Katherine Hung ’19
Terminal illness deprives its victims of their independence. It erodes their dignity and causes inexorable suffering. At times, terminally ill patients seek to end their prolonged and painful lives on their own terms—choosing the time, place, and manner of their death. For patients in six US states and a few countries, physician-assisted suicide is a legal possibility. While highly controversial, licensed doctors can prescribe lethal doses of medication to their mentally competent, yet terminally ill patients who voluntarily self-administer the drugs.
For nearly two decades, physician-assisted suicide (PAS) has been the focus of ongoing research. Studies have sought to evaluate different aspects of the practice, ranging from physicians’ opinions and judgments, to the effects of depression, trust, and power on patients’ decisions. Other research has delved into the complexities inherent in assessing mental capacity and the extent to which patients adapt or change their desires relevant to suicidal behaviors (1).
In recent months, the controversy of PAS has found itself back into the public eye with two high profile cases. Canadian novelist W.P. Kinsella—author of the book Shoeless Joe that inspired the 1989 film “Field of Dreams”—chose a PAS passing in September after his health deteriorated due to his struggles with diabetes (2). That same month, Paralympian Marieke Vervoort of Belgium elicited an international discussion of the issue when she revealed that she had considered PAS. Vervoort is a decorated Paralympian who won gold in the 100m wheelchair sprint in London, as well as silver medals in the 200m in London and the 400m in Rio this summer. Since the age of 15, Vervoort has battled an incurable and degenerative spinal condition that resulted in her paraplegia. Her progressive disease causes her unimaginable pain that sometimes prevents her from sleeping more than ten minutes a night. Vervoort disclosed that she signed euthanasia papers that permit her to choose death with dignity, drawing worldwide opinion on her willingness to possibly choose PAS in the future (3)(4).
This month, Colorado became the sixth state to legalize physician-assisted suicide, joining Oregon, Washington, Vermont, California, and Montana. Colorado voters approved Proposition 106, a measure that grants the choice of assisted suicide to mentally competent, terminally ill residents over the age of 18 with under six months to live (5). Washington D.C. also initially approved similar legislation to legalize PAS in an 11-2 vote (6). Opponents to the D.C. bill, however, claim that it fails to contain necessary safeguards against potential abuse or medical errors. These include protections against coercion of the disabled, elderly or poor, as well as inaccurate predictions of a patient’s final six-month window to live.
Still, an important question falls into the realm of ethics. Is physician-assisted suicide morally right? Seeing as PAS preserves the autonomy and self-esteem of patients—allowing them to live out their final days in peace and with dignity—physician-assisted suicide is a morally permissible act.
With death as a natural part of life, the ability to decide the timing and nature of one’s passing is firmly rooted in autonomy, self-determination, and one’s inalienable right to freedom of choice. Under the principle of personal autonomy, individuals have the inherent power to act according to their beliefs, motivations, and virtues, as long as they do not imperil the ability of others to do the same. They retain control over matters that are most intimately connected to their lifestyle and well-being, including the extent of their lives and the circumstances of their death. Accordingly, terminally ill patients should retain the sole freedom to determine their lives in a manner consistent with their own ideals, views, and motives. Dictating the amount of suffering a dying person must endure by banning his right to physician-assisted suicide is cruel and unethical treatment. PAS is morally permissible because it preserves a patient’s autonomy to determine if his or her pain is intolerable, as well as his or her freedom of choice to seek relief.
Beyond the importance of individual choice, the conditional value of life makes physician-assisted suicide ethically acceptable. The value of one’s life can fluctuate according to existing situations; it never remains absolute. Take physical assault, for example, an action that can alter life’s conditional value. If an aggressor violently threatens the safety of another individual, the victim can defend himself or herself with potentially lethal force under the law, reducing the conditional value of the assailant’s life. Similarly, the quality of a person’s life can alter its conditional value. It is understood that a better quality of life raises the value of a life, while a poorer quality of life results in a lower value of life. In today’s culture, the importance of quality of life trumps the idea of sanctity of life, which regards human life as continually sacred regardless of a person’s physical or mental well-being. For terminally ill patients, the prospective quality of life is bleak at best. They not only struggle physically with symptoms like severe pain, seizures, or nausea, but also mentally with hallucinations, loss of awareness, personality shifts, or feelings of isolation and abandonment. This low quality of life—coupled with the negligible amount of time left to live—reduces the overall value of a patient’s life, since variations in one’s quality of life govern the value of that life, and quality prevails over sanctity.
Ultimately, physician-assisted suicide is not about suicide. It’s about compassion. Patients with a terminal illness do not want to die. But since they are dying, they deserve the choice to decide whether they want to endure the inexorable suffering that accompanies their inevitable death. No one should dictate how much agony someone else must endure before dying, nor categorically deny them the right to a dignified death. Yet, regardless of these ethical considerations, physician-assisted suicide will face the review of lawmakers and doctors before it becomes a reality for many terminally ill patients.