures or invasive interventions to prolong the person's life. In my last Ethical Musings' post, "At What Age Do You Wantto Die?" I discussed Ezekiel Emmanuel's decision to decline medical treatment after age seventy-five, which, in the case of a treatable illness, is a form of passive, unassisted suicide.

Eleventh, anecdotal evidence suggests that a large number, perhaps a majority, of terminally ill people who legally obtain drugs from a doctor with which to commit assisted suicide, opt not to commit suicide. Having the drugs restores a measure of dignity and control to the dying person sufficient to restore hope and meaning to an otherwise bleak, painful existence.

Twelfth, facing death squarely and openly follows Jesus' example. From the gospel records, he recognized that going to Jerusalem for the Passover would lead to his death. He talked about that prospect with his disciples (the gospels record tantalizing snippets of those discussions). In choosing to go to Jerusalem, Jesus recognized that longevity was not the sole measure of the value of life. Indeed, he took a measure of responsibility (or control) over his life and its span. We should do likewise.

My next post will outline some specifics for laws regulating assisted suicide.

1 comment:

Anonymous said...

Suicide is a choice to be taken seriously. I agree the person should make his wishes known several times. My disagreement comes from others; lawyers, courts, family, friends, doctors, ministers, and psychologists inferring you have lost your mind in depression or some other mental disease. It is our right to make decisions that others think are wrong.
We do it every day and no one says don't buy this car, house, trip, church affiliation, divorce etc. Watching 60 minutes on Sunday proves just how others interfere with your life and hold others guilty of assisted suicide. Even if you have directions in a living will or DNR they can be overridden by others. It is wrong and can our medical system take care of those who have no quality of life or will die in a few months. The answer is no.
Not one, not one of these people or groups have stood up and said no more war as the results included suicides in the field or returning home. All those killed could be treated as suicides as we have solved none of the issues we are fighting for in these many countries.
Are you guilty?
I'm disgusted with the Greatest Generation for allowing these wars to continue without their protest. They understand war where few others do.