(by Wesley J. Smith) April 28, 2015
*To view a map of assisted suicide legislation in the United States, click here.
Introduction For the last twenty years, the United States has been subjected to an unremitting, well- financed, and intensely emotional campaign to legalize assisted suicide as a supposedly compassionate way to help end the suffering of people with terminal illnesses. Assisted suicide became prominent in the public square with the late Jack Kevorkian’s notorious campaign that resulted in the deaths of at least 130 people from 1991-1999, ending only when Kevorkian was finally imprisoned for murder.
 Concerted efforts have also been made all around the country to pass laws permitting doctor-prescribed death. While the movement has made gains, it has been slow going. As of this writing, only three states have formally legalized assisted suicide: Oregon voters approved a law in 1994 allowing doctors to prescribe lethal doses of barbiturates to patients diagnosed with six months or less to live. Washington voters followed suit in 2008. The Vermont legislature passed a similar law in 2013. But advocates have failed more often than they have succeeded. Voters rejected legalization in California (1992), Michigan (1998), Maine (2000), and Massachusetts (2012). Legislatures throughout the country have repeatedly refused to pass laws permitting doctors to prescribe lethal overdoses to terminally ill patients, for example, in California, Connecticut, Hawaii, New Jersey, and Wisconsin.
There have also been a few judicial rulings on the question. In a rather muddled decision, the Supreme Court of Montana found that there is no state constitutional right to assisted suicide, but also that doctors who assist patients to die are not violating the existing public policy of Montana. A trial judge in New Mexico found a constitutional right to assisted suicide in that state, but as of this writing the case is on appeal. But most cases have gone against the assisted-suicide-as-a-right position. Most notably, in 1997, the Supreme Court of the United States ruled unanimously that there is no right in the U.S. Constitution to assisted suicide. Other such efforts have failed – for example, in Florida and Alaska.
The assisted suicide movement is, if anything, indefatigable. Not only is it undeterred by its failures, but it is now more energized than any other time in recent years. By the end of March of 2015, bills were introduced in twenty-five state legislatures to legalize assisted suicide.
Defining the Subject
Many people remain confused about the exact nature of assisted suicide advocacy, sometimes confusing it with other medical issues involving end-of-life care. Thus, to fully understand the subject, we must distinguish between ethical choices at the end of life that may lead to death and the poison of euthanasia/assisted suicide.
1. Refusing unwanted medical treatment is not assisted suicide: Fear of being “hooked up to machines” when one wishes to die at home has traditionally been a driving force behind the assisted suicide movement. But we all have the right to refuse medical interventions—even if the choice is likely to lead to death. Thus, a cancer patient can reject chemotherapy and a patient dying of Lou Gehrig’s disease can say no to a respirator. Indeed, in 1997, the U.S. Supreme Court ruled unanimously that the right to refuse medical treatment is completely different from assisted suicide.
2. Assisted suicide/euthanasia is not the same as medical treatment for pain control: Because pain control may require strong drugs, which can cause death, assisted suicide advocates often claim that palliation and euthanasia are ethically the same under the “principle of double effect.” But this is all wrong:
- Any legitimate medical treatment can unintentionally lead to death, including pain alleviation. In assisted suicide death is the intended effect.
- We would never say that a patient who died during open heart surgery was euthanized. Similarly, a patient who dies from the unintended side effects of pain control has not been assisted in suicide or euthanized.
- Pain control experts state that aggressive pain control generally does not shorten life.
3. Assisted suicide/euthanasia is antithetical to hospice: Hospice was founded by the great medical humanitarian Dame Cicely Saunders in the late 1960s as a reform movement to bring the care of the dying out of isolated hospitals and into patients’ homes or non-institutional local care facilities. Its purpose is to provide dying people with proper treatment of pain and other disturbing symptoms as well as to render spiritual, psychological, and social support toward the end that life be lived as fully as possible until natural death. In contrast, assisted suicide is about rushing death, making it happen sooner rather than later through lethal actions. Or to put it another way: Hospice is about living. Assisted suicide/euthanasia is about dying. As the noted palliative care expert and assisted suicide opponent Dr. Ira Byock has written, “There’s a distinction between alleviating suffering and eliminating the sufferer — between enabling someone to die gently of their disease and ending that person’s life with a lethal pill or injection.”
4. Assisted suicide/euthanasia are acts that intentionally end life: In contrast to the above, the intended purpose of assisted suicide and euthanasia is to end life, e.g., to kill. In assisted suicide, the last act causing death is taken by the person who dies, for example, ingesting a lethal prescription of barbiturates. In euthanasia, the death is a homicide, an act of killing taken by a third person, such as a doctor injecting a patient with poisonous drugs.
The “Slippery Slope” Is All Too Real
Since the emergence of the contemporary euthanasia/assisted suicide movement in the 1980s, opponents have warned against the “slippery slope” that would be set in motion once assisted suicide and/or euthanasia became legal and accepted. The term refers to the commonsense worry that once killing is accepted as a permissible method of alleviating human suffering—the core premise of assisted suicide/euthanasia philosophy—it will lead inexorably to an ever-expanding regimen of hastening death.