The Case Against Assisted Suicide: Ethical and Practical Arguments

Introduction: The Controversy of Assisted Suicide

Few topics in medicine today generate as much controversy as assisted suicide. Although headlines on the subject may be less frequent than during Dr. Jack Kevorkian's era or the Terri Schiavo case, legal and ethical battles regarding the issue continue to unfold. Several states have passed laws legalizing assisted suicide in certain circumstances, and many other states have considered similar measures. The question is: at what cost? Suicide has been condemned by nearly every civilization and proscribed even in ancient codes of law. What does it say about modern values that the human condition has become so degraded and devalued that we consider ending another's life acceptable—and worse, that we permit and even encourage medical doctors to assist in this act?

Mankind has always felt the need to control its own destiny at both societal and individual levels. Human beings, perhaps more than any other species, are driven to obtain the knowledge, skills, and status that enable the longest, fullest, and healthiest life possible. This drive has developed as an evolutionary imperative: without the desire and increased ability to survive, the human species—or any species so poorly suited to a world of danger and scarcity—would long ago have disappeared entirely.

Evolutionary and Biological Arguments

Suicide, whether assisted or not, flies in the face of millions of years of evolutionary progress. It makes even less sense for a society to actively condone such an act than for an individual to commit it. We must continue to grow, adapt, and evolve as a species. Allowing ourselves to be killed off—even by choice—will not help humanity achieve this end; rather, it serves as a detriment to those close to the suicide victim and to humanity as a whole.

The human body is an intricate group of systems working in conjunction to achieve a long and healthy life. These systems have evolved over millions of years with one overriding purpose: ensuring the survival of the individual. While all humans and all living bodies must eventually die, the body's systems are designed to delay this inevitable fate for as long as possible. This biological reality has shaped certain social and psychological aspects inherent to our species. Although the systems themselves are biological and the suffering they cause may have little to do with the mind or spirit, they still have significant psychological ramifications.

The Grieving Process and Family Impact

When biological systems deteriorate and death is certain and imminent, the family and friends of the suffering individual—as well as the individual themselves—are granted a period of time that is often absent in other circumstances. Though it is painful to watch a loved one deteriorate due to an end-of-life illness, this period allows family and friends to care for and grieve with the patient, enabling everyone involved to begin the process of emotional healing. Assisted suicide eliminates this period, robbing patients and their loved ones of a vital and constructive step in the grieving process.

Additionally, assisted suicide can leave family and friends with feelings of guilt and other emotional stresses and disturbances that extend far beyond the normal period of grief. These are excellent reasons—though not the only ones—to disallow assisted suicide.

Practical Medical and Ethical Considerations

There are also issues of practicality. Many chronic illnesses are on the verge of treatment or even cure, and most symptoms are manageable with current medical technologies and techniques. Even in cases where cures seem unlikely, the chance at a healthier life is certainly preferable to ending all opportunity for life altogether. While patients are alive, there is at least a possibility of recovery; once they are permitted to take their lives in any manner—medically prescribed and supervised or otherwise—all opportunities vanish along with their life.

Each year, national and international medical and scientific communities spend billions of dollars and countless hours in research aimed at treating and eradicating disease. The goal of society, science, and most explicitly medicine is to sustain and protect life, not to end it. Any civilized society that allows death as an option is making an ethical error. Medical ethics have opposed suicide in all forms, especially when aided by a physician, for millennia. In order to continue protecting and sustaining life, it seems obvious that ending life should not be permitted. The two cannot coexist.

There is also no rational way to claim we are capable of determining when to end life or that we have the moral right to do so. While there are other instances—proscribed by law or circumstance—in which the death of another human being is permissible, the ethics of such cases are questionable in all instances except those involving death by direct self-defense. Even legally accepted instances of purposeful death—such as the death penalty, which is illegal in several states and has dubious ethical standing—exist as a measure of defense. Generally, people subjected to capital punishment have repeatedly committed violent crimes and are considered ongoing dangers.

If the only justification for killing another is to protect our own lives, then there could be no reason to allow assisted suicide. The violation of ethical principles in cases of assisted suicide is especially egregious given that in most cases, decisions to simply end life-sustaining care while still managing quality-of-life issues such as pain and other degenerative symptoms is entirely viable. In this way, death comes as a natural event whenever it was meant to occur, without conscious intervention.

Kantian Ethics and Universal Moral Law

Death itself, and even ending the struggle for life, is not inherently unethical. There are instances when death might be preferable, both to end individual discomfort and pain and for the benefit of others. However, there is a large and recognized difference between letting someone die and causing their death. Letting someone die by their own choice requires no action, and treating their other symptoms to make them comfortable during the end of life would be almost universally considered ethical. Causing another's death, however—even if they express a desire for it—requires intervention into the natural design of our bodies. Inaction is only unethical when it purposefully ignores suffering, but all actions must be examined for ethical correctness.

Assisted suicide generally does not withstand these ethical considerations. In fact, most traditional ethical systems can be applied to demonstrate the inappropriateness of assisted suicide. The wide array of views against the topic, from thinkers who developed their theories long before assisted suicide became a social issue, lends further weight to the argument against it.

The most steadfast—and admittedly, the most controversial—view against assisted suicide from a traditional ethical system is that supplied by Kantian ethics. Immanuel Kant believed that moral laws were absolute; what was wrong in one situation was wrong in all situations: "Moral rules, then, have no exceptions. Killing is always wrong. Lying is always wrong." The intent of an action, not its effects, is what determines moral rectitude. According to this ethical theory, which though extreme is also the one that allows for the least equivocation and can be applied most objectively and fairly, the only relevant fact is that one person is helping to kill another person. This act is simply wrong; the extenuating circumstances, though real, are not pertinent to the situation.

This argument may seem far-fetched and impractical, but in fact it can be shown to be one of the most practical solutions. A major issue in the debate over assisted suicide is the purely practical and very real problem of defining the boundary of assisted suicide if it is to be allowed at all. What about people who suffer from purely psychological illnesses such as depression and bipolar disorder? Often, people with such conditions do not respond as effectively as hoped to medication and feel as though their frustration and emotional pain will continue for the rest of their lives. If assisted suicide is allowed for other chronic illnesses, should it be allowed in cases of mental illness as well? And what about patients who do not have the mental capacity to determine the right time to die? Does someone decide for them?

Utilitarian Ethics and the Greater Good

These concerns demonstrate the practicality of Kant's ethics. If the act of killing another is simply universally banned, the definition of ethical action is greatly simplified, and all gray areas are decided on the side of caution. The above areas of concern are very real; there is evidence that non-voluntary euthanasia occurs in other countries where assisted suicide is an accepted medical practice. Mental health is often an issue with chronic diseases and end-of-life care, and determining when people are capable of making the choice to request assisted suicide is an impossible task. Some would even argue that the request itself is evidence of mental illness and should be interpreted as a request for better care.

John Stuart Mill, who wrote directly and explicitly in opposition to Kant with his Utilitarian ethics, believed that only the effects of an action determined its morality: "the influence of actions on happiness is a most material and even predominant consideration in many of the details of morals." This is often interpreted as "the greatest good for the greatest number." In cases of assisted suicide, the detriment to society at large, as well as to friends, family, and even the patients themselves, far outweighs any perceived benefits derived from a premature death. On a practical level, medical science is deprived of information regarding the patient's condition and its progression, which reduces the level of care available to others. This occurs in addition to the mental stress on surviving loved ones already mentioned and the missing opportunities for the patient after their death.

Conclusion: Why Assisted Suicide Must Remain Prohibited

There are many reasons that assisted suicide should not be permissible. This paper only touches the surface of several key points of the debate, but the message is, I hope, quite clear: killing people is wrong, and it is not something doctors or society should engage in.