Euthanasia Ethics: Autonomy, Law, and Assisted Suicide

Introduction: Suicide as a Social and Ethical Controversy

Suicide, assisted or otherwise, is a contentious issue in modern society. While most people would be upset if a loved one took his or her own life, there is nonetheless widespread recognition that an individual's right to autonomy might supersede such concerns — especially when the choice is between a dignified death and a prolonged, painful terminal illness. However, there are still those who believe that suicide is always, or usually, wrong. This ongoing debate is reflected in laws, societal values, and the philosophy of medical ethics.

Historical Background and the Legal Landscape

Euthanasia, from the Greek words for "good death," is an old concept. In Sir Thomas More's Utopia, written during the reign of Henry VIII, citizens may end their lives with permission from religious and governmental officials (Minois 2001, 67). The concept of medically assisted suicide is, however, a largely late-twentieth-century invention (Minois 2001, 328). Proponents argue that — despite continuing legal and religious prohibitions — it should be lawful for someone with a terminal or progressive illness to end his or her life, with proper medical assistance to ensure a painless death. Opponents generally point to the Hippocratic Oath — the basis for modern medical codes of ethics — which begins, "First, do no harm" (Weir 1997, 140). The question then becomes: what is more harmful, helping a patient to die, or forcing that patient to live in agony or incapacity?

In the United States, the issue crystallized around the controversial figure of Dr. Jack Kevorkian. A medical doctor whose specialty was forensic pathology, Kevorkian became interested in the plight of terminally ill patients who wished to end their lives before the onset of unbearable pain or loss of faculties (Weir 1997, 219). Kevorkian participated in a number of well-publicized assisted suicides in an attempt to compel courts or legislatures to revise laws against suicide. He was eventually convicted and served time in prison.

The end result of Kevorkian's campaign was that individual states reached contradictory conclusions. In some states, such as Alabama, there is no legislation addressing suicide — assisted or otherwise — in the legal code, leaving the matter subject to common law, which considers it illegal. As a more positive response to Kevorkian's efforts, Oregon passed the Death with Dignity Act in 1997 (Weir 1997, 130). This Act allows terminally ill Oregonians to seek physician-assisted suicide in order to end their suffering. The situation differs dramatically in Ohio, where assisting a suicide is grounds for professional discipline against health care providers (PRC). Clearly, there is very little legal consensus among states on the question of suicide and euthanasia — a fragmentation that mirrors the divisions found in philosophical tradition.

Philosophical Frameworks: Kant versus Sartre

Opinions on the ethics of suicide divide broadly into two schools. Arguments against suicide generally derive from the philosopher Immanuel Kant, while arguments that suicide can be an ethical act tend to draw on the Existentialist philosophy of Jean-Paul Sartre. Kantian ethics proposes the "categorical imperative": an act is ethical only if it would be acceptable were everyone to perform it (Minois 2001, 273). Telling the truth is ethical because we would be satisfied if everyone did so; lying is not, because if everyone lied habitually, society would cease to function. Applied to suicide, this framework argues against the practice — though it is a weaker argument against assisted suicide specifically, since that option is available only to those with terminal or incurable conditions.

Sartre's philosophy, by contrast, defends the right to suicide on the grounds of individual freedom of choice (Minois 2001, 326). Even those who find assisted suicide ethically permissible under this framework, however, can encounter troubling edge cases when autonomy arguments are extended to their logical limits.

Conclusion: The Case for Regulated Physician-Assisted Suicide

Ethically speaking, physician-approved suicide harms nobody but the person who chooses it — and a physician is well positioned to determine whether such a choice represents less harm than continued suffering from a chronic or terminal condition. After all, in jurisdictions where suicide is illegal, it remains the only felony that cannot result in prosecution if successfully committed: the legal prohibition exists primarily to create social stigma. If examples from Belgium seem troubling to American observers, it is because American physicians would in all likelihood approach such cases differently. The real question is not whether extremes can be imagined, but whether the option should exist at all — and on that question, it is clear that Oregon's regulated model is far more humane than outright prohibition.

References

Braw, E. (2013). Should a sick child be allowed to choose death? Belgians think so. Newsweek, December 5, 2013.

Buchanan, R. T. (2015). Right to die: Belgian doctors rule depressed 24-year-old woman has right to end her life. The Independent, July 2, 2015.

Gayle, D. (2013). Transsexual, 44, elects to die by euthanasia after botched sex-change operation. The Daily Mail, October 1, 2013.

Minois, G. (2001). History of suicide: Voluntary death in western culture. Baltimore: Johns Hopkins University Press.

Weir, R. F. (1997). Physician-assisted suicide. Bloomington: Indiana University Press.