Death with dignity, either alone or with others, is certainly preferable to death without dignity, whether it be lingering or rather sudden. When one can choose the time of one’s death or knows of its impending inevitability, dignity seems all the more desirable. But what aspects of the process or experience of dying with dignity, certainly otherwise unique for each human being, are most relevant to law, especially human rights law? Is there and should there be a human right to die with dignity? What might the content and contours of such a right involve? Choice, respect, recognition of the worth of each person, whether dying or a survivor?
In an arena nearly outside of legal attention, hospice 1 already affords such a right and each of the latter possibilities to terminally ill patients. With or without hospice, a caring family and responsible, caring health professionals can provide the same experience for the dying person and their family or friends. There are undoubtedly other institutional and group arrangements that can also suffice. In any event, human rights law does not address the hospice experience directly, nor indeed death or dying. And hospice, although quite conforming to human rights values, is not global, does not reach far enough yet, and does not reach even in the direction of all who choose death or who are dying—nor do I imagine that it should. [End Page 463]
I. the General Problem: Contextual Complexities and Overreaching Domestic Laws
Laws, however, (although here not human rights laws) intrude rather directly in circumstances outside the hospice experience and, in my opinion, they pose significant affronts to what should be recognized more generally as a human right to die with dignity. More particularly, I have in mind domestic laws addressing an anathema for hospice, 2 and those prohibiting all aspects of potentially complex processes of suicide and/or assisted-suicide and even assisted-death. Do such laws serve human dignity? Do they serve a right to die with dignity? Do they even address a choice that the law should judge?
A. Contexual Complexities
The complexities of context to which such general legal prohibitions might relate are enormous, and yet, such laws often intrude with a simplistic, broad, even antihuman prohibition of the ending of one’s own life or the assistance of others in ending life. A series of introductory questions demonstrates merely some of these complexities. What, in fact, is prohibited suicide or assisted-suicide? Are distinctions with respect to conduct [End Page 464] such as active versus passive (for example, act or omission, “killing” or “letting die”) 3 realistic? Is heroic self-endangerment or self-extinction “suicide”? Are certain actions in war “suicide”? When law has failed to provide adequate health care and alternatives, and there is suffering and indignity [End Page 465] accompanying disabilities or disease, is choice to be considered differently? Indeed, is choice legally different for those who are terminally ill, just “ill,” not ill at all, for an elderly couple abandoned by society if not their children, when fragile lives seem broken?
Who should make such choices—the individual, family members, health professionals, legislators, or lawyers and judges? Should they be made secretly or openly, with or without evident consent of the individual? Should we test or differentiate on the basis of whether consent is informed, uninformed, misinformed, competent, incompetent, or not really possible (for example, where the individual is “experiencing” a quality of life perhaps appropriately referred to as “vegetative state”)? Should we consider whether the consent comes from the seemingly rational or irrational, from those with tangled dreams, from the very young or very old? Should problems related to the development and allocation of material resources or medical appropriateness make a difference? 4 And whose dignity, needs, demands, interests, and concerns are most important—those of the dying [End Page 466] person, of close survivors, or of society more generally? A law or legal decision unmindful of relevant policies at stake and features of context such as those noted above is altogether too simplistic, too dangerous, too inhuman. What pain, what consequences...
The right to assisted suicide is a significant topic that concerns people all over the United States. The debates go back and forth about whether a dying patient has the right to die with the assistance of a physician. Some are against it because of religious and moral reasons. Others are for it because of their compassion and respect for the dying. Physicians are also divided on the issue. They differ where they place the line that separates relief from dying--and killing. For many the main concern with assisted suicide lies with the competence of the terminally ill. Many terminally ill patients who are in the final stages of their lives have requested doctors to aid them in exercising active euthanasia. It is sad to realize that these people are in great agony and that to them the only hope of bringing that agony to a halt is through assisted suicide.When people see the word euthanasia, they see the meaning of the word in two different lights. Euthanasia for some carries a negative connotation; it is the same as murder. For others, however, euthanasia is the act of putting someone to death painlessly, or allowing a person suffering from an incurable and painful disease or condition to die by withholding extreme medical measures. But after studying both sides of the issue, a compassionate individual must conclude that competent terminal patients should be given the right to assisted suicide in order to end their suffering, reduce the damaging financial effects of hospital care on their families, and preserve the individual right of people to determine their own fate.
Medical technology today has achieved remarkable feats in prolonging the lives of human beings. Respirators can support a patient’s failing lungs and medicines can sustain that patient’s physiological processes. For those patients who have a realistic chance of surviving an illness or accident, medical technology is science’s greatest gift to mankind. For the terminally ill, however, it is just a means of prolonging suffering. Medicine is supposed to alleviate the suffering that a patient undergoes.Yet the only thing that medical technology does for a dying patient is give that patient more pain and agony day after day. Some terminal patients in the past have gone to their doctors and asked for a final medication that would take all the pain away— lethal drugs. For example, as Ronald Dworkin recounts, Lillian Boyes, an English woman who was suffering from a severe case of rheumatoid arthritis, begged her doctor to assist her to die because she could no longer stand the pain (184). Another example is Dr. Ali Khalili, Dr. Jack Kevorkian’s twentieth patient. According to Kevorkian’s attorney, “[Dr. Khalili] was a pain specialist; he could get any kind of pain medication, but he came to Dr. Kevorkian. There are times when pain medication does not suffice”(qtd. in Cotton 363). Terminally ill patients should have the right to assisted suicide because it is the best means for them to end the pain caused by an illness which no drug can cure. A competent terminal patient must have the option of assisted suicide because it is in the best interest of that person.
Further, a dying person’s physical suffering can be most unbearable to that person’s immediate family. Medical technology has failed to save a loved-one. But, successful or not, medicine has a high price attached to it. The cost is sometimes too much for the terminally ill’s family. A competent dying person has some knowledge of this, and with every day that he or she is kept alive, the hospital costs skyrocket. “The cost of maintaining [a dying person]. . . has been estimated as ranging from about two thousand to ten thousand dollars a month” (Dworkin 187). Human life is expensive, and in the hospital there are only a few affluent terminal patients who can afford to prolong what life is left in them. As for the not-so-affluent patients, the cost of their lives is left to their families. Of course, most families do not consider the cost while the terminally ill loved-one is still alive.When that loved-one passes away, however, the family has to struggle with a huge hospital bill and are often subject to financial ruin.Most terminal patients want their death to be a peaceful one and with as much consolation as possible. Ronald Dworkin, author of Life’s Dominion, says that “many people . . . want to save their relatives the expense of keeping them pointlessly alive . . .”(193). To leave the family in financial ruin is by no means a form of consolation. Those terminally ill patients who have accepted their imminent death cannot prevent their families from plunging into financial debt because they do not have the option of halting the medical bills from piling up. If terminal patients have the option of assisted suicide, they can ease their families’ financial burdens as well as their suffering.
Finally, many terminal patients want the right to assisted suicide because it is a means to endure their end without the unnecessary suffering and cost. Most, also, believe that the right to assisted suicide is an inherent right which does not have to be given to the individual. It is a liberty which cannot be denied because those who are dying might want to use this liberty as a way to pursue their happiness. Dr. Kevorkian’s attorney, Geoffrey N. Fieger, voices the absurdity of curbing the right to assisted suicide, saying that “a law which does not make anybody do anything, that gives people the right to decide, and prevents the state from prosecuting you for exercising your freedom not to suffer, violates somebody else’s constitutional rights is insane” (qtd. in Cotton 364). Terminally ill patients should be allowed to die with dignity. Choosing the right to assisted suicide would be a final exercise of autonomy for the dying. They will not be seen as people who are waiting to die but as human beings making one final active choice in their lives. As Dworkin puts it, “whatever view we take about [euthanasia], we want the right to decide for ourselves . . .”(239).
On the other side of the issue, however, people who are against assisted suicide do not believe that the terminally ill have the right to end their suffering. They hold that it is against the Hippocratic Oath for doctors to participate in active euthanasia. Perhaps most of those who hold this argument do not know that, for example, in Canada only a “few medical schools use the Hippocratic Oath” because it is inconsistent with its premises (Barnard 28). The oath makes the physician promise to relieve pain and not to administer deadly medicine.This oath cannot be applied to cancer patients. For treatment, cancer patients are given chemotherapy, a form of radioactive medicine that is poisonous to the body. As a result of chemotherapy, the body suffers incredible pain, hair loss, vomiting, and other extremely unpleasant side effects. Thus, chemotherapy can be considered “deadly medicine” because of its effects on the human body, and this inconsistency is the reason why the Hippocratic Oath cannot be used to deny the right to assisted suicide. Furthermore, to administer numerous drugs to a terminal patient and place him or her on medical equipment does not help anything except the disease itself. Respirators and high dosages of drugs cannot save the terminal patient from the victory of a disease or an illness. Dr. Christaan Barnard, author of Good Life/GoodDeath, quotes his colleague, Dr. Robert Twycross, who said, “To use such measures in the terminally ill, with no expectancy of a return to health, is generally inappropriate and is—therefore—bad medicine by definition” (22).
Still other people argue that if the right to assisted suicide is given, the doctor-patient relationship would encourage distrust. The antithesis of this claim is true. Cheryl Smith, in her article advocating active euthanasia (or assisted suicide), says that “patients who are able to discuss sensitive issues such as this are more likely to trust their physicians” (409). A terminal patient consenting to assisted suicide knows that a doctor’s job is to relieve pain, and giving consent to that doctor shows great trust. Other opponents of assisted suicide insist that there are potential abuses that can arise from legalizing assisted suicide.They claim that terminal patients might be forced to choose assisted suicide because of their financial situation.This view is to be respected. However, the choice of assisted suicide is in the patient’s best interest, and this interest can include the financial situation of a patient’s relatives. Competent terminal patients can easily see the sorrow and grief that their families undergo while they wait for death to take their dying loved ones away. The choice of assisted suicide would allow these terminally ill patients to end the sorrow and griefof their families as well as their own misery. The choice would also put a halt to the financial worries of these families. It is in the patient’s interest that the families that they leave will be subject to the smallest amount of grief and worry possible.This is not a mere “duty to die.” It is a caring way for the dying to say, “Yes, I am going to die. It is all right, please do not worry anymore.” Further, legalization of assisted suicide will also help to regulate the practice of it. “Legalization, with medical record documentation and reporting requirements, will enable authorities to regulate the practice and guard against abuses, while punishing real offenders”(Smith 409).
There are still some, however, who argue that the right to assisted suicide is not a right that can be given to anyone at all. This claim is countered by a judge by the name of Stephen Reinhardt. According to an article in the Houston Chronicle, Judge Reinhardt ruled on this issue by saying that “a competent, terminally-ill adult, having lived nearly the full measure of his life, has a strong liberty interest in choosing a dignified and humane death rather than being reduced at the end of his existence to a childlike state of helplessness, diapered, sedated, incompetent” ( qtd. in Beck 36). This ruling is the strongest defense for the right to assisted suicide. It is an inherent right. No man or woman should ever suffer because he or she is denied the right. The terminally ill also have rights like normal, healthy citizens do and they cannot be denied the right not to suffer.
The right to assisted suicide must be freely bestowed upon those who are terminally ill. This right would allow them to leave this earth with dignity, save their families from financial ruin, and relieve them of insufferable pain. To give competent, terminally-ill adults this necessary right is to give them the autonomy to close the book on a life well-lived.
Barnard, Christaan. Good Life/Good Death. Englewood Cliffs: Prentice, 1980.
Beck, Joan. “Answers to Right-to-Die Questions Hard.”Houston Chronicle 16 Mar. 1996, late ed.: 36.
Cotton, Paul. “Medicine’s Position Is Both Pivotal And Precarious In Assisted Suicide Debate." The
Journal of the American Association 1 Feb. 1995: 363-64.
Dworkin, Ronald. Life’s Dominion. New York: Knopf, 1993.
Smith, Cheryl. “Should Active Euthanasia Be Legalized: Yes.” American Bar Association Journal April 1993. Rpt. in CQ
Researcher 5.1 (1995): 409.
--Esther B. De La Torre