Abstract
Consider these three positions about physician-assisted suicide:
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1.
Physician-assisted suicide should be illegal for everyone.
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2.
Physician-assisted suicide should be legal for only the terminally ill.
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3.
Physician-assisted suicide should be legal for all competent adults.
So far, the debate in America has been primarily between positions 1 and 2. I think it should be between positions 1 and 3. Both those positions embody reasonable viewpoints, and I will not try to decide between them in this chapter. But I will argue that the double standard embodied in position 2 is morally untenable.
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- 1.
“Assisted Suicide in the United States,” https://en.wikipedia.org/wiki/Assisted_suicide_in_the_United_States Because of space limitations, I will confine my discussion to suicide in this country.
- 2.
Ronald Dworkin, Life’s Dominion: An Argument About Abortion, Euthanasia, and Individual Freedom (New York: Vintage 1994), 217.
- 3.
Jennifer Medina, “When to Die? Californians Wrestle with Assisted Suicide,” The New York Times, June 10, 2016, A3, https://www.nytimes.com/2016/06/10/us/assisted-suicide-california-patients-and-doctors.html
- 4.
Ronald Dworkin, Introduction to “Assisted Suicide: The Philosophers’ Brief,” The New York Review of Books, March 27, 1997, 41.
- 5.
Robert L. Fine, MD, “Depression, Anxiety, and Delirium in the Terminally Ill Patient,” Baylor University Medical Center Proceedings, 14, no. 2 (April 2001), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1291326/
- 6.
William Breitbart et al., “Depression, Hopelessness, and Desire for Hastened Death in Terminally Ill Patients With Cancer,” JAMA, 284, no. 22 (December 13, 2000), https://jamanetwork.com/journals/jama/fullarticle/193350
- 7.
“Not Dead Yet Disability Activists Oppose Assisted Suicide as a Deadly Form of Discrimination,” http://notdeadyet.org/assisted-suicide-talking-points
- 8.
- 9.
Nietzsche, Friedrich Wilhelm, and Duncan Large, Twilight of the Idols. New York: Oxford University Press, Oxford, 1998. eBook Academic Collection (EBSCOhost), EBSCOhost.
- 10.
Dworkin , Life’s Dominion, 212. The excerpt that Dworkin quotes from the Nietzsche passage has some minor differences in wording that do not affect the views expressed.
- 11.
Laurence H. Tribe, “On the Edges Of Life and Death,” review of Life’s Dominion, by Ronald Dworkin, The New York Times, http:/www.nytimes.com/1993/05/16/books/on-the-edges-of-life-and-death.html?pagewanted=all
- 12.
T.M. Scanlon, “Partisan For Life,” review of Life’s Dominion, by Ronald Dworkin, The New York Review of Books, http://www.nybooks.com/articles/1993/07/15/partisan-for-life/
- 13.
M. Pabst Battin, “Suicide: A Fundamental Human Right?” in Suicide: The Philosophical Issues, ed. M. Pabst Battin and David J. Mayo (New York: St. Martin’ s Press, 1980), 274.
- 14.
M.P. Battin, Ethical Issues in Suicide (Englewood Cliffs, NJ: Prentice-Hall, 1995), 126.
- 15.
See Susan Wendell, The Rejected Body: Feminist Philosophical Reflections on Disability (New York: Routledge, 1996), 150.
- 16.
Dworkin, Life’s Dominion, 210.
- 17.
Jane Gross, “Quiet Doctor Finds a Mission in Assisted Suicide Case,” The New York Times. January 2, 1997, BI (italics added).
- 18.
I include the parenthetical phrase because, to quote Wendell, “independence” is “defined according to a society’s expectations about what people ‘normally’ do for themselves and how they do it.” She adds that few people in her city would consider her a dependent person because she relies on others to provide her with electricity and running water, but most would consider her highly dependent if she needed help getting out of bed or going to the toilet. She points out, “The philosophical arbitrariness of our ideas concerning which of us is ‘independent’ seems obvious,” The Rejected Body, 146.
- 19.
Dworkin, Life’s Dominion, 210 (italics in original).
- 20.
Life’s Dominion diverges from The Philosophers’ Brief in that Life’s Dominion endorses physician-assisted suicide for the severely and permanently disabled as well as for the terminally ill.
- 21.
Dworkin, Life’s Dominion, 217.
- 22.
Statement of the American Association of Suicidology: “‘Suicide’ is Not The Same as ‘Physician Aid in Dying,’” http://www.suicidology.org/Portals/14/docs/Press%20Release/AAS%20PAD%20Statement%20Approved%2010.30.17%20ed%2010-30-17.pdf
- 23.
“Not Dead Yet Disability Activists Oppose Assisted Suicide as a Deadly Form of Discrimination,” http://notdeadyet.org/assisted-suicide-talking-points
- 24.
I owe the parenthetical observation to Sara Ann Ketchum.
- 25.
Joyce Appleby, “‘Prophylactic’ Suicide,” The New York Times, November 15, 2014, https://www.nytimes.com/2014/11/16/opinion/sunday/prophylactic-suicide.html
- 26.
Dworkin, Life’s Dominion, 231.
- 27.
Dworkin, Life’s Dominion, 231.
- 28.
Dworkin, Life’s Dominion, 231.
- 29.
Dworkin, Life’s Dominion, 221.
- 30.
Dworkin, Life’s Dominion, 226–27.
- 31.
Dworkin, Life’s Dominion, 226.
- 32.
See Dworkin , Life’s Dominion, 228, for a different sort of case where Dworkin rejects the “later gratefulness” criterion.
- 33.
Dworkin , Life’s Dominion, 231.
- 34.
This disrespectful dismissiveness should be distinguished from the difficulty of acting in accord with the wishes of dementia patients who, independently of any pre-dementia advance directives they have made, “express wishes and desires [that] change rapidly and … show very little continuity even over periods of days or hours” (Dworkin , Life’s Dominion, 218).
- 35.
Dworkin , Life’s Dominion, 232 (italics in original). In “Alzheimer Disease and Pre-Emptive Suicide” (Journal of Medical Ethics, July 10, 2013), Dena S. Davis points out that a person facing dementia who believes that his advance directive for death would not be followed might stage a preemptive suicide while still able to do so. This might lead to an earlier death than he would choose if he could count on the directive’s being carried out. This problem, however, is not specific to dementia. A similar case would involve a Jehovah’s Witness who declines a potentially lifesaving operation unless he receives assurance that, if he turns out to need a transfusion after the operation, he will not get one even if he changes his mind and begs for it.
- 36.
Daniel Callahan, “Terminating Life-Sustaining Treatment of the Demented,” Hastings Center Report, 25, no. 6, 25 (November–December 1995).
- 37.
Callahan, “Terminating Life-Sustaining Treatment,” 26.
- 38.
Dworkin, Life’s Dominion, 231.
- 39.
In “Dworkin on Dementia: Elegant Theory, Questionable Policy,” Hastings Center Report, 25, no. 6 (December 1995), Rebecca Dresser considers the possibility that the advanced dementia patient is not even the same person as the one who issued the advance directive and so should not be bound by the other person’s judgment. Space limitations prevent me from discussing this view about personal identity except to say that endorsing it is not necessary in order to justify rejecting Dworkin’s dismissive attitude toward the severely demented. Obviously, there are many things that a dementia patient is no longer competent to decide. But when it comes to the value of his demented but happy existence, there is a sense in which his judgment is more competent than that embedded in his previous, cognitively snobbish mentality.
- 40.
See Dennis R. Cooley, “A Kantian Moral Duty for the Soon-to-be Demented to Commit Suicide,” The American Journal of Bioethics 7, no. 6, 37–44 (2007) as well as my comment, “Lucinda Among the Bioethicists,” The American Journal of Bioethics 7, no. 6 (2007): 61–66.
- 41.
Dworkin, Life’s Dominion, 239.
- 42.
I thank David Christensen and Sara Ann Ketchum for their helpfully ruthless comments on drafts of this chapter and Peter Schroeder for letting me use the names of his late, much-lamented cats Emma Sue and Rachel. Some material in this chapter previously appeared in “Everyone should have the right to assisted suicide — or no one should,” Vox.com, November 21, 2016, https://www.vox.com/the-big-idea/2016/11/21/13693016/assisted-suicide-referendums-philosophy and is used here by permission.
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Ackerman, F.N. (2018). “I Support the Right to Die. You Go First”: Bias and Physician-Assisted Suicide. In: Boonin, D. (eds) The Palgrave Handbook of Philosophy and Public Policy. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-93907-0_53
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