Assisted Suicide and Personal Autonomy: Freedom of Choice …But Only for the Sick

Posted on September 22, 2015 by


On Friday of last week, the state legislature of California passed a bill to allow assisted suicide. If Governor Jerry Brown signs the bill into law, California will become the fifth state in the Union to make assisted suicide legal.

How do advocates of assisted suicide justify allowing doctors to assist people in killing themselves? Supporters typically appeal to personal autonomy, in one form or another, as a primary justification. For example, Mark Leno, a Democrat in the California legislature, said of the bill, “It allows for individual liberty and freedom, freedom of choice.” The Supreme Court of Canada, in their recent decision to legalize assisted suicide, expressed the need to balance between “the autonomy and dignity of a competent adult who seeks death as a response to a grievous and irremediable medical condition” and “the sanctity of life and the need to protect the vulnerable.” (Footnote: Supreme Court Ruling) A practice previously considered murder or manslaughter under the law they ruled legal in the name of “autonomy and dignity.”

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Lastly, Dr. Jack Kevorkian, known as “Dr. Death” for his role in dozens of suicides, once stated in court, “The patient’s autonomy always, always should be respected, even if it is absolutely contrary—the decision is contrary—to the best medical advice and what the physician wants.” (Footnote: PBS Frontline transcript) In other words, if the patient wants to use Kevorkian’s “suicide machine” to inject herself with lethal drugs, it’s her choice.

This raises the question for me: If personal autonomy were truly a primary justification for allowing assisted suicide, then why is the choice limited to adults suffering a “grievous and irremediable medical condition”?  Why can’t a healthy young woman walk into an Oregon clinic and get the same suicide pills as cancer patient Brittany Maynard?

Where the practice is legal in North America, the law restricts access to doctor assisted suicide to a small minority of people—namely, the sick, the suffering, and the dying. The healthy, or those who merely find life meaningless, or even the severely depressed, must rely on other means to kill themselves. Instead of taking a neat and tidy dose of pills prescribed by a doctor in the comfort of their own home, they are forced to choose among less attractive, somewhat messier options, like jumping off a bridge, lying across train tracks, hanging, putting a gun in their mouth, or slitting their wrists.

Why can’t all people who want to kill themselves be allowed to get medical help in order to do so? Why this discrimination of the law based on one’s health?

Clearly, it isn’t simply a matter of saying, “The healthy and the young don’t want to kill themselves, and, therefore, there is no need to extend access for doctor assisted suicide to everyone.” Suicide is relatively common on university campuses, but, quite obviously, this is not a celebrated fact, and measures are taken to prevent them, like the decision to place netting under bridges around Cornell University. No one protested the netting by saying that we should allow adults to exercise their freedom of choice or liberty in killing themselves.

Suicide is not illegal in Canada and the United States. In fact, the British Columbia Supreme Court Justice based her decision to strike down the law against assisted suicide on this very fact. Healthy people, she reasoned, can commit suicide legally. Therefore, since disabled people like the plaintiff, Gloria Taylor, cannot kill themselves, the law against assisted suicide is discriminatory. The sick ought to have equal access to the right to kill oneself! (Ironically, because of her ruling, the healthy are now prevented from the same medically assisted suicide that the sick enjoy.)

Why, then, is there such a concerted effort to prevent suicide in those who are not sick and dying? Shouldn’t we encourage people to embrace their “individual liberty” and “freedom of choice” in how and when they die?

Something more than just personal autonomy is at work in the advocacy for assisted suicide.

The obvious response here is that we allow doctors to help people kill themselves in order to relieve suffering, which, many would argue, goes beyond just physical pain to include the indignity of watching one’s body deteriorate and lose normal function. Surely no one with an ounce of compassion would wish the suffering endured by Brittney Maynard and her family on anyone. The end is to relieve suffering; the means is to give the sufferer enough pills to end her life with.

The question, Does the end justify the means? is not my interest here. I’m not here concerned with whether assisted suicide is morally acceptable. The question I want to ask is, Why does suffering set apart those people who can get the magic pills? Why can’t healthy people get them too, especially if they so desire them? Why are only the sick allowed to “die with dignity”?

Again, why this discrimination of the law based on one’s health? Why do we celebrate that sick people can get help killing themselves, but mourn the fact that healthy people commit suicide? I’d love to know what you think.

-Gordon Hawkes

Posted in: Bioethics, Ethics, Law