Physician-Assisted Suicide: "Slippery Slope" or Civil Right?

Article excerpt

The issue of physician-assisted suicide for the terminally ill has once more landed on the front pages of the nation's newspapers due to four major court rulings earlier this year. Both supporters and opponents of physician-assisted suicide agree that the rulings are likely to have a major impact, although they disagree as to the effects. In the eyes of those who oppose physician-assisted suicide, the proverbial "slippery "slippery slope" has become a sheet of glazed ice, slick and dangerous. In the eyes of those who support the death-with-dignity movement, the rulings were a resounding triumph for civil rights. The language in both cases has been similar to the response that Roe v. Wade provoked from abortion opponents and supporters, and for good reason: both issues touch on those most intimate of human concerns--life and death, tradition and innovation, medicine and religion. And considering that state authorities have already promised to appeal two of the rulings to the U.S. Supreme Court, the issue of physician-assisted suicide is likely to remain on the front pages for many years to come.

In many respects, the modern death-with-dignity debate is an extension of the ethical, legal, and medical arguments surrounding the New Jersey Supreme Court's unanimous ruling on March 31, 1976, that allowed Julia and Joseph Quinlan to remove their daughter Karen from life-support equipment. Some medical ethicists warned then that the ruling was the beginning of a trend--the so-called slippery slope--which, followed to its logical conclusion, could lead to decisions to end a person's life being made by third parties not only on the basis of medical condition but also on such considerations as age, economic status, or even ethnicity.

After 20 years, and within the space of several months, four new court rulings have significantly expanded the reasoning behind the Quinlan decision. The most sensational of the four were the March 9 and May 14 acquittals by Michigan juries of Dr. Jack Kevorkian, who has attended the suicides of 28 seriously ill people since 1990, of charges in connection with the deaths of four of them. But while the Kevorkian verdicts were the subject of much popular attention, it was the other two decisions which had the experts opining on the nation's op-ed pages and on the more substantive interview shows.

The first of these decisions came on March 6, 1996, when the U.S. Court of Appeals for the Ninth Court in San Francisco overturned a Washington State law that made assisted suicide a felony. The other occurred on April 2, 1996, when the U.S. Appeals Court for the Second Circuit in New York struck down that state's law making it illegal for doctors to help terminally ill people end their own lives. While acknowledging that "people of good will can and do passionately disagree about the proper result" of assisted suicide, Ninth Circuit Judge Stephen Reinhardt wrote in the majority opinion:

Like the decision of whether or not to have an abortion, the decision how and when to die is one of "the most intimate and personal choices a person may make in a lifetime," a choice "central to personal dignity and autonomy."

But whereas the Ninth Circuit decision was based on the Fourteenth Amendment and privacy issues, the Second Circuit ruling in April invoked an "equal protection" argument that people suffering terminal illnesses should have the same right as those, such as Quinlan, who are in a coma and have the law on their side in the decision to halt life-sustaining nourishment or treatment. "Physicians do not fulfill the role of `killer' by prescribing drugs to hasten death," wrote Second Circuit Judge Roger J. Miner, "any more than they do by disconnecting life-support systems."

After the federal appeals court decisions came down, I contacted Alan Meisel, professor of law and director of the University of Pittsburgh's Center for Medical Ethics. Meisel picked up on the Ninth Circuit Court's abortion language and its expansion of termination of life support to the right to assisted suicide, which he calls physician aid in dying. …