Life's Worth: The Case against Assisted Suicide



Editor's note: The following is an excerpt from the Center book Life's Worth: The Case Against Assisted Suicide by Arthur J. Dyck.

"Favoring physician-assisted suicide (hereafter PAS) is intuitive, self-evident; it is a matter of compassion." That is what one of my students recently claimed, and his view is shared by others. "After all," he went on to argue, "what else would any humane person do but assist those who are suffering and terminally ill to die if they wish such assistance?"

Such a view is certainly understandable. Consider the situation of Sidney Cohen, who was told by his physician that he had cancer and that he would die a painful death in less than three months. The cancer was diagnosed in November and by January 1 Sidney Cohen described himself as "bed bound by pain and weakness, having been able to drink only water for six weeks . . . desperate, isolated and frightened" and wishing for euthanasia. If this is what one knows about Sidney Cohen's condition and his feelings about it, does it not seem inhumane to deny him a painless death and, if the prognosis is correct, spare him the suffering he is slated to endure for another month?

But that is not the whole story. What we have before us is a static snapshot of this man. Indeed, this description is only part of what Sidney Cohen wrote about himself eight months after he was diagnosed with cancer and given only three months to live. On January 1, he tells us, "I truly wished that euthanasia could have been administered." But it wasn't! So what has transpired in the months following January 1? In Sidney Cohen's own words,

I now know that only death is inevitable and since coming under the care of the MacMillan Service [hospice homecare] my pain has been relieved completely, my ability to enjoy life restored and my fears of an agonizing end allayed. . . . I'm still alive today. My weight and strength have increased since treatment made it possible to eat normally and I feel that I'm living a full life, worth living. My wife and I have come to accept that I'm dying and we can now discuss it openly between ourselves and with the staff of the MacMillan Service, which does much to ease our anxieties.

My experiences have served to convince me that euthanasia, even if voluntary, is fundamentally wrong and I'm now staunchly against it on religious, moral, intellectual and spiritual grounds. My wife's views have changed similarly.

Clearly there are those who, hearing a description of someone in Sidney Cohen's condition on that January 1, are convinced that honoring his request to assist him to die then, rather than suffer longer, is the morally appropriate, compassionate response. Indeed, one hears the argument accompanying such case descriptions that it is reasonable that no one would want to live under those circumstances. At the same time, the opponents of PAS and euthanasia can provide snapshots of cases helped by hospice home care or other medical interventions, documenting peaceful deaths and/or gratitude for dying relatively free of anxiety and virtually or completely free of pain.

But such snapshots, or even fuller case descriptions, do not settle the issues raised by the experiences of Sidney Cohen and others diagnosed as terminally ill or suffering from severely debilitating illnesses. What should such individuals ask of their caregivers and loved ones, and what kind of care ought to be offered? How should such seriously ill individuals relate to others, and how should others relate to them? What moral responsibilities do caregivers and those being cared for have to one another and to their communities? What moral responsibilities do communities have toward the severely ill and those who provide care for them?

Some in effect argue that these questions are not relevant for those who are dying unless they want to put these questions to themselves. As a dying person, they say, "I will and I should act on the basis of my own snapshot of myself, and on my own view of whether my life should continue beyond a certain time. And, furthermore, I should have the right to receive assistance to discontinue life if and when I request it. So why even write a book trying to persuade me to think ever so carefully about whether or not PAS is ever morally justifiable and whether PAS should or should not be against the law? I should not have the manner of my dying dictated by governments and by legislation, once I am in a condition in which it is rational for me to seek to end my life, or to seek assistance to accomplish that quickly and painlessly."

But a decision to request PAS is influenced and shaped by assessments that are not simply those of the patient making the request. What patients regard as reasonable is not solely based on their own thinking, their own feeling, or their independent assessment of their illness and its future course. To regard oneself as terminally ill is, certainly to begin with, usually and largely based on a medical assessment, a diagnosis by a physician or physicians. To conclude that any given symptom, such as extreme pain, will persist until death is largely a function of a prognosis and can be largely, if not entirely, a function of the quality of care and knowledge of the caregivers. A change in care, as in Sidney Cohen's case, can change one's condition, one's self-assessment, and even what one considers to be reasonable care for those who are dying. Furthermore, what is perceived as reasonable may be unreasonable because the diagnoses and/or prognoses that shape one's perceptions are mistaken.

. . .The central argument of this book is that there is a solid moral and practical basis for the laws against assisted suicide that now exist in the United States and elsewhere. Furthermore, in the current debate that case is not being made in a convincing way. The members of any community need to know the reasons why everyone should want to prevent suicide and what laws are necessary to sustain such efforts and achieve a high degree of success. At the same time, all of us need to know whether the traditions that favor PAS will undermine not only efforts to curb suicide but also killing more generally. This is a real possibility since, as I argue, the moral and practical bases for the laws against assisted suicide are also the bases for the laws that specify and punish what constitutes murder.