Tuesday, October 6, 2015

Should There Be a Right to Die?

Quite recently, California--the most populous state in the nation--legalized physician-assisted suicide for terminally ill patients of sound mind. This provides an opportunity to discuss a controversial issue that's been debated for quite some time now, so I thought that I might as well weigh in while the issue has re-entered the spotlight. To state the obvious, the "right to die" is a difficult issue that's likely to raise strong emotions on both sides. And I understand both sides, as my position on the issue has changed over time. So, as in my blog post on the death penalty, I'll try to make an argument based on rationality rather than emotion.

Dr. Jack Kevorkian, noted advocated of
assisted suicide (photo taken from here)
According to critics of assisted suicide, it runs against the idea of the sanctity of life. They aren't wrong; it certainly means that we have embraced the idea that society has a more fundamental cause than keeping alive the largest possible number of people. In my view, though, that's a reasonable idea. If we required everyone to stay inside and away from physical contact with other people at all times, and simply delivered food and other necessary supplies to everyone (assuming this was a practical idea), perhaps that could increase human longevity. But it's not exactly anyone's idea of a great society.

A premise more fundamental, in my view, than the idea that human life should be protected (even against those to whom the life in question belongs) is that each person should have autonomy--that is, the right to make decisions about their own body. This principle has also been referred to as self-ownership, although I've previously voiced my problems with that term and concept. Why should autonomy be such a valuable concept? Because it's the central nature of human existence--the ability to make decisions and act accordingly. Certainly, when those decisions impact other people, it's justifiable to restrict or regulate them. But when those decisions impact only the actor themselves? That, in my view, is far less justifiable.

Ultimately, to restrict someone from stopping their heart from beating and their brain from functioning does not seem to me, in principle, any different from telling them what food they are allowed to eat, or requiring them to exercise a certain amount of time each day. In practice, of course, restricting one's ability to take their own life is far less authoritarian than either of those examples. That's because of how infrequently one seriously wants to take their own life compared to how frequently those regulations would impact a person's behavior. But, in my view, all are impermissible because of the same principle--the principle of autonomy.

In fact, I wouldn't restrict one's right to take their own life simply to cases in which they're terminally ill. Rather, any person of sound mind should, in my view, be allowed to kill themselves. By sound mind, I mean any person who has the mental capacity to rationally make their own choices, is not suffering from a treatable mental condition that is likely to be affecting their decisions, and who has not had some event in their life that is likely clouding their judgment (such as the death of a close friend). These conditions, of course, would exclude many of the people who take their own lives, which is a good thing. However, there are some conceivable circumstances--aside from terminal illness--that could lead to someone deciding to commit suicide. They could be suffering from a non-terminal but severely painful condition that has drastically reduced their quality of life, for instance. Or they could want to make a political statement, a la the self-immolating Buddhist monk. Ensuring that everyone who is given permission to commit suicide is of sound mind is a different matter; but if we can do so with a high degree of accuracy, then I would support the legalization of suicide for anyone who meets that standard.

Certainly, this right could be abused; even people of sound mind could make decisions based on bad information, or with total disregard for their friends and family. But, ultimately, neither of those reasons override the importance of autonomy. People are free to make potentially harmful decisions based on bad information, and free to do things that upset others, and rightly so. In my opinion, there's no reason for those factors to trump the importance of autonomy here if they don't elsewhere.

To anyone concerned that my proposal would lead to some massive societal disregard for human life or the normalization of suicide, I would like to strongly argue that it will not. It is a fundamental, natural urge to stay alive; of course, it can be overpowered by other urges--the urge to escape suffering, for instance--but it is, in a healthy person, a very strong urge. Perhaps my proposal could even help reduce the rate of suicide, by encouraging suicidal people to come forward in order to be evaluated (since, if they are determined to be of sound mind, they will be given permission to commit suicide in, ideally, a near-painless and surefire way), detecting those who are suffering from mental disorders (as many suicidal people are),
and helping them get appropriate treatment.

To some, the involvement of doctors in the suicide question is an issue, because of the maxim that a doctor should do no harm. But harm is quite subjective--we already acknowledge that if someone is dying naturally and wants to be allowed to die, a doctor would not be permitted to force them to stay alive through extraordinary means. How different, then, is it for a doctor to help a person to die? Further, if a doctor were to perform a surgery on a person who didn't want it, that would certainly be considered a form of harm, but it is entirely permissible to do so on a person who does want it. What constitutes "harm" comes down to the desires of the patient. Certainly, no doctor should be forced to be involved with assisted suicide. But those who are willing to do so, in my view, are not contradicting the principles of medicine.

As I said before, I fully understand the rationale of people who oppose legalizing assisted suicide, and I invite anyone, agree with me or disagree with me, to comment on this post. The concern that assisted suicide would devalue human life is certainly a comprehensible one to me, even if it's not a concern that I share. So are concerns about the impact on family and friends, and whether the decision will always be made wisely--those concerns I do share, in fact, but they're not enough to change my position. I will openly acknowledge that, as usual, my opinions on this issue are far outside the mainstream, and I don't expect everyone to agree with them. And I can certainly respect the opinions of those who disagree with me. But hopefully my opinion and rationale is of some use on this issue.

NOTE: Originally in the fifth paragraph I had said the conditions I specified would exclude the vast majority of people that kill themselves; I changed this to reflect the varying estimates of how many suicides are related to mental illness.

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