Last week in Washington state a 66-year-old woman with terminal cancer made history as the first person to undergo physician-assisted suicide since that state legalized the practice in November of 2008.
Proponents of legalized suicide celebrated Washington's approval of this policy as a victory for the "death with dignity" movement. These suicide advocates, in keeping with the rhetorical tactic of their ideological cousins in the pro-abortion movement, equate "dignity" with "choice." Unfortunately, as with the abortion debate, the "choice" rhetoric of the right-to-die movement eclipses critical moral and ethical questions which ought to be at the forefront of the debate.
Is suicide really a way to honor life and preserve dignity? What are the social and cultural implications of normalizing the "right to die?" Will voluntary physician-assisted suicide give way to involuntary physician-assisted suicide where doctors decide whether their patients would be better off dead? Will the "right" to suicide be transmogrified into a "duty" to commit suicide? Will the elderly who consume more than they produce be deemed "resource hogs" that have a duty to die and get out of the way? In an age of scarce economic resources, will the critically ill or the handicapped or the demented be viewed as expendable by their younger, healthier counterparts? How will the medical profession be transformed if those who are trained to cure are given a license to kill? These and many other questions should be asked and answered before we decide it's okay to encourage terminally-ill persons to choose self-destruction in the name of dignity.
But we won't get answers if we allow this debate to be defined solely in terms of the euphemistic "right to choose." Indeed, these questions won't even be asked.
Dying with dignity does not require suicide. The question, "Do you want to suffer and die or die with dignity?" presents a false choice and assumes that there are only two alternatives at the end of life—pain or death. Properly employed, modern medicine has the tools to mitigate pain. Hospice care, for example, employs a multi-disciplinary approach to ensure that terminally-ill patients endure their final time on earth with dignity—free from pain and nourished physically, emotionally, mentally, and spiritually. Hospice care does not seek to stop the dying process. The goal of hospice care is to make a difficult time as comfortable and peaceful as possible for both the patient and their loved ones. The important distinction between palliative care and physician-assisted suicide is that the first respects the inviolability of human life in spite of the difficulties presented by illness while the second rejects the sanctity of life in favor of an expedient escape from pain and fear.
The embrace of the right to physician-assisted suicide endorses a form of radical, atomistic individualism that ignores the fact that people are part of a larger community—including families and society—and that the decisions of individuals impact others as well. One does not have to look very far to see that granting a license to kill to those who are trained to cure undermines the ethics of the medical profession: Holland's embrace of voluntary physician-assisted suicide quickly led to a rash of involuntary "suicides" perpetrated by doctors who presumed to know what end was best for their patients.
We ought not to confuse curing with killing. For thousands of years, physicians have taken an oath to first "do no harm" to their patients. Changing the paradigm to "kill or cure" will wreak havoc on medical ethics and put untold numbers of lives in jeopardy.
The philosophy animating the right-to-die movement is that life's value is measured only by material standards. Once those standards are no longer being met, one's life no longer has value. In contrast, those who view life as a sacred gift from God believe that every stage of life is precious and holds unique meaning. This is true even at the end of life. There is meaning to be found in suffering, not only for the person suffering, but for those providing care and comfort to the sufferer. A person's final time on this earth is a time for reflection and absolution, a time to share love and forgiveness. For those providing care, this time provides an invaluable opportunity to provide comfort and succor in a most profound way, and it affirms the fragile and precious nature of life.
Euthanasia means "good death"—but where should we draw the line? Exchanging a "sanctity of life" ethic for a "quality of life" ethic will put the weakest among us at great risk. If our society adopts the notion that the terminally-ill are mere vessels of pain and decay—no longer worthy of our best efforts at care and comfort—it will set a dangerous precedent that will inevitably impact other vulnerable members of our society.
When quality of life becomes the reigning criteria, then not only the terminally-ill, but the disabled, the elderly, and the infirm become prime candidates for "dignified" death by suicide. Consider the elderly for a moment: A significant proportion of elderly residents in nursing homes are afflicted with age-related disabilities and dementia. They often don't know who they are, or where they are. Frequently, they don't recognize their children and, in child-like fashion, they may require assistance with even the most basic activities of daily living. A compelling argument can be made that their "quality of life" has been diminished. How long will it be before doctors, family members, and legal guardians who embrace the quality of life calculus decide that the lives of such individuals (who are also expensive to maintain) are no longer "dignified" and are unworthy of living? This terrifying prospect has already become a reality for some vulnerable individuals right here in America. It will only get worse unless we seriously reevaluate the merits of the right-to-die movement.
As with other issues involving life's most critical questions, the right to die is not a simple matter of "choice." Its implications stretch much further than the wishes of any one individual. It is incumbent upon policy makers to understand these implications, and to not be swayed by the misleading rhetoric of choice, or the allure of the bottom line. They will also do well to remember that the idea that there are some lives "not worth living" undergirded Adolph Hitler's Aryan-supremacy world view. His policy of eliminating the "unworthy" began with the mentally handicapped and physically disabled but spread to millions of Jews.
The world has seen what happens when we embrace the notion that there are those among us whose lives are not worth living. We must not repeat this mistake again.
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