General
Medical News Today. What are euthanasia and assisted suicide? (2018)
Euthanasia: A doctor is allowed by law to end a person’s life by a painless means, as long as the patient and their family agree.
Assisted suicide: A doctor assists a patient to commit suicide if they request it.
Voluntary and involuntary euthanasia
Euthanasia can also be classed as voluntary or involuntary.
Voluntary: When euthanasia is conducted with consent. Voluntary euthanasia is currently legal in Belgium, Luxembourg, The Netherlands, Switzerland, and the states of Oregon and Washington in the U.S.
Non-voluntary: When euthanasia is conducted on a person who is unable to consent due to their current health condition. In this scenario the decision is made by another appropriate person, on behalf of the patient, based on their quality of life and suffering.
Involuntary: When euthanasia is performed on a person who would be able to provide informed consent, but does not, either because they do not want to die, or because they were not asked. This is called murder, as it’s often against the patients will.
Passive and active euthanasia
There are two procedural classifications of euthanasia:
Passive euthanasia is when life-sustaining treatments are withheld. The definitions are not precise. If a doctor prescribes increasing doses of strong painkilling medications, such as opioids, this may eventually be toxic for the patient. Some may argue that this is passive euthanasia.
Others, however, would say this is not euthanasia, because there is no intention to take life.
Active euthanasia is when someone uses lethal substances or forces to end a patient’s life, whether by the patient or somebody else.
Active euthanasia is more controversial, and it is more likely to involve religious, moral, ethical, and compassionate arguments.
Pro
Christopher Riddle. Assisted Dying & Disability (2011)
I arrive at the conclusion that if we respect and value people with disabilities, we ought to permit assisted dying. I do so in the following manner. First, I examine recent changes in legislation that have occurred since the aforementioned report. I suggest that these changes are likely to only strengthen opposition to assisted dying from disability rights activists and people with disabilities. Second, I explore the opposition to assisted dying that focuses on risk and the vulnerability of people with disabilities. Here I suggest that this risk ought not to be of special concern. Third, I focus on respect for people with disabilities and in particular, respect for their autonomy and decision-making abilities. Ultimately, I conclude that upholding this respect requires the legalization of assisted dying, rather than the denial of access in a misguided effort to protect people
Current Oncology. (2011) A legal right to die: responding to slippery slope and abuse arguments (2011)
Bernadette Spina. Ethical Justifications for Voluntary Active Euthanasia (1998)
Advances in medical technology provide many options for prolonging a terminally ill patient’s life, often beyond the point at which he is able to derive value from that life or even live free from pain. For such a patient, voluntary active euthanasia is ethically justifiable. If a patient is competent, autonomy dictates that he should have the right to choose when and how he will die. In addition, the principle of justice asserts that it is unjust to deny such patients the opportunity to end their pain. Doctors have responsibilities of beneficence and nonmaleficence toward their patients and both are served in the practice of voluntary active euthanasia. Legalizing this form of euthanasia and controlling its practice with regulations provides the best compromise between opponents interested in protecting against abuses and terminally ill patients who could benefit from the practice by ending their suffering. For such patients, death is not a tragedy, but a blessing.
Anton Van Nierkerk We have a right to die with dignity. The medical profession has a duty to assist (2016)
The most compelling argument in favour of physician assisted suicide or voluntary active euthanasia is the argument in support of committing suicide in a democracy. The right to commit suicide is, as far as I am concerned, simply one of the prices we have to be willing to pay as citizens of a democracy.
We do not have the right, and we play no discernible role, in coming into existence. But we do have the right to decide how long we remain in existence. The fact that we have the right to suicide, does not mean that it is always (morally) right to execute that right.
It is hard to deny the right of an 85-year-old with terminal cancer of the pancreas and almost no family and friends left, to commit suicide or ask for assisted death. In this case, he or she both has the right, and will be in the right if exercising that right.
Compare that with the situation of a 40-year-old man, a husband and father of three young children, who has embezzled company funds and now has to face the music in court. He, also, has the right to commit suicide. But, I would argue, it would not be morally right for him to do so, given the dire consequences for his family. To have a right, does not imply that it is always right to execute that right.
My argument in favour of physician assisted suicide or voluntary active euthanasia is thus grounded in the right to suicide, which I think is fundamental to a democracy.
Take the case of a competent person who is terminally ill, who will die within the next six months and has no prospect of relief or cure. This person suffers intolerably and/or intractably, often because of an irreversible dependence on life-support. This patient repeatedly, say at least twice a week, requests that his/her life be terminated. I am convinced that to perform physician assisted suicide or voluntary active euthanasia in this situation is not only the humane and respectful, but the morally justified way to go.
The primary task of the medical profession is not to prolong life or to promote health, but to relieve suffering. We have a right to die with dignity, and the medical profession has a duty to assist in that regard.
Kelly Crocker. Why Euthanasia and Physician-Assisted Suicide are Morally Permissible (2013)
I argue in favor of the moral permissibility of these two topics. The major arguments addressed include some that are frequently addressed such as models of correct use of physician-assisted suicide, quality of life, and individual rights, as well as a few that arguments that have gotten little to no attention such as the utilitarian argument of less suffering and a thought experiment comparing the common euthanization of animals to the controversial euthanization of humans. I next address the major objections that opponents of physician assisted suicide and euthanasia claim, these include: corruption of the doctor’s role as a healer, slippery slope and fear of abuse, and that there are alternatives to euthanasia. Lastly, I respond to these objections with further evidence to support my claim that these acts are morally permissible. The aim of this paper is to make a comprehensive argument in favor of physician assisted suicide and euthanasia, which are frequently addressed in separate debates.
Individual Rights
In the eyes of Oregon’s governor, former emergency room physician John Kitzhaber, the answer to the euthanasia controversy is simple: “I believe an individual should have control, should be able to make choices about the end of their life. . . . As a physician, I can tell you that there’s a clear difference between prolonging someone’s life and prolonging their death,” (Worsnop, 1997). Most would agree that each person has the right to control what happens to his or her body and his or her life, then following this logic, why doesn’t this right carry over to the right to control how one dies? Values such as privacy, freedom, and autonomy are highly regarded in our society and are frequently protected and yet these rights are not applied to one of the most personal moments of a person’s life – death. Although these arguments are valid and thus used frequently, there are other arguments that receive little to no attention in the intellectual conversation about physician-assisted suicide and euthanasia. These arguments include the utilitarian argument of less suffering and comparing animal euthanasia to human euthanasia.
The Utilitarian Argument: Less Suffering
Jeremy Bentham made an argument for an innovative conception of morality, known as the Crocker 6 utilitarian approach, which is not about pleasing God or being faithful to theoretical rules, but rather is focused on increasing happiness and decreasing suffering as much as possible. The utilitarian approach would argue that euthanasia is morally acceptable because it decreases the misery of everyone involved: the patient, the caretakers, and the family and friends of the patient. Flaws do exist in the utilitarian principle when applied to certain situations, for example: the utilitarian approach would argue that a peeping tom is not immoral if he is not caught, meaning that if his victim was unaware, no suffering would occur and his pleasure would be all that mattered. However, most people would agree that other values such as individual rights, justice, and freedom are equally important. The safeguards that exist in the laws of states that legalized physician-assisted suicide protect patients’ rights and maintain justice. Not allowing a patient to decide when his life should end is in fact denying him his freedom. In the case of physicianbassisted suicide, the utilitarian approach would state that when a terminally ill patient is kept alive only to die slowly and painfully, suffering is greatly increased for everyone involved. Rather than taking the radical utilitarian approach and killing anybody who is in pain or suffering, I argue for the more moderate utilitarian approach in which the physician-assisted suicide is conducted justly (at the wishes of the patient whose rights are not violated and by a doctor whose moral convictions do not go against the act), then the act alleviates unnecessary suffering and only the suffering of losing a loved one (that will occur no matter the circumstance of death since the patient is terminal) will occur for the family and friends of the patient.
Steven Wolhander Voluntary Active Euthanasia for the Terminally Ill and the Constitutional Right to Privacy (1984)
Competent terminally ill persons have a right to choose the time and manner of their death. This choice is protected by the constitutional right to privacy. This Note contends that the protection afforded by the right to privacy extends to individuals whose assistance is necessary to help competent terminal patients end their lives. It proposes guidelines for both prosecutors and courts to ensure that a terminal patient’s decision to end his life is made in a voluntary and competent manner
Brian Hix Physician-Assisted Suicide and Federalism (2003)
Under federalist principles, which prescribe the separation of political decision-making among different levels of government, it seems natural that some states might choose to legalize physician-assisted suicide, because it reflects the values of the citizens of those states. Additionally, it is beneficial that there be such “experiments” going on, as long as the spillover effects of the experiment can be minimized. At the moment, Oregon is the only such experiment in the United States, but it may be a sufficient “laboratory” for ascertaining the likely long-term effects of legalization
Carol Gill No, we don’t think our doctors are out to get us: Responding to the straw man distortions of disability rights arguments against assisted suicide (2010)
The arguments that disability rights advocates present in opposition to legalized assisted suicide are frequently misconstrued in public debate. The goal of this paper is to identify and analyze key ‘‘straw man’’ fallacies about the disability rights opposition in order to clarify this position and the factors that contribute to its distortion. The author adopts a first-person perspective as a disability scholar/activist who has participated in ‘‘right to die’’ debates for over two decades. Three possible barriers that potentially impede comprehension of disability rights arguments are discussed. Prominent fallacies that assisted suicide proponents attribute to disability rights opponents are analyzed in relation to the dynamics of the assisted suicide debate, social views of disability and incurable illness, and available evidence. The author’s position is that disability rights arguments against legalized assisted suicide contribute a complex intellectual and experience-based perspective to the debate that can illuminate immediate and distal consequences of altering public policy
Con
Allowing physician-assisted suicide would be a grave mistake for four reasons. First, it would endanger the weak and vulnerable. Second, it would corrupt the practice of medicine and the doctor–patient relationship. Third, it would compromise the family and intergenerational commitments. And fourth, it would betray human dignity and equality before the law. Instead of helping people to kill themselves, we should offer them appropriate medical care and human presence. We should respond to suffering with true compassion and solidarity. Doctors should help their patients to die a dignified death of natural causes, not assist in killing. Physicians are always to care, never to kill.
Rejecting Rights: The Disability Critique of Physician Assisted Suicide (2001)
Finally, if it can be morally right to kill some competent patients at their request, then it must be morally justified to give them the medical wherewithal to kill themselves. It is open to debate whether what Mrs Pretty requires can best be described as voluntary euthanasia or assisted suicide. To provide either of these to appropriate patients who make a competent request represents respect for their autonomy and their desire to die with what they perceive to be dignity.
Physician-Assisted Suicide: Promoting Autonomy or Medicalizing Suicide? (1999)
There Is No Free Lunch Let us assume that from the point of view of particular patients who will eventually undergo assisted suicide the practice does demedicalize their dying: as long as it hastens death, it liberates them not only from pain and suffering but from the hands of medicine and its paraphernalia as well. This liberation is achieved through torturous ways, however: first, it is precisely physicians who are in charge of freeing patients from medicine. Second, this emancipation presupposes and is achieved at the cost of the individual’s submission to medical norms and scrutiny. What the patients’ rights movement still struggles to recapture from medicine-control over the decision to die-is being returned to medicine through physician-assisted suicide. Eventually, people will have physician-assisted suicide not only because they want it, but because physicians agree they can have it. At the societal level too physicianassisted suicide in fact extends the medicalization of death. First, physician-assisted suicide radicalizes the right of the medical profession to make life and death decisions, for now even (assisted) suicide must surrender to its hands. Second, physician-assisted suicide translates one more sphere of personal and intimate meaning into a medical event. Moreover, placing assisted suicide under physicians’ control and supervision ends up transforming moral categories (such as “rationality” and “voluntariness”) into medical ones. Perhaps submitting to medical scrutiny individually and to the increasing medicalization of death and dying societally are lesser evils than the agony some people endure at the end of life. Nevertheless, this tradeoff should not obscure the price being paid. It urges us, further, to reexamine the claims of honoring personal autonomy and demedicalizing death and dying as the argumentative basis on which physician-assisted suicide rests.
Physician-assisted Suicide: The Wrong Approach to End of Life Care (2003)
There is, of course, a final reason given for physician-assisted suicide: it is cheaper to kill a person than to provide care. Yet a physician’s first obligation is to “Do No Harm.” Until that is replaced with “Save more money,” it will be difficult to support physician-assisted suicide.
The Lethal Logic of Assisted Suicide (2015)
Allowing physician-assisted suicide would be a grave mistake for four reasons. First, it would endanger the weak and vulnerable. Second, it would corrupt the practice of medicine and the doctor–patient relationship. Third, it would compromise the family and intergenerational commitments. And fourth, it would betray human dignity and equality before the law. Instead of helping people to kill themselves, we should offer them appropriate medical care and human presence. We should respond to suffering with true compassion and solidarity. Doctors should help their patients to die a dignified death of natural causes, not assist in killing. Physicians are always to care, never to kill.
Say No to Physician Assisted Suicide (2012)
Moreover, the logic of decriminalizing PAS for the terminally ill who are suffering grievously would lead inexorably to allowing (and encouraging) other types of killing. If the rationale for PAS is to respect autonomy, then why limit it to those are terminally ill? Why privilege the autonomy of those who are suffering and terminally ill above those who are suffering chronically? If the rationale for PAS is that a person is in misery or has allegedly lost her dignity—if, for such people, death is a benefit—then it will be impossible to deny this alleged benefit to those who lack decisionmaking capacity, those who are unconscious, or demented, or too young to have such capacity (as has occurred in the Netherlands with the open euthanasia of infants).
PAS=Physician Assisted Suicide
PAS is ableist, ageist, destroys human dignity and patient-doctor trust- palliative care is the alternative that allows death with dignity, no safeguards really solve
Anderson 3/24 [Ryan T. Anderson, Ph.D., William E. Simon Fellow in Religion and a Free Society, Heritage Foundation, Always Care, Never Kill: How Physician-Assisted Suicide Endangers the Weak, Corrupts Medicine, Compromises the Family, and Violates Human Dignity and Equality, March 24, 2015, https://www.heritage.org/research/reports/2015/03/always-care-never-kill-how-physician-assisted-suicide-endangers-the-weak-corrupts-medicine-compromises-the-family-and-violates-human-dignity-and-equality]
In 2015, at least 18 state legislatures and the District of Columbia are considering whether to allow physician-assisted suicide (PAS).[2] Legalizing physician-assisted suicide, however, would be a grave mistake because it would:
Endanger the weak and vulnerable,
Corrupt the practice of medicine and the doctor–patient relationship,
Compromise the family and intergenerational commitments, and
Betray human dignity and equality before the law.
First, PAS endangers the weak and marginalized in society. Where it has been allowed, safeguards purporting to minimize this risk have proved to be inadequate and have often been watered down or eliminated over time. People who deserve society’s assistance are instead offered accelerated death.
Second, PAS changes the culture in which medicine is practiced. It corrupts the profession of medicine by permitting the tools of healing to be used as techniques for killing. By the same token, PAS threatens to fundamentally distort the doctor–patient relationship because it reduces patients’ trust of doctors and doctors’ undivided commitment to the life and health of their patients. Moreover, the option of PAS would provide perverse incentives for insurance providers and the public and private financing of health care. Physician-assisted suicide offers a cheap, quick fix in a world of increasingly scarce health care resources.
Third, PAS would harm our entire culture, especially our family and intergenerational obligations. The temptation to view elderly or disabled family members as burdens will increase, as will the temptation for those family members to internalize this attitude and view themselves as burdens. Physician-assisted suicide undermines social solidarity and true compassion.
Fourth, PAS’s most profound injustice is that it violates human dignity and denies equality before the law. Every human being has intrinsic dignity and immeasurable worth. For our legal system to be coherent and just, the law must respect this dignity in everyone. It does so by taking all reasonable steps to prevent the innocent, of any age or condition, from being devalued and killed. Classifying a subgroup of people as legally eligible to be killed violates our nation’s commitment to equality before the law—showing profound disrespect for and callousness to those who will be judged to have lives no longer “worth living,” not least the frail elderly, the demented, and the disabled. No natural right to PAS exists, and arguments for such a right are incoherent: A legal system that allows assisted suicide abandons the natural right to life of all its citizens.
Instead of embracing PAS, we should respond to suffering with true compassion and solidarity. People seeking PAS typically suffer from depression or other mental illnesses, as well as simply from loneliness. Instead of helping them to kill themselves, we should offer them appropriate medical care and human presence. For those in physical pain, pain management and other palliative medicine can manage their symptoms effectively. For those for whom death is imminent, hospice care and fellowship can accompany them in their last days. Anything less falls short of what human dignity requires. The real challenge facing society is to make quality end-of-life care available to all.
Doctors should help their patients to die a dignified death of natural causes, not assist in killing. Physicians are always to care, never to kill. They properly seek to alleviate suffering, and it is reasonable to withhold or withdraw medical interventions that are not worthwhile. However, to judge that a patient’s life is not worthwhile and deliberately hasten his or her end is another thing altogether.
Citizens and policymakers need to resist the push by pressure groups, academic elites, and the media to sanction PAS. Recent experience with PAS both in the United States and in Europe suggests how problematic it is.
This isn’t a slippery slope argument- the legal argument for PAS will sanction euthanasia
Anderson 3/24 [Ryan T. Anderson, Ph.D., William E. Simon Fellow in Religion and a Free Society, Heritage Foundation, Always Care, Never Kill: How Physician-Assisted Suicide Endangers the Weak, Corrupts Medicine, Compromises the Family, and Violates Human Dignity and Equality, March 24, 2015, https://www.heritage.org/research/reports/2015/03/always-care-never-kill-how-physician-assisted-suicide-endangers-the-weak-corrupts-medicine-compromises-the-family-and-violates-human-dignity-and-equality]
Endangering the Weak and Marginalized
To understand how PAS endangers the weak and marginalized, one must understand what PAS entails and where it leads. With PAS, a doctor prescribes the deadly drug, but the patient self-administers it. While most activists in the United States publicly call only for PAS, they have historically advocated not only PAS, but also euthanasia: the intentional killing of the patient by a doctor.
This is not surprising: The arguments for PAS are equally arguments for euthanasia. Neil Gorsuch, currently a federal judge, points out that some contemporary activists fault the movement for not being honest about where its arguments lead. He notes that legal theorist and New York University School of Law Professor Richard Epstein “has charged his fellow assisted suicide advocates who fail to endorse the legalization of euthanasia openly and explicitly with a ‘certain lack of courage.’”[3]
The logic of assisted suicide leads to euthanasia because if “compassion” demands that some patients be helped to kill themselves, it makes little sense to claim that only those who are capable of self-administering the deadly drugs be given this option. Should not those who are too disabled to kill themselves have their suffering ended by a lethal injection?
And what of those who are too disabled to request that their suffering be ended, such as infants or the demented? Why should they be denied the “benefit” of a hastened death? Does not “compassion” provide an even more compelling reason for a doctor to provide this release from suffering and indignity?[4] As Professor John Keown points out:
If compassion justified us in giving a lethal prescription to a terminally ill patient on request to end their suffering, it would equally justify us in giving them a lethal injection, particularly if they were physically unable to commit suicide. It would also justify us in giving a lethal injection to a terminally ill patient who was incapable of making a request.[5]
Judge Gorsuch notes that for the Dutch, “it is the physician’s assessment of the patient’s quality of life as ‘degrading’ or ‘deteriorating’ or ‘hopeless’ that stands as the ultimate justification for killing.”[6]
Although the Supreme Court of the United States has ruled in two unanimous decisions that there is no constitutional right to PAS, three states permit it by statute: Oregon, Washington, and Vermont.[7]Physician-assisted suicide and euthanasia are allowed in three European countries—the Netherlands, Belgium, and Luxembourg—and Switzerland allows assisted suicide.[8]
The evidence from these jurisdictions, particularly the Netherlands, which has over 30 years of experience, suggests that safeguards to ensure effective control have proved inadequate. In the Netherlands, several official, government-sponsored surveys have disclosed both that in thousands of cases, doctors have intentionally administered lethal injections to patients without a request and that in thousands of cases, they have failed to report cases to the authorities.[9]
Physician Assisted Suicide requires and reinforces ableist assumptions about “autonomy” and “dignity” – Ask yourself, how do Doctors decide who *needs* “suicide prevention” vs. who *gets* “suicide encouragement”? We should focus on ending ableism instead of ending disabled lives
Coleman 2010 (Diane, “Assisted suicide laws create discriminatory double standard for who gets suicide prevention and who gets suicide assistance: Not Dead Yet Responds to Autonomy, Inc.”, Disability and Health Journal Volume 3, Issue 1, Pages 39–50, January 2010 https://www.disabilityandhealthjnl.com/article/S1936-6574(09)00089-2/fulltext)
People with terminal conditions are a subset of people with disabilities. The real issue is the reasons people ask for assisted suicide. Although intractable pain has been emphasized as the primary reason for enacting assisted suicide laws, the reasons Oregon physicians actually report for issuing lethal prescriptions are the patient’s “loss of autonomy” (89.9%), “less able to engage in activities” (87.4%), “loss of dignity” (83.8%), and “feelings of being a burden” (38.3%).13 People with disabilities are concerned that these psychosocial factors have become widely accepted as sufficient justification for assisted suicide, with most physicians not requesting a psychological consultation (only 3.3% in 2008)14 or the intervention of a social worker familiar with home- and community-based services that might alleviate these feelings. The societal message is “so what?” The primary underlying practical basis for the physician’s determination that the individual is eligible for assisted suicide is the individual’s disabilities and physical dependence on others for everyday needs, which is viewed as depriving them of what nondisabled people often associate with “autonomy” and “dignity,” and may also lead them to feel like a “burden.” This establishes grounds for physicians to treat these individuals completely differently than they would treat a physically able-bodied suicidal person. Those feelings often arise when a person acquires physical impairments that necessitate relying on other people for help in activities formerly carried out alone. In a society that prizes physical ability and stigmatizes impairments, it’s no surprise that previously able-bodied people may tend to equate disability with loss of dignity. Studies of patient attitudes toward assisted suicide confirm that “[p]atients’ interest in physician-assisted suicide appeared to be more a function of psychological distress and social factors than physical factors.”15 “When patients ask for death to be hastened,” one study concluded, “the following areas should be explored: the adequacy of symptom control; difficulties in the patient’s relationships with family, friends, and health workers; psychological disturbances, especially grief, depression, anxiety ….”16 And another study exploring psycho-social factors provided the following analysis: The desire for euthanasia or assisted suicide resulted from fear and experience of two main factors: disintegration and loss of community. These factors combined to give participants a perception of loss of self … . Symptoms and loss of function can give rise to dependency on others, a situation that was widely perceived as intolerable for participants: “I’m inconveniencing, I’m still inconveniencing other people who look after me and stuff like that. I don’t want to be like that. I wouldn’t enjoy it, I wouldn’t, I wouldn’t. No, I’d rather die.” Participants frequently used the notion of dignity to describe the experiences associated with disintegration: “You’ve become a bag of potatoes to be moved from spot to spot, to be rushed back and forth from the hospital, to be carried to your doctors’ appointments or wheeled in a wheelchair, and it really does take away any self-worth, any dignity, or any will to continue to live.” … Loss of community entailed the progressive diminishment of desire and opportunities to initiate and maintain close personal relationships, owing to loss of mobility, exclusion and alienation by others … . Participant: “… I used to be somebody, but now, like I mean, you know, I’m no better than like a doll, somebody has to dress me and feed me and I guess it’s uh, I don’t know how to explain it, really.”17 These feelings are understandable for newly disabled people, whether due to a chronic or a terminal condition. Disability groups, however, disagree that needing help in dressing, bathing, and other intimate daily tasks robs a person of dignity. Unfortunately, popular culture has done virtually nothing to educate the public about how people with severe disabilities actually live autonomous and dignified lives. Our lives are portrayed as tragedies or
The motives of HMO’s and managed care amplifies the problems of euthanasia – there is no monetary incentive to prolong life and pursue treatment versus the $50 for a lethal injection—means people don’t have autonomy because they can’t pay for the other option
Golden, 1997 (Marilyn, Senior Policy Analyst at the Disability Rights Education and Defense Fund, “Why Assisted Suicide Must Not Be Legalized” https://dredf.org/assisted_suicide/assistedsuicide.html JED)
Perhaps the most significant problem is the deadly mix between assisted suicide and profit-driven managed health care. Again and again, health maintenance organizations (HMOs) and managed care bureaucracies have overruled physicians’ treatment decisions. These actions have sometimes hastened patients’ deaths. The cost of the lethal medication generally used for assisted suicide is about $35 to $50, far cheaper than the cost of treatment for most long-term medical conditions. The incentive to save money by denying treatment already poses a significant danger. This danger would be far greater if assisted suicide is legal.
Assisted suicide is likely to accelerate the decline in quality of our health care system. A 1998 study from Georgetown University’s Center for Clinical Bioethics underscores the link between profit—driven managed health care and assisted suicide. The research found a strong link between cost—cutting pressure on physicians and their willingness to prescribe lethal drugs to patients, were it legal to do so. The study warns that there must be “a sobering degree of caution in legalizi ng [assisted suicide] in a medical care environment that is characterized by increasing pressure on physicians to control the cost of care” (Sulmasy et al., 1998).
The deadly impact of legalizing assisted suicide would fall hardest on socially and economically disadvantaged people who have less access to medical resources and who already find themselves discriminated against by the health care system. As Paul Longmore, Professor of History at San Francisco State University and a foremost disability advocate on this subject, has stated, “Poor people, people of color, elderly people, people with chronic or progressive conditions or disabilities, and anyone who is, in fact, terminally ill will find themselves at serious risk” (Longmore, 1999).
Rex Greene, M.D., Medical Director of the Dorothy E. Schneider Cancer Center at Mills Health Center in San Mateo, California and a leader in bioethics, health policy and oncology, underscored the heightened danger to the poor. He said, “The most powerful predictor of ill health is [people’s] income. [Legalization of assisted suicide] plays right into the hands of managed care.”2
Supporters of assisted suicide frequently say that HMOs will not use this procedure as a way to deal with costly patients. They cite a 1998 study in the New England Journal of Medicine that estimated the savings of allowing people to die before their last month of life at $627 million. Supporters argue that this is a mere .07% of the nation’s total annual health care costs. But significant problems in this study make it an unsuitable basis for claims about assisted suicide’s potential impact. The researchers based their findings on the average cost to Medicare of patients with only four weeks or less to live. Yet assisted suicide proposals (as well as the law in Oregon) define terminal illness as having six months to live. The researchers also assumed that about 2.7% of the total number of people who die in the U.S. would opt ffor assisted suicide, based on reported assisted suicide and euthanasia deaths in the Netherlands. But the failure of large numbers of Dutch physicians to report such deaths casts considerable doubt on this estimate. And how can one compare the U.S. to a country that has universal health care? Taken together, these factors would skew the costs much higher (Rowen, 1999).
Claims of free choice are illusory, disabled (and elderly) folks will have no choice in selecting death. Golden, 1997 (Marilyn
Golden, 1997 (Marilyn, Senior Policy Analyst at the Disability Rights Education and Defense Fund, “Why Assisted Suicide Must Not Be Legalized” https://dredf.org/assisted_suicide/assistedsuicide.html JED)
Assisted suicide purports to be about free choice and self-determination. But there is significant danger that many people would take this “escape” due to external pressure. For example, elderly individuals who don’t want to be a financial or caretaking burden on their families might choose assisted death. In Oregon’s third year Report, “a startling 63% of [reported cases] cited fear of being a ‘burden on family, friends or caregivers’ as a reason for their suicide” (United States Conference of Catholic Bishops, 2001).
Also very troubling, research has documented widespread elder abuse in this country. The perpetrators are often family members (National Elder Abuse Incidence Study, 1996).4 Such abuse could easily lead to pressures on elders to “choose” assisted suicide.
In addition, leaders and researchers in the African-American and Latino communities have expressed their fears that pressures to choose death would be applied disproportionately to their communities (Page, 1999; Montemayor, 1999; Ann Arbor News, 1997; Detroit Free Press, 1997).
Still others would undergo assisted suicide because they lack good health care, or in-home support, and are terrified about going to a nursing home. As Diane Coleman noted regarding Oregon’s law, “Nor is there any requirement that sufficient home and community-based long-term care services be provided to relieve the demands on family members and ease the individual’s feelings of being a ‘burden’ … The inadequacy of the in-home long
PAS will result in non-voluntary forms of life-taking – will result in the deaths of tens of thousands
Smith 1 (Wesley, Author, lawyer, + senior fellow at the Discovery Institute’s Center on Human Exceptionalism, National Review, “Culture of Death Angels,” https://www.hoshuha.com/articles/deathangels.html)
The seeming increase in the number of medical professionals accused of killing their patients in recent years may be a mere coincidence. Then again, it may be the beginning of a trend. This isn’t idle speculation. The sanctity of human life is under as intense attack in this country as we have seen since those bad old days when the likes of Sen. John C. Calhoun promoted slavery as a positive good. Indeed, our country is currently steeped in a “culture of death” in which dying — and even killing — are promoted by bioethicists and assisted-suicide advocates as acceptable answers to the individual difficulties associated with serious illness and disability, the emotional and financial hardships sometimes generated by family care-giving responsibilities, and the “crisis” in health-care resources. We have actually gotten to the point where the predominate opinion in bioethics holds that people with a “lower” quality of life have less moral value than “normal adults.” These death-culture attitudes lead to actual medical policies that hurt real people. Most famously, Oregon has legalized assisted suicide where studies show that most who swallow prescribed poison do so in order not to “burden” their families. Meanwhile, beneath the media’s radar, “futile care” protocols are being quietly implemented in hospitals across the country that arrogantly give doctors and ethics committees the right to refuse wanted life-extending treatment unilaterally if the doctor believes the patient’s quality of life is insufficient to justify the cost of care. At the same time, cognitively disabled patients — both conscious and unconscious — are made to die slow deaths by dehydration in all 50 states by having their tube-supplied food and water withheld or withdrawn on the basis that their lives are no longer worth living. In such a cultural milieu, is it really surprising that some medical professionals would take the extra step of “mercy” killing dying, elderly, and disabled patients or that a few evil psychopaths would use “compassion” as a front for the fulfillment of their homicidal obsessions? We need only look to the Netherlands for proof that widespread acceptance of the culture of death leads inexorably to non-voluntary euthanasia. The Netherlands has permitted doctors to kill patients who volunteer to die since a court decision essentially decriminalized the practice in 1973. Since then, Dutch doctors have skied down the steepest of slippery slopes, normalizing medicalized killing in the process. Today, Dutch doctors lethally inject dying people who ask for it; chronically ill people who ask for it; disabled people who ask for it; depressed people who ask for it; and, disabled babies whose parents ask for it. More to the point of this essay, killing by Dutch doctors has not been limited to voluntary cases. Study after study of Dutch euthanasia have repeatedly demonstrated that more than one thousand people who have not asked to be killed receive lethal injections by their doctors each year. The practice is so common that the ever-rational Dutch have given non-voluntary killing a name: “termination without request or consent.” The murders of tens of thousands of Dutch patients killed in the last 30 years without request or consent (for that is what such killings are considered technically under Dutch law) have led to only a handful of prosecutions, and no doctors have been jailed for the practice. A case reported just last week in the British Medical Journal News illustrates vividly the license that country has given Dutch doctors to kill catastrophically ill and disabled patient — even if they have not asked for euthanasia. Dr. Wilfred van Oijen, a Dutch general practitioner, was recently found guilty of murdering a dying 84-year-old patient despite her statements that she did not wish to die. The doctor said he killed the comatose woman because she had bed sores and was soaked in urine. But bed sores can be mostly prevented through regular turning and a catheter will prevent an incontinent patient from soiling her linens. Despite this, Oijen was not penalized, because the Amsterdam court ruled that he had merely made an “error of judgment” while acting “honorably and according to his conscience” when he ended his patient’s life. (So much for “choice.”) We have not yet become so accustomed to medicalized killing in the United States that we are willing to countenance murder in our hospital wards. But we are moving in that general direction. Unless we begin to reassert the sanctity and inherent value of all human lives — most especially of those among us who are dying, disabled, and elderly — we may soon find that patients who need our protection the most will find themselves increasingly in danger of being hustled into an early grave by the very professionals they counted upon to do them no harm.
Rejecting assisted suicide is essential in protecting the right to life
Mendelson and Bagaric 13 (Danuta and Mirko, Profs of Law @ Deakin Univ (Australia), “Assisted suicide through the prism of the right to life,” International Journal of Law and Psychiatry, https://www.sciencedirect.com/science/article/pii/S0160252713000666)
The most important interest at stake in the debate involving suicide and assisted suicide is the right to life. An examination of the nature of this right and its proper bounds, establishes that suicide and assisted suicide do not come within an exception to the right. Moreover, the weight of existing evidence supports the view that legalising assisted suicide leads to adverse side-effects in the form of a greater incidence of suicide. It follows that suicide and assisted suicide should be prohibited, unless there is a concrete countervailing interest that can trump the right to life. This issue has not been explored at length in this paper, however, it is suggested that it is unlikely that any interest (apart from life itself) can override the right to life. Advances in medical technology have enabled prolongation of life through mechanical ventilators as well as artificial nutrition and hydration even in circumstances where there is no hope that the patient would return to sapient life, or where the patient wished that these medical measures be abated or withheld. Common law courts and legislatures provided a principled response to the physicians’ concern about civil and criminal liability that may attach to abatement and withholding of life-sustaining treatment if they act in accordance with the doctrine of patients’ right to self-determination, including ‘the right to die’.131 They uphold the principle of personal self-determination in the sense of the right to refuse medical treatment and provided legal immunity to physicians whose adult patients died as a result of their request for non-treatment, as long as such requests did not amount to an aid in committing suicide.132 Hence, the insistence that (1) adults who refuse life-saving or life-sustaining treatment must be of ‘sound mind’, that is, free of psychiatric conditions such as clinical depression or psychosis that would render them decisionally impaired; and (2) that medical practitioners do not cause or aid and abet their patients’ death.133 Thus, consistency of the law and such practical measures,134 as healthcare initiatives, suicide help lines (telephone and online)135 and educational measures aimed at suicide prevention are necessary. Legalisation of assisted suicide changes this paradigm. By allowing physicians to prescribe lethal drugs in the form of ‘medical treatment’,136 the State implicitly abandons its duty to protect the lives of its citizens from self-destruction. Legislation of assisted suicide is inconsistent with principles that underlie criminal and civil immunity for those who act to prevent another person from self-destruction. For, if assisted suicide is good, why is ‘unassisted’ suicide bad? The outcome o both actions is premature death: is assisted suicide good because it has the imprimatur of the State and/or its Courts, whereas the ‘unassisted’ suicide is bad because, though tolerated, it lacks official approval? Yet, there is no intrinsic difference between death caused by suicide and death caused by assisted suicide — both, in the majority of cases, are committed by vulnerable persons suffering from depression and other health problems. If ‘unassisted’ suicide needs to be discouraged so should ‘assisted’ suicide: this is the only coherent approach which pays sufficient regard to the ultimate right—life.
Legalization of PAS harms the most disadvantaged – elderly and disabled and crushes value to life and inevitably leads to a slippery slope
Patrick Lee June 1, 2013 Ph.D., is the John N. and Jamie D. McAleer Professor of Bioethics and the director of the Institute of Bioethics at Franciscan University of Steubenville. The slippery slope of physician-assisted suicide https://www.legatusmagazine.org/the-slippery-slope-of-physician-assisted-suicide/
The protection of life is as an essential component of the public good. Especially important is how the culture as a whole — which is profoundly influenced by the law — regards human life. If a culture regards human life as inviolable, that fact protects all of us; if not, then the most vulnerable among us — especially the elderly and the disabled — are in danger. A culture that condones PAS views life as merely contingently valuable and so views the lives of many of the most vulnerable among us as mere burdens. Consider laws that prohibit physicians from amputating healthy limbs or performing female genital mutilation. Such laws exist precisely because we recognize that physicians should perform surgery only to provide a real medical (or cosmetic) benefit to the patient — or at least not significantly harm her. Rescinding such laws would send the message that these practices are not inherently harmful. In the same way, rescinding the law against PAS would send the message that in many cases a person’s life is simply not worth living and, by implication, is merely a burden on his or her family. The sense of self-worth among the elderly, dying, and disabled would be profoundly harmed by legalizing physician-assisted suicide, and it would lead many to despair and request suicide out of undue deference to others. A society cannot, then, be neutral with respect to the lives of these people: It will either protect their lives or it will help shape a culture that views them as better off dead. The logic of de-criminalizing PAS for the terminally ill who are suffering grievously would lead inexorably to allowing (and encouraging) other types of killing. If the rationale for PAS is to respect autonomy, then why limit it to those who are terminally ill? Why privilege the autonomy of those who are terminally ill above those who are suffering chronically? Alternatively, if the rationale for PAS is that a person is in misery or has allegedly lost her dignity — if the law is based on the belief that for some people death is a benefit — then it will be impossible to deny this alleged benefit to other groups who lack decision-making capacity, for example, those who are unconscious, demented, or are children (as the Netherlands has been led to do with the open euthanasia of infants). Thus, PAS is a denial of the equal and inherent dignity of the elderly, the dying, and the disabled. Respect for human life and genuine compassion and care for all requires that PAS remain illegal.