Death with “Dignity”- Physician Assisted Suicide

Although I have spoken about this elsewhere, I wanted to post some ideas about Oregon’s Death with Dignity Act here.

Via healthlawblog, anop/ed piece in the New York Times this summer discussed Oregon’s Death with Dignity Act. After telling one of the horrific stories typical of those who support Oregon’s experiment (capable man incapacitated with crippling painful terminal disease, doesn’t want to go on living like that, able to “die with dignity” by taking a lethal dosage of medication prescribed by OR doctor under OR law…) and ranting about Attorney General Ashcroft’s attempts to get the law overturned, here is what Mr. Kristof concludes:

The Oregon law deserves to be upheld. It forces us to examine the question of what is special about human life. The answer, I think, is the autonomy and dignity inherent in our individuality — in making hard decisions for ourselves and determining our own destinies. Oregon honors that vision of what is sacred about life.

Autonomy (one of the four basic principles of biomedical ethics proposed by Beauchamp & Childress) is important, and I also believe it is inherent in our individuality. But life (as well as the ethical obligations of non-maleficence and beneficence) is also important, and there are many religious and philosophical reasons for protecting it. I think most religious and philosophical traditions would allow a person to exercise autonomy in refusing medical treatment for terminal illnesses (and legal precedent in the United States supports this idea as well).

However, refusing medical treatment is a far cry from intentionally drinking a lethal dose of medicine to end it all (“with dignity”, mind you). When one drinks a lethal cocktail like the one prescribed to the patient in Kristof’s piece, one drinks with the intention of ending life. When one decides not to allow medical treatment for a terminal (or other disease), although the result may be the cessation of life, the intention is often to simply let nature take its course and live for another 2 years or die tomorrow.  Indeed, intentionally bringing about one’s own death by drinking a lethal concoction or otherwise is different enough from refusing medical treatment or demanding that medical treatment be stopped that in that instance our concern for protecting against the intentional ending of human life ought to outweigh the concern for personal autonomy. We let it happen in outlawing suicide– and as I mentioned I fail to see a reason (or value) to allow autonomy to outweigh protection of life in this situation as well.

If the reason for allowing a patient to hasten death by drinking a lethal cocktail of drugs is to palliate pain and not have to undergo futile treatment that would sap dignity, that concern is addressed by allowing a patient to forego medical treatment and take pain killers (though not in a lethal amount) to alleviate the suffering.

I think the Oregon law is a travesty and that it ought to be repealed. It allows what no other state has ever allowed under any circumstances- suicide. The intentional killing of oneself. It excuses physicians from what has typically been a crime- assisted suicide. Finally, it seems to me to be against a doctor’s ethical obligation of non-maleficence to engage in such a behavior.

The so-called “Oregon experiment” was not even worth trying in the first place. The law seems unjustifiable and contrary to normative values in the United States. It should be repealed.

5 Responses to Death with “Dignity”- Physician Assisted Suicide

  1. john f. says:

    Great post. I also think it should be repealed because far from enshrining “human dignity,” it debases life as a mere commodity, worth having only as long as it is comfortable and “individual.” In a sense, then, the only way that proponents of the law can claim that it furthers human dignity is by ignoring the inherent value of human life, and in so doing lessening the human dignity that every human enjoys by the mere fact of being alive and functioning biologically. The human brain is an incredible organism with cognitive capacities that are unparalleled in the natural world; in this cognition and awareness lies the core of human dignity; in this capacity for creative constellations and irrationality is the miracle of being human.

  2. Jordan says:

    This post has been removed by the author.

  3. Jordan says:

    In a sense, then, the only way that proponents of the law can claim that it furthers human dignity is by ignoring the inherent value of human life, and in so doing lessening the human dignity that every human enjoys by the mere fact of being alive and functioning biologically. . .I mostly agree, but I wouldn’t go quite that far in villifying those who support such legislation. You are right that they don’t necessarily see any human dignity simply in the mere functioning of the organism on some level- to them it is personal autonomy which is the crown of dignity. And in a way, I agree with them. But unfortunately, they carry the autonomy argument too far.

    I agree with such people that autonomy should be respected as far decisions to refuse or discontinue medical treatment goes. But as I said, letting nature take its course free from medical intervention is different enough from actively inducing death by drinking a lethal cocktail (or similar) that the latter ought not be condoned. In other words, it is at that point that society’s interest in protecting life as life trumps the individual interest in personal autonomy, in my opinion.

    Part of the problem here is that we as a society have been so quick to want to save life at any cost that as medical technology has advanced, we have failed to pay attention to the QUALITY of the life that is prolonged.

    But I still don’t think that this justifies physician assisted suicide, that is, the active inducement of death by the knowing introduction of a death causing agent into the body, as opposed to the withholding of medical treatment at the patient’s bidding to allow nature to take its course.

    Anyway, the point is that we can’t completely discount the centrality of autonomy to those characteristics makes up human dignity.

  4. Anonymous says:

    My concern is that the existence of this possibility places a measure of guilt on a patient who is long convalescing. The patient has to consider the possibility that they could commit suicide and thus relieve family members of “the burden” that has been placed upon them. At the same time, relatives of a person who is suffering can be thinking about how selfish a person is being for not removing themselves. Human nature simply doesn’t need this “incentive” for suicide.

    Danithew
    http://www.wump.info/wumpblog

  5. john f. says:

    Great point Danithew. I hadn’t thought about it from that angle before. I agree that human nature would indeed tend towards these reactions, no matter how idealistic we want to be about it.

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