Physician-Assisted Suicide | Introduction
On June 26, 1997, the U.S. Supreme Court ruled that individuals do not have a fundamental, constitutional right to physician-assisted suicide. This ruling reversed two previous decisions by U.S. courts of appeals. In the first case, Washington State vs. Glucksberg, the Ninth Circuit court had determined that a Washington state law prohibiting individuals from aiding in suicides was unconstitutional. The court supported its decision by concluding that individuals have a constitutionally protected right under the Due Process Clause of the Fourteenth Amendment to control the timing and method of their death. In New York vs. Quill, in a ruling similar to the Ninth Circuit’s decision, the Second Circuit court of appeals had declared unconstitutional a New York state law that prohibited assisting someone in committing suicide. The court justified its decision by arguing that the law violated the Equal Protection Clause of the Fourteenth Amendment. Both courts’ decisions had, in effect, recognized a constitutional “right to die.”
Although the Supreme Court overturned the decisions of the two courts of appeals, its ruling did not put an end to the debate over assisted suicide. As Justice Sandra Day O’Connor noted, the Court concluded that there “is no generalized right to commit suicide.” However, the Court emphasized that its decision and the Constitution do not place absolute restrictions on state law, leaving open the possibility for states to create their own laws to establish such a right. In addition, the Court indicated that laws that prohibit physician-assisted suicide could still be challenged in specific cases in the future. According to legal experts who evaluated the decision, the Court recognized that physician-assisted suicide is a complicated issue and that each case has a unique set of circumstances that must be evaluated separately. In short, the Court shifted the responsibility for this issue to the states, and by doing so it indirectly ensured that the controversy and legal battles over physician-assisted suicide will continue.
What is physician-assisted suicide?
There are varying degrees to which a person can be involved in hastening the death of a terminally ill individual. It is important to understand the terms for and distinctions between these degrees. Euthanasia, a word that is often associated with physician-assisted suicide, is defined by the Merriam-Webster Dictionary as “the act or practice of killing for reasons of mercy.” There are two types of euthanasia: passive and active. Passive euthanasia takes place when life-saving measures are withheld or withdrawn and the terminally ill person is allowed to die of natural causes. A son’s electing to take his mother off life-support machines, which leads to her death, would be an example of passive euthanasia. Today, there is little controversy and debate over passive euthanasia. The constitutional right of a patient (or if the patient is incompetent, the patient’s guardian) to refuse treatment was established in 1976 by the Supreme Court’s decision in the case of Karen Ann Quinlan. In 1975, Quinlan fell into an irreversible coma after a drug overdose and was put on a life-support system. Her parents, who wished to bring an end to their family’s suffering, met resistance after requesting that their daughter be removed from life support. They fought a legal battle all the way to the Supreme Court. The Court decided in favor of Quinlan’s parents and granted them the right to remove their daughter from the system, establishing a legal precedent for passive euthanasia.
In active euthanasia, a person actually causes the death of a terminally ill individual. For example, a person who gives a dying friend a lethal injection to hasten death would be performing active euthanasia. Although active euthanasia is presently illegal, many medical professionals claim that it is practiced in secrecy on a regular basis. Active euthanasia is highly controversial: Its critics argue that patients are often not informed of what is being done to them or are coerced into agreeing to the act.
Assisted suicide takes place when a dying person who wishes to precipitate death requests help in carrying out the act. There is a distinction between assisted suicide and euthanasia. In euthanasia, the dying patients may or may not be aware of what is happening to them and may or may not have requested to die. In an assisted suicide, the terminally ill person wants to die and has specifically asked for help. Physician-assisted suicide occurs when the individual assisting in the suicide is a doctor rather than a friend or family member. Because doctors are the people most familiar with their patients’ medical condition and have knowledge of and access to the necessary means to cause certain death, terminally ill patients who have made the decision to end their lives often turn to their physicians for advice and help. Studies indicate, however, that many physicians are unwilling to provide their assistance in suicide because it conflicts with their ethical beliefs or because it is illegal.
The controversy over legalization
Much of the controversy surrounding physician-assisted suicide focuses on the debate over whether the practice should be legalized. Oregon is the only state in which physician-assisted suicide is legal. In 1994, voters in that state approved a referendum called the Death with Dignity Act, which was enacted in 1997. This law allows doctors to prescribe lethal doses of medication to mentally competent, terminally ill patients to use to hasten their own deaths. Between 1998 and 2000, ninety-six lethal prescriptions were written, and seventy patients took the fatal doses. In the rest of the country, the practice remains illegal.
Supporters of legalization believe that terminally ill individuals have the right to end their own lives in some instances. Because physicianassisted suicide is illegal in most states, they maintain, many patients are unable to get the help necessary to end their lives and must involuntarily endure extreme pain and suffering. Others argue that physicianassisted suicide must be legalized for purposes of regulation. They contend that in spite of current law, the practice is conducted regularly in secrecy; therefore, the potential for abuse already exists. According to Cheryl Smith, former staff attorney for the Hemlock Society, “Legalization, with medical record documentation and reporting requirements, will enable authorities to regulate the practice and guard against abuses, while punishing the real offenders.”
On the other hand, opponents of physician-assisted suicide argue that widespread legalization would cause abuse rather than reduce or control it. They maintain that legalized assisted suicide would lead to the deaths of patients who do not really wish to die. For example, they contend that influential doctors or family members, unrestricted by law, may persuade patients to choose death or that greedy insurance companies may pressure doctors to control insurance costs by ending lives prematurely.
Others worry that universal legalization of assisted suicide would be the first step down the “slippery slope” that would lead to widespread, unregulated mercy killing of individuals whom society considers undesirable or whose lives have been arbitrarily deemed not worth living. As expressed by legal experts Robert George and William Porth, “It is not unrealistic to fear that government may assume what began as a private prerogative, and move from making life-and-death decisions for the comatose, to making them for the insane, for the retarded, for those of less than average intelligence, and finally for those who are entirely rational and intelligent, but whose desire to cling to life brands them as obstinate, uncooperative, and just plain unreasonable.” These fears lead many to oppose physicianassisted suicide even under carefully regulated conditions.
The legalization of physician-assisted suicide is an extremely sensitive, complicated, and controversial topic. If future legislation is to be successful, it will need to protect both the rights of terminally ill patients who rationally choose death and the rights of weak or incompetent patients who do not wish to die. This anthology, At Issue: Physician-Assisted Suicide, explores a variety of perspectives on the legal, ethical, and moral aspects of physician-assisted suicide.
