Rules Are for Schmucks: Death with Complication

Most of us have known personally, or at least heard about, individuals for whom life is no longer worth living. People who suffer from permanent and severe pain, with no reasonable prospect for recovery, have decided that in their particular circumstance the positives of continuing life are heavily outweighed by the negatives, so it’s time to pack it in. It’s hard to condemn people who make this choice—so long as it’s entirely voluntary, based on overwhelming evidence, and others (e.g. children) are not overly reliant on the person’s continued existence.

That’s where assisted suicide laws, sometimes called “Right to Die” or “Death With Dignity” laws, come into play. Without the protection of these laws, any doctor (or other person) who provided such assistance would be guilty of a serious crime. Jennifer Ouellette, in her speech accepting the American Humanist Association’s Humanist of the Year Award last spring, spoke movingly of the need for more such laws.

She is right, and AHA is justly proud of being one of the first national organizations to support this kind of legislation. However, the devil is in the details. Not every legal maneuver in the direction of assisted suicide is a good idea. Here are some issues to ponder.

Age: The model statute enacted in several states can only be used by adults. In Belgium, though, the law has been extended to include children as well, so long as there is parental consent. This sounds shocking at first, but children can experience just as much misery, with just as little hope for recovery. Why should they be forced to suffer more than adults?

Conversely, the Netherlands has considered “Completed Life” legislation legalizing assisted suicide for anyone over age seventy-five (or in another version, over seventy), regardless of the person’s health. It seems insulting to give people fewer protections under the law just because they happen to be older.

Mental capacity: The US model statute can only be used by mentally competent persons. Some of the worst suffering, though, is experienced by people who are mentally deficient. The Netherlands has an ongoing case of a seventy-four-year-old woman who had signed an ambiguous advance directive before incurring serious dementia. She had no medical condition that would likely result in death, but doctors decided that her suffering was so great that her life should be ended. When she resisted, relatives were brought in to hold her down so that the lethal injection could be administered. Maybe that’s legally right, but it seems unsettling.

Bureaucracy: While a fair amount of opposition to assisted suicide comes from a religious perspective, some of it comes from fellow humanists. Prominent UK humanist Brendan O’Neill argues that the bureaucratic red tape involved in some legislative regimes promotes needless suffering in and of itself. For example, the US model statutes are exceedingly detailed, with waiting periods and multiple layers of protection to assure that the patient genuinely desires this result. If the time ever comes when I seek aid, I will absolutely hate all that. The process itself might finish me off.

By contrast, the Netherlands seems to be moving toward few rules or protections at all. There are reports this month of a case there involving a doctor who unquestionably violated the rules but who did so “in good faith,” according to a regional review board. A prosecutor is pressing the case forward, not to put the doctor in jail, but to establish a legal precedent for future situations. “Good faith” seems awfully nebulous when someone—perhaps a person who is merely temporarily depressed—has his or her life is on the line. A National Institutes of Health study that analyzed Dutch assisted suicide in the 2012-2016 period found thirty-three cases where the rules on the books were not followed.

Money: Having people live too long can be a real pain in the pocketbook for family members, medical bureaucracies, and health insurance companies. Once you can move yourself out of the way, the argument might go, then why shouldn’t you? People who are already struggling in a fragile emotional condition could be especially susceptible to subtle or unsubtle nudging toward death.

California passed a law this autumn that may be problematic. Previously, it had been a felony to advise or encourage another person to commit suicide. It still is, but there is now an exception for the kind of assisted suicide sanctioned by California’s “End of Life Option” law. You’re now free to pester and wheedle grandma all you want, to get your inheritance more quickly. So is the hospital staff—you know, those folks who make big bonuses if they meet budget goals established by the insurance companies. There are already documented cases of insurance companies pushing doctors toward recommending assisted suicide rather than more expensive courses of treatment.

I can picture myself possibly wanting assisted suicide someday, or being willing to assist in the suicide of another. But I cannot picture myself ever encouraging anyone else to make that choice—if anything, I would push anyone who wanted to confide in me to be extremely certain before taking the irrevocable step. I have serious misgivings about that new California law.

Life-or-death issues are terribly complicated, and we’re far from being in a good place. But we must get over our discomfort, and in the case of religion a total ban, regarding end-of-life decisions.