AEU Publications

Doctor Assisted Suicide

by Dr. Joseph Chuman -- Leader of the Bergen Ethical Society.

Margaret was a proud woman. Her coifed hair, meticulous attire, a love of art and music testified to her refined, aristocratic tastes. Her bearing suggested a person whose sense of self was firmly rooted in the ability to order her life and tame the ruffles of unruly misfortune.

I well remember the day ten years ago when we sat face to face by her bay window overlooking the garden below. I was on a pastoral visit, responding to a call that Margaret was seriously ill. I feared the worst and my fears were justified. Yet, I was impressed with how matter-of-factly she described her condition in a steady voice which belied the horror that lay ahead. In her 70's Margaret was diagnosed with amyotrophic lateral sclerosis, commonly known as Lou Gehrig's disease.

If nature were malicious, it could not devise a more sadistic path leading to life's end. She explained that paralysis starts at the feet and gradually ascends to the torso and upper body. Death is inevitable. It comes either through starvation, as the voluntary ability to swallow is destroyed, or through suffocation, as the lungs relentlessly fill up with fluid.

As the months passed, I became a regular visitor to Margaret's home. She moved to a walker and then permanently to bed. With the disease ravaging her body, she grew more steadfast in her purpose, and found a sense of grace and humor which she had long sought.

As I sat by her bedside one afternoon, she told me how she feared most an invasion of her bodily integrity. She wanted no part of ventilators or feeding tubes. With her options drastically diminished, she turned to me, and without a ripple of hesitation, asked whether I would help her administer an overdose of medication. As a humanist, Margaret cherished the value of self-determination, of people striving to expand the reach of responsibility in the governance of their lives, even in deciding, if necessary, how it will end. And so do I. She was reassured when I responded that I would help fulfill her wish in whatever way necessary.

The issue of physician-assisted suicide for the terminally ill has burst upon the moral and legal stage, and it will not retreat. Organizations such as the Hemlock Society have gained broad public attention after decades of quiet activism. Juries in Michigan, in three separate trials, have refused to convict Dr. Jack Kevorkian. Recently, two federal appellate courts in Washington State and New York employed different judicial reasoning to arrive at the conclusion that mentally competent, terminally ill patients may legally request a doctor's assistance to end their lives. The Supreme Court has agreed to rule on appeals to the Washington and New York cases this term, a decision which promises to be the most socially fractious since Roe v. Wade. All these developments are in accord with recent polls finding that a majority of both the public and physicians favor voluntary euthanasia for the terminally ill.

Each of us will confront our own death and the deaths of those we love. For many people the medical world has become menacingly impersonal as end-life care is increasingly subject to heroic efforts to prolong life. People fear becoming unwilling objects of unbending medical protocols, at times when they are beyond the point of raising a protest or influencing their fate. The thought that one will be kept alive, wracked with pain after all hope is gone and all quality drained from life, is horrific indeed, for our greatest nightmares emerge from the loss of freedom and autonomy.

Arguments in opposing physician-assisted suicide for the terminally ill are weighty, and deserve the greatest attention from a morally sensitive public. But I conclude, upon scrutiny, that they are not compelling.

It's often noted that the physician's role is that of healer, and if doctors are permitted to assist in their patients' deaths, their role will be subverted and widespread distrust will result. This point neglects, however, that doctors are givers of comfort as much as they are healers. For the terminally ill, who are suffering intractable pain, the denial of assistance in ending life is a refusal to provide comfort at the time of greatest need. New technologies in pain management may help many patients, but some are beyond its reach.

Others point to the dangers of a slippery slope If the law sanctions the killing of one category of people, will we not render more vulnerable those segments of the population deemed marginal and less able to defend themselves? Will the terminally ill be openly and subtlely pressured to end their lives rather than continue as a burden to their relatives, some who may exert that pressure out of self-interest? While society can never prevent all abuses, the same dangers which might confront those contemplating assisted suicide in the future are precisely those confronting patients who refuse life sustaining treatment now. We do not permit the potential for abuse to interfere in the patient's prevailing right to guide his or her destiny in these cases.

Moreover, there is always the potential that any new freedom or prohibition, sanctioned by law, will expand beyond control and take on malignant, socially destructive forms. Many initiatives, however, do not. Laws mandating the inspection of luggage in airport terminals, for example, were initially feared as a threat to individual freedom protected by the Fourth Amendment. Yet popular consensus would affirm that a productive balance between freedom and security in that instance has been struck without encroachment upon other freedoms. The perceived dangers inherent in physician-assisted suicide, do not call for its prohibition, but for strict guidelines and tight regulations.

Lastly, there is no longer a moral, nor legal debate over the withdrawal of life-sustaining equipment which allows a hopelessly ill patient to die. Many who compassionately defend this view, nevertheless argue that physician-assisted suicide is morally different and therefore must remain illegal.

But is it? For the past two decades, since the Karen Quinlan decision, self-determination has steadily replaced paternalism as the prevailing value guiding medical care. Physician-assisted suicide is on a continuum with this progression, and not a radical break from it. To remove a terminally ill patient from life sustaining equipment in order to let him or her die is to kill the patient as assuredly as to mercifully help enable a painless death at the patient's request. Once a decision is made to let the patient die, in moral terms positive action has been taken bringing predictable consequences bearing a similar weight of responsibility.

If moral decisions are to be based on compassion, is it morally preferable, when death is inevitable, to let a patient linger in pain, than to help deliver a swift and painless end to uncontrollable suffering? At what point does enabling the prolongation of life, after all quality and hope are gone, become the prolongation of agony, pure and simple, and, as such, an act of gratuitous cruelty?

The legalization of physician-assisted suicide will not mandate that a doctor become engaged in the practice. It will, rather, reinforce the wise notion that there are matters of life and death which touch the inner sanctum of conscience and thus are beyond the limits of state intervention. People representing the values of traditional religion may argue that our lives are on loan from God and therefore it is not for us to end it, however dire the circumstances. Respect for life is the paramount value. In a constitutional democracy such as ours, these arguments have a voice, but not a final one. For we have become an increasingly pluralistic society which includes millions of humanists, agnostics, atheists and religious dissenters who, with equal conscience, are inspired by different metaphysical beliefs.

A conclusion such believers may reach is that for the terminally ill, whose lives are tragically without quality and without hope, society has an obligation to respect the self-determination of the patient who asks for deliverance. When the end of life is near, respect for the final wish of the patient is not to deny a reverence for life. It is, rather, to uphold it.