Aid in Dying

Physician-Assisted Suicide Confronts High Court and Public With Moral Questions

By Michael J. Meyer

The U.S. Supreme Court is once again positioned to answer a question of monumental ethical, religious, and cultural import: Is physician assisted aid in dying a constitutionally guaranteed right?

The debate over this bold social experiment is surely as complex and vexed as the debate over legalized abortion; arguably, it is of even broader significance. Any decision to legalize physician-assisted suicide would affect, in a very direct and intimate way, almost every person in the United States.

Although a great deal has been written about this issue, a few topics seem to be of lasting ethical importance.

Death With Dignity
Those who support the legalization of suicide often argue that individuals have a basic (constitutional) right to die with dignity, but this rhetoric is worth unveiling. Establishing a right to physician-assisted suicide doesn't guarantee a dignified death.

Some might argue that having the liberty to choose how we die is synonymous with dignity. But unless we are willing to stipulate that a dignified death is any death under the auspices of a legal right to die, then all the legal right provides is an opportunity for a dignified death.

A truly dignified death is presumably an extension of a dignified life. Meeting death with dignity, like meeting it with courage, is likely to be the result of a life in pursuit of these characteristics. As philosopher Ronald Dworkin notes, "It is a platitude that we live our whole lives in the shadow of death; it is also true that we die in the shadow of our whole lives."

All parties to the debate should admit that a dignified death cannot be secured by a simple expansion of rights; such a death will require further personal and communal courage, compassion, fortitude, and faith.

The Value of Life
Beyond death with dignity is another issue: basic respect for life, a fundamentally important value in any civilized society. Some parties to this debate will contend that the very decision to legalize physician assisted suicide is a serious violation of this fundamental value. One seemingly cogent rebuttal is that, at the end of life, the best way to respect it is to honor the liberty of those who have no reasonable way to end their suffering other than ending their life.

But how will legally sanctioned suicide in these cases affect our view of those who suffer? As a society, we already tend to put higher value on happy and productive lives and to devalue those that are, in various ways, "substandard" or "dysfunctional." We have a particular fear of dependence. If physician-assisted suicide is deemed a constitutional right, will this further erode the value we place — both publicly and personally — on those who are dependent on us?

This question, of course, points toward some worrisome "slippery slopes," all of which suggest that any implementation of physician assisted suicide is only the beginning of a social movement, the end of which may appall even those who supported it at the outset.

Adequate Safeguards
A cogent reply to any particular slippery slope argument is that we will not slide to the bottom; we will institute adequate safeguards to prevent abuses. The question of safeguards has been hotly contested in the debate over physician-assisted suicide.

Yale Kamisar, professor of law at the University of Michigan and an important, long-standing opponent of legalizing euthanasia, has remarked, "If assisted suicide went through, we'd be providing more safeguards for criminals picked up on the street than we would for the dying." This point is, at the same time, misleading and important.

On the misleading side, the analogy is simply not as strong as Kamisar suggests. Any decent society sets an appropriately high level of safeguards for criminals, faced as they are with the overwhelming power of the state. Yet, in the matter of safeguards, few cases can be usefully compared with the plight of criminals.

For example, we provide more explicit constitutional safeguards for criminals than we do for schoolchildren. We do not thereby degrade the status or the safety of schoolchildren. Adequate safeguards against abuses of power are not defined solely by what we do for criminals.

This point having been made, we must take seriously Kamisar's general worry about safeguards for legalized physician-assisted suicide. It is far from obvious that a society as large, diverse, and unequal as ours can implement adequate safeguards.

In a nation with great — and ever-increasing — disparities of wealth and education and ever-growing numbers of uninsured and underinsured citizens, the problem that people who cannot pay for health care might regularly be coerced to die may be genuinely unmanageable. Add to these already large and systemic forces the fact that for-profit HMOs are increasingly taking over our health-care system, and the problem of adequate safeguards may very well be intractable.

Overconfidence
Those with confident answers to these and other hard questions will step forward as the Supreme Court deliberates assisted suicide. Yet, we are well advised to avoid overconfidence on such issues.

In many ways, those with certain answers regarding physician-assisted suicide are like Miranda in Shakespeare's Tempest, regarding the brave new world she sees with innocent wonder. As we confront our own brave new world of high-technology health care and aid in dying, we might do well to remember the sober reply of Miranda's father, Prospero, who has seen something of the perils in the brave new world his daughter wants to embrace. Her father's reply: "'Tis new to thee."

Michael J. Meyer, associate professor of philosophy at Santa Clara University, is on the Markkula Center for Applied Ethics Steering Committee. His current work is on the idea of human dignity as well as liberal virtues like tolerance and civility. A version of this article appeared in the San Jose Mercury News.

Further Reading

Beauchamp, Tom, ed. Intending Death: The Ethics of Assisted Suicide and Euthanasia. Englewood Cliffs, N.J.: Prentice Hall, 1996.

Beauchamp, Tom and Veatch, Robert, eds. Ethical Issues in Death and Dying, 2nd ed. Englewood Cliffs, N.J.: Prentice Hall, 1996.

Meyer, Michael J. "Dignity, Death and Modern Virtue." American Philosophical Quarterly 32:1 (January 1995).

Compassion in Dying v. State of Washington. Federal Reporter, 3rd series, 79, p. 790.

Quill v. Vaco. Federal Reporter, 3rd series, 80, p. 716.