A sign carried by a supporter of assisted suicide in Washington, D.C., read: “You would do it for your dog. Why not for me?”
That neatly encapsulates the fundamental problem with assisted suicide laws.
This week, the Utah Legislature will hear arguments over a bill that would allow doctors to give lethal drugs to patients so they can commit suicide if the doctor believes they only have a few months to live. This is the fourth time a proposal to allow assisted suicide has come to the Legislature.
The proposal should be decisively rejected.
We should be particularly cautious about embracing a right to suicide for vulnerable individuals. The experience of other nations suggests that this “right,” initially limited to those experiencing terminal diseases and advertised as strictly voluntary, begins to be applied to a wider variety of cases, including some not strictly medical and, as in the case of Belgium, now extended to non-voluntary situations such as the euthanasia of children. Recently, a doctor in the Netherlands was cleared of wrongdoing by the government after he asked family members to hold a patient down so she could administer a lethal injection when the patient fought the procedure.
The much-valued “choice” to end one’s life does not occur in a vacuum. A person who is ill enough that the doctors guess (and it is usually just that, a guess) she or he will soon die, must act in the context of pressures, real and imagined, from other people — family and friends, physicians and insurance providers (including, often, the state itself). As reports from Oregon, the first state to approve this option, suggest, the doctors involved in these cases are not so much wise counselors giving ethical advice as resources called in near the end to dispense drugs.
Insurance companies, and the state as the provider of medical care to the needy, have a possible motivation of encouraging the less-costly route of suicide. One patient in Oregon was told by her insurance company that it would pay for the inexpensive suicide drugs but not for medication her doctor prescribed to extend her life.
Nearly half of those who opted for assisted suicide in Oregon in 2015 reported a concern with being a burden on family, friends and caregivers. Even where family members have no desire to encourage suicide by an ill family member, the existence of that option colors their interactions. That option may lead a sick person, particularly one with undiagnosed emotional or psychiatric illness (a very real possibility, as the evidence makes clear), to conclude that others would be better off if they died, even if those others don’t actually feel that way.
The motives of family and friends can be mixed. Take an example from the summer 2016 newsletter of End of Life Washington (slogan: “Your life. Your death. Your choice.”). A psychotherapist told a story about a former patient referred to her for anxiety and depression. The patient had twice planned suicide only to change his mind. After 25 years of no contact, the patient called to say goodbye after he’d picked up his suicide prescription to end his life in the face of a terminal cancer diagnosis.
The therapist reported: “He died in the loving presence of his brother and the close friend he had stayed connected with through the years, both of whom actively supported his choice.” In fact, his family and friends had “entreated” him to pursue physician-assisted suicide so that he did not take his own life by jumping from a bridge. The article reports family and friends were “horrified by the suffering his suicide would cause not only him but them.” So, he took advantage of Washington’s law with “their help, encouragement and advocacy.”
The option of legal suicide certainly makes such pressure more effective. It is like the pressure reported by parents of children prenatally diagnosed with Down syndrome to abort their children.
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It is a serious problem that we speak of the crisis of suicide in some contexts and in other contexts we valorize it as an exercise of personal autonomy. That mixed message may be fatal.
Consider again the disturbing sign: “You would do it for your dog. Why not for me?”
Utah should reject the idea that we should “put down” those who are sick like we would a pet. It is a matter of basic human decency, of protection for the vulnerable.
William C. Duncan, J.D., is a senior fellow at Sutherland Institute.