In light of Dr. Jack Kevorkian’s passing away earlier this month, dozens of pundits and bloggers have weighed in on the right to die and euthanasia. Ross Douthat argues that a right to die would mean that physician-assisted suicide can’t reasonably be limited to only the infirmed or the terminally ill. It must apply as well to “a devastated widower, or a parent who has lost her only child.” I agree.
Ezra Klein points to a 1997 Atlantic article by Ezekiel Emanuel demonstrating that mental illness, rather than unbearable physical pain, more commonly motivates patients to seek euthanasia.
Most of the patients interested in physician-assisted suicide or euthanasia will not be suffering horrific pain. As noted, depression, hopelessness, and psychological distress are the primary factors motivating the great majority. Should their wishes be granted? Our usual approach to people who try to end their lives for reasons of depression and psychological distress is psychiatric intervention—not giving them a syringe and life-ending drugs.
Perhaps. But if we acknowledge a person’s right to die, as Kevorkian advocated, then how can we attempt to define what qualifies as “horrific pain”?
Emanuel worries that broad legalization would lead to worse care for the dying, coercion by relatives, and even doctors who begin to see dying patients as burdens on an already-overtaxed healthcare system. “Broad legalization of physician-assisted suicide and euthanasia,” he writes, “would have the paradoxical effect of making patients seem to be responsible for their own suffering.” Klein agrees that it would “give the people around them too much choice, and that the long-term consequences of that are unsettlingly unpredictable.”
I’m generally skeptical of arguments against too much choice, especially regarding something as profound as a right to die. If there is such a right (or if we ought to create one), the possibility of poorer care for the terminally ill in the long run seems like a pale excuse for denying it. But Emmanuel doesn’t want to deny the truly suffering the right to die; he just opposes making it legal.
By establishing a social policy that keeps physician-assisted suicide and euthanasia illegal but recognizes exceptions, we would adopt the correct moral view: the onus of proving that everything had been tried and that the motivation and rationale were convincing would rest on those who wanted to end a life. Such a policy would recognize that ending a life by physician-assisted suicide or euthanasia is an extraordinary and grave event. To recognize a legal right to physician-assisted suicide or euthanasia transforms the practices into routine interventions that can be administered without the need for a publicly acceptable justification. Doctors who end patients’ lives would no longer bear the burden of having to prove the appropriateness of their action, if called upon to do so, but could simply justify their action as a legally sanctioned procedure.
Kevorkian’s imprisonment notwithstanding, this may effectively be the policy in many cases where physician-assisted suicide is suspected but it’s acknowledged that “the motivation and rationale” were appropriate. But although Emmanuel rejects a right to die, he seems to hang on to it for “acts of desperation when all other elements of treatment . . . have been tried.” As for the “correct moral view,” is there (or ought there be) a bona fide right to die? If not, then those who engage in physician-assisted suicide even under intuitively justifiable circumstances are, at best, less-than-fully-culpable murderers. If so, then the law has no business sitting in judgment of motivations and rationales. Broad legalization, even with safeguards against coercion, seems to follow. But it means that people may choose to end their lives as they see fit, without the law or an ethics committee looking over their shoulders. If that’s not something we’re prepared to accept, then we shouldn’t create a right to die.
