This week, Professor John Ashton, president of the Faculty of Public Health, weighed in on the ‘right to die’ debate. In an interview with The Guardian, he said that ‘doctors should be able to help terminally ill patients end their lives’. It is of no coincidence that Ashton’s public declaration of support for assisted suicide comes just weeks before the second reading of Lord Falconer’s Bill for Assisted Dying on 18 July in the House of Lords.
Here in the US, there are four states which have legalized assisted suicide: Oregon, Washington, Vermont and Montana. Oregon was the first to take this step, passing the Dying with Dignity bill in 1997.
Lord Falconer’s ‘Assisted Dying’ bill appears to be modelled on Oregon’s ‘Dying with Dignity’. In Oregon, a doctor is allowed to prescribe lethal medication, but the patient must administer it. The patient must be an adult (18 years or above), mentally competent, and be diagnosed with a terminal illness with less than 6 months to live. They must request the physician’s assistance with dying. Lord Falconer’s Bill includes all these stipulations.
If Lord Falconer is going to take Oregon as a model, then proponents of the Bill may argue that he can point to a rather ‘successful’ assisted suicide practice in that state. Oregon appears so far to have resisted some of the ‘slippery slopes’ prophesized by those of us who opposed assisted suicide. This includes the notion that the option to kill oneself when one’s life is characterised by suffering will lead us as a society to view the lives of certain groups of people who often suffer, such as the disabled and elderly, as not worth living. This, in turn, may lead to ‘involuntary’ assisted suicides of people in these groups, instead of giving them the best possible care.
Oregon boasts that its assisted suicide practice is rare, and governed by strict laws. And, happily, because causing death is now a legitimate medical activity, the illegal practice of involuntary physician-assisted deaths is reported to be lower in Oregon than in other states.
Yet, there are slippery slopes which we have gone down. The first is that once a practice becomes legal, it becomes culturally normalized. Oregon’s assisted suicide practice may be relatively ‘rare’ at the moment, but it increases every year. Only 16 people in that state chose assisted suicide in 1998. In 2012, the number had risen to 77 people. This trend is evidence that the longer this bill in force, the more socially acceptable it becomes to voluntarily end one’s life, and therefore the more likely people are to exercise their ‘right to die’. In Washington state, too, the number of people choosing to exercise this ‘right’ rises every year.
This argument about the right to die becoming a cultural norm is important, because it bears directly on some key concepts in the assisted suicide campaign. Those who support the right to die use words like ‘dignity’, ‘compassion’, ‘autonomy’, and ‘choice’. The idea is that people who are suffering should be able to choose how and when they die, and that this choice is an expression of their autonomy, the exercise of which allows them to maintain their human dignity.
This argument implies that the ‘choice’ to die is made by someone on their own, without a context other than their suffering. It is a specifically liberal idea that autonomy takes place, as I have pointed out before, in a kind of vacuum.
Yet, none of us lives in a vacuum. We are creatures that live and think within a cultural context. In other words, the exercise of our autonomy is influenced greatly by our cultural norms. If exercising the right to die becomes normalised – and make no mistake, it will be eventually it will be if it is legalised – what kinds of pressures will terminally ill people feel to end their lives?
Our autonomy cannot be exercised separately from our concern for our loved ones, our fear, our guilt, or our feelings of worthlessness. And all of these are compounded by the confused option to take one’s life.
We speak of autonomy, but we also need to speak of the values that form the context of our autonomy. For it is possible that holding autonomy up as our highest value may undo everything that we hold dear. For instance, the concept of autonomy has already been used by the bioethicist Jacob Appel to argue that the right to die should extend to all mentally competent adults.
If our laws allow us to declare that our own lives are not worth living, and assist us to end those lives, politics will become not only about ‘life, liberty and the pursuit of happiness’, but also about enabling us to pursue our death. That, to me, seems like a very dangerous prospect indeed.