In November, the District of Columbia Council overwhelmingly approved a bill that would allow doctors to help patients commit suicide if doctors believed the person had six months or less to live.
Utah Representative Jason Chaffetz announced last week that he will seek to have Congress overturn the law. Congress, of course, has this responsibility to oversee District laws under the Constitution (Article I, section 8), and all D.C. Council legislation is submitted to Congress for review before it goes into effect.
The author of the bill responded to the announcement: “This is entirely a local matter and he may have philosophical or perhaps even religious objections, but we have made our own choice and it should be respected.” The “local matter” remark suggests a misunderstanding of the Constitution, but the more interesting comment is the dismissive reference to Representative Chaffetz’s “philosophical or perhaps even religious objections.”
This kind of comment is a common tactic to denigrate unwanted opinions. It is to say, in effect, “That is your idiosyncratic belief based on some subjective, probably irrational, thought process but it need not restrain us from doing what we like.” That dismissal is particularly inapt here because there are compelling reasons to oppose the District of Columbia’s promotion of suicide for the ill and infirm.
For instance, we should be particularly cautious about embracing a right to suicide for vulnerable individuals. The experience of other nations suggests that this “right,” initially limited to those experiencing terminal diseases and advertised as strictly voluntary, begins to be applied to a wider variety of cases, including some not strictly medical and, as in the case of Belgium, now extended to non-voluntary situations such as the euthanasia of children.
Second, the much-valued “choice” to end one’s life does not occur in a vacuum. A person who is ill enough that the doctors guess (and it is usually just that, a guess) she or he will soon die, must act in the context of pressures, real and imagined, from other people – family and friends, physicians and insurance providers (including, often, the state itself). As reports from Oregon (the first state to approve this option) suggest, the doctors involved in these cases are not so much wise counselors giving ethical advice as resources called in near the end to dispense drugs.
Insurance companies, and the state as the provider of medical care to the needy, have a possible motivation of encouraging the less-costly route of suicide. One patient in Oregon was told by her insurance company that it would pay for the inexpensive suicide drugs but not for medication her doctor prescribed to extend her life.
Nearly half of those who opted for assisted suicide in Oregon in 2015 reported a concern with being a burden on family, friends and caregivers. Even where family members have no desire to encourage suicide by an ill family member, the existence of that option colors their interactions and may lead a sick person, particularly one with undiagnosed emotional or psychiatric illness (a very real possibility, as the evidence makes clear), to conclude that others would be better off if they died, even if those others don’t actually feel that way.
The motives of family and friends can be mixed. Take an example from the summer 2016 newsletter of End of Life Washington (slogan: “Your life. Your death. Your choice.”). The story is told by a psychotherapist about a former patient referred to her for anxiety and depression. The patient had twice planned suicide only to change his mind. After 25 years of no contact, the patient called to say goodbye after he’d picked up his suicide prescription to end his life in the face of a terminal cancer diagnosis.
The therapist reported: “He died in the loving presence of his brother and the close friend he had stayed connected with through the years, both of whom actively supported his choice.” In fact, his family and friends had “entreated” him to pursue physician-assisted suicide so that he did not take his own life by jumping from a bridge. The article reports family and friends were “horrified by the suffering his suicide would cause not only him but them.” So, he took advantage of Washington’s law with “their help, encouragement and advocacy.”
The option of legal suicide certainly makes such pressure more effective. It is like the pressure reported by parents of children prenatally diagnosed with Down Syndrome to abort their children.
It is a serious problem that we speak of the crisis of suicide in some contexts and in other contexts we valorize it as an exercise of personal autonomy. That mixed message may be fatal.
A supporter of the D.C. law carried a sign that neatly encapsulates the fundamental problem with assisted suicide laws. The sign read: “You would do it for your dog. Why not for me?”
Chaffetz is right to reject the idea that we should “put down” those who are sick like we would a pet. That’s not a narrow theological belief but a basic tenet of human decency, of protection for the vulnerable.