The Moral Wrong of Physician-Assisted Suicide

Though a New York Appellate court recently ruled that there is no right to physician-assisted suicide under the current laws of the state, the issue remains far from settled. Not only are the plaintiffs expected to appeal the decision, but a bill recently proposed in the New York legislature also seeks to legalize the practice. The Medical Aid in Dying Act, proposed May 10, 2016, by State Senator Diana Savino and Assemblywoman Amy Paulin, would allow terminally ill patients with a life expectancy of less than sixth months to receive life-ending drugs from a physician. Should the bill be passed, New York would become the sixth U.S. state to legalize physician-assisted suicide.

The philosophical and theological arguments against suicide are numerous and cogent. We should expect, then, that the advocates of physician-assisted suicide will try to avoid a direct engagement with these arguments. One such evasion is already apparent in the name of the New York bill: cooperation with suicide is hidden under the benign term “medical aid,” as if the attending physician would merely be arranging the pillows on the bed. The subterfuge continues in the text of the bill itself, which specifies that the terminal illness of the patient must be listed as the cause of death on the death certificate instead of “suicide.”

Another likely evasion, the one with which this present article is directly concerned, will be the presentation of physician-assisted suicide as a sort of lesser evil in comparison to “normal,” non-assisted suicide. “You may think suicide is wrong,” they will say. “In fact, you are surely correct in thinking so. But these suicides are going to happen anyway. The result will be a great deal of avoidable human suffering because of many failed suicide attempts. By allowing competent physicians to oversee the process, we can ensure that these tragic suicides will at least be quick and painless.” “In fact,” they will continue, “by making a diagnosis of terminal illness necessary, as well as the testimony of other people ensuring that the request for suicide is actually voluntary, the law will help to ensure that vulnerable people are not pressured into taking this tragic and irreversible step.” Finally, the denouement: “These strict regulatory requirements will probably cause the overall number of suicides to decrease. This is a ‘pro-life’ measure!”

This presentation of physician-assisted suicide as a lesser evil is a seductive ploy, and one we have seen used before with regard to abortion. However, a strong argument can be made that physician-assisted suicide is by no means a lesser evil. In at least two ways, physician-assisted suicide is an even graver offense than other, more “solitary” forms of suicide: first, physician-assisted suicide morally implicates others in the evil of suicide; and second, the legalization of physician-assisted suicide tends to lead, both in theory and in practice, to euthanasia.

Physician-assisted suicide spreads the evil of suicide. Given the social nature of the human being, there has always been a good argument to be made that suicide is not actually a “solitary” evil. Other people will almost always be affected by the action, and so Aristotle classifies suicide as an offense against society, not against oneself. However, at least in practice, suicide has tended to be an action undertaken in solitude. It is a sort of strange homage that this vice has paid to virtue, or at least to human nature: many suicidal people have an intuitive sense that others would attempt to hold them back from self-destructive actions. Because of this, those contemplating suicide often attempt to keep their intentions a secret. The suicidal people wish others to truthfully be able to say, after the fact, “I had no idea what he was planning to do, or I would have tried to stop him.” The survivors might accuse themselves of failing to care enough or failing to be perceptive enough; but they could not accuse themselves of being complicit in the actual suicide.

A suicide undertaken with the “assistance” of a physician destroys the hiddenness of suicide—not in order to bring it to light to prevent it, but to make others active accomplices in the evil action. At least in a quantitative sense, assisted suicide generates more evil, more sin. In addition to the person committing suicide, there will be the physician formally cooperating in the evil action. Since he facilitates the action, writing a prescription for the lethal dosage of medication used in the act, he bears moral responsibility for the action as well. In the case of the New York bill, other doctors would be involved in order to confirm the diagnosis of the terminal illness and the prognosis of less than six months to live. In some cases a mental health professional would assist in determining mental competency, and two other people would have to witness the written request for death. The degree of moral culpability of these various agents would vary, but since all of their actions are ordered to enabling the suicide, all would carry some degree of moral responsibility.

On a more informal level, physician-assisted suicide often draws in family members as well. For example, Dan Diaz, the widower of Brittany Maynard, now campaigns for physician-assisted suicide in order “to fulfill a promise to his late wife.” Here the corruption is most complete: those bound to the suicidal person by the order of love, those with the greatest duty to try to prevent the suicide, are asked to “accompany” the suicidal person in the action, and they bear the wounds of their complicity going forward in time.

Furthermore, physician-assisted suicide would not simply “spread the evil” in the sense of eliciting the cooperation of others; it would also “spread the evil” in the sense of opening the door to new evils such as euthanasia—even non-voluntary and even involuntary euthanasia. Of course the proponents of physician-assisted suicide vigorously deny the plausibility of this “slippery slope.” They point out that there is a clear conceptual difference between assisted suicide and any form of euthanasia. In physician-assisted suicide, the suffering person kills himself. In euthanasia, the doctor kills him. In some cases there are even criminal penalties specified for any doctors who cross the line into euthanasia. However, the conceptual difference is not as clear as the proponents of assisted suicide would have us believe. And in practice, the line becomes blurrier.

As the philosopher Robert Spaemann and others have pointed out, these seemingly different practices of assisted suicide and euthanasia have an important factor in common: both practices involve the judgment that someone else’s life is not worth living, that someone else’s life has no value. This is easy to see in the case of non-voluntary and involuntary euthanasia, in which the decision to kill is made by the doctor alone. But Spaemann’s critique applies just as much in assisted suicide and voluntary euthanasia. Physicians are not simply robots who carry out the orders of their patients: they bring their own judgment and expertise to the medical situation. If a physician consents to prescribe a lethal dose of medication to his “patient,” then it can only be because on some level the physician has come to concur in the judgment of the suicidal person: “Yes, your life as you now lead it is unbearable. The suffering you are in takes away all the value of your life. Better for it to simply end.” Physician-assisted suicide allows for this line of thought to gain a cultural and legal foothold, preparing the way for “enlightened” societies to progress to euthanasia itself. Once a doctor becomes comfortable making the determination that a life lacks value in the case of a conscious patient, what would hold him back in the case of a patient in a persistent coma?

In addition to these theoretical considerations, the actual practice of assisted suicide will also begin to generate a “pull” towards euthanasia. To see how this could happen, imagine the temptations assaulting the assisting physicians in the case of suicide attempts gone awry. Is a physician who thinks that the death of the suffering patient is the best possible outcome likely to sit idly by if a patient begins to fail in the midst of a suicide attempt? If the patient grows too weak to lift the bottle and drink the requisite amount of the barbiturate, if the patient weeps and begs for “help,” what is such a physician likely to do? In the stress of the moment, worries about medical malpractice lawsuits or a loss of good reputation could trouble the physician. It will be difficult to hold the line at mere intellectual oversight of death in such situations. The temptation will be to lift the bottle to the patient’s mouth or to give the patient a quick and painless injection.

No, we must be clear and confident in our response to physician-assisted suicide: it is no improvement on suicide. Assisted suicide is morally worse, for it involves more people in evil, and brings greater evils in its wake. We should bear in mind, too, that it is good for evil actions such as suicide to be difficult. That it can sometimes be difficult to do evil is a great mercy. It would only be good for us to be equal to God in power if we were also equal to him in his goodness.

Alexander Schimpf

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Alexander Schimpf teaches philosophy at the University of St. Thomas, Houston, and blogs at Retrievals. Professor Schimpf earned his Ph.D. in philosophy from The Catholic University of America.

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