He may be its most recognized practitioner, but Jack Kevorkian did not invent assisted suicide. The practice of assisted suicide is not a modern phenomenon. In ancient Greece, the government gave hemlock to those who wanted it. William Shakespeare memorialized the Roman practice in Julius Caesar by depicting Brutus running into the sword held by Strato. Opposition to the practice is also not new, including in the United States; by 1868, more than half of the thirty-seven states in the nation prohibited assisted suicide.
In ancient days, assisted suicide was frequently seen as a way to preserve one’s honor. For the past twenty-five years, on the other hand, the practice has been viewed as a response to the progress of modern medicine. New and often expensive medical technologies have been developed that prolong life. However, the technologies also prolong the dying processes, leading some people to question whether modern medicine is forcing patients to live in unnecessary pain when there is no chance they will be cured. Passive euthanasia—disconnecting a respirator or removing a feeding tube—has become an accepted solution to this dilemma. Active euthanasia—perhaps an overdose of pills or a deadly injection of morphine—remains controversial. Assisted suicide is most widely defined as a type of active euthanasia in which a doctor provides the means of death—usually by prescribing a lethal dose of drugs—but the patient is responsible for performing the final act.
Despite the changes in modern medicine, the attitudes toward assisted suicide in America’s courts and legislatures have not altered considerably. For instance, in June 1997, the U.S. Supreme Court ruled that people do not have a constitutional right to assisted suicide. Although a constitutional right was not established, the ruling did not preclude states from passing laws prohibiting or permitting assisted suicide. However, similar to its status 130 years ago, assisted suicide is not widely supported in America’s state legislatures. As of 1997, physician-assisted suicide was legal in only one state—Oregon. Moreover, that law faced challenges from right-to-life opponents and the Justice Department, which was trying to decide whether the Oregon statute violated any federal law. The other states remained strongly opposed to assisted suicide. As of this writing, thirty-five states have statutes that prohibit assisted suicide, nine states and the District of Columbia have common-law prohibitions, and five states have unclear laws. The common-law prohibitions are not always enforced; Kevorkian, who has been present at over seventy assisted suicides, has never been convicted in any of several trials held in Michigan, despite that state’s common-law ban.
Debate over assisted suicide nearly always centers on the “slippery slope” argument. This argument holds that permitting one behavior will lead to a series of increasingly dangerous behaviors. Critics argue that if voluntary assisted suicide is legalized for competent, terminally ill adults, the acceptance of involuntary euthanasia for incompetent, elderly, or uninsured people will follow. This view is reflected in an amicus curiae brief that was presented to the U.S. Supreme Court when it considered Washington v. Glucksberg and Vacco v. Quill (the two cases in which the Supreme Court decided there is no constitutional right to die). Written by a collection of doctors and nursing home staff, the brief states: “Any new constitutional right to suicide will extend to persons who are not terminally ill, persons who are merely disabled and/or suffering physically, and persons who are comatose, in a persistent vegetative state, or otherwise incompetent.”
Assisted-suicide advocates contend that the slippery-slope argument is fallacious. They argue that legalizing assisted suicide would not place patients’ right to life at risk because America is founded on democratic values that would ensure the rights of all citizens. Derek Humphry, founder of the Hemlock Society, a group that seeks to legalize physician-assisted suicide, writes:
Is this the start of the slippery slope toward killing off the burdensome—our expensive elder folk, our physically and mentally handicapped, our citizens on welfare? If you believe that, it would be best to leave the country now, because you have no faith in the goodness of human nature or the ability of the American democratic system to protect the weak.
The use of euthanasia in the Netherlands, which was first permitted in 1973, can be examined in order to gain insight into whether legalized assisted suicide would threaten the weaker segments of American society. Although the practice is technically illegal, Dutch physicians are permitted to assist a patient’s suicide if certain guidelines are followed. These guidelines require that the patient make a voluntary, informed, and repeated request for euthanasia because of unbearable suffering and that the doctor consult at least one colleague and write a report. Studies suggest that these regulations are not always followed faithfully. For example, the 1996 Remmelink report shows that one thousand cases of involuntary euthanasia occur in a typical year and that guidelines are not followed completely in nearly 60 percent of euthanasia and assisted suicide cases.
The inefficacy of the Dutch guidelines, as suggested in the Remmelink report, raises concerns among many opponents of assisted suicide. However, supporters of the practice argue that similar guidelines in the United States—such as the ones in Oregon that include waiting periods and confirmation from two doctors that the patient has less than six months to live—will actually protect patients by increasing physician accountability. They contend that the present underground system of assisted suicide, with doctors adhering to individual guidelines, is more problematic. Betty Rollin, who assisted in the suicide of her terminally ill mother, writes, “The current non-system is particularly troubling in cases where patients are helped to die by relatives, not doctors. . . . No legalization means no safeguards are in place to ensure these patients really wanted to die!”
The debate over whether assisted suicide should be legalized in the United States—a nation considerably larger and more diverse than the Netherlands—is not likely to be resolved in the near future. People on both sides of the issue will undoubtedly pay close attention to developments in Oregon, and perhaps other states, in an effort to bolster their side of the slippery-slope argument. The legalization of physician-assisted suicide is just one of the topics discussed in Assisted Suicide: Current Controversies. Other issues addressed by authors in this anthology include the ethics of assisted suicide, whether a constitutional “right to die” exists, and the effect that assisted suicide has on society as a whole.