In the course of the years, my views with respect to the morality of physician-assisted suicide have not wavered one bit. I'm opposed to it. Strongly opposed to it. I agree with Karl Barth that "it is for God and God alone to make an end of human life" and that God gives life to us "as an inalienable loan." (1) I believe that meaning and hope are possible in all of life's situations, even in the midst of suffering. I am very uncomfortable with the idea of physicians, who are trained to preserve life, dispensing lethal drugs to be used to end life.
In recent years, however, as Oregon has legalized physician-assisted suicide and other states have considered doing so, I have found myself wrestling with a very difficult question. Do those of us with deep moral reservations about the morality of physician-assisted suicide have any business using the coercive power of government to try to prevent those who disagree with us from doing what they believe is right? Are there any compelling arguments to justify placing legal roadblocks in the way of terminally ill individuals who wish to end their suffering by ending their lives, provided such decisions are made only after thoughtful, careful deliberation in an environment devoid of social pressure?
When what some might do poses a significant risk to the health and well-being of others, a strong case can be made for intervention. But does a rationale based on protection of those who might be harmed work in the case of physician-assisted suicide? Protecting vulnerable individuals from threats posed by others is one matter. But what it the consequences of the act are born primarily by the perpetrator of the act?
One of the most frequent arguments made by those opposed to legalization--an argument with strong overtones of paternalism--holds that we always ought to intervene to prevent self-destructive behavior. But do we have either the right or the wisdom to decide what is best for other people in situations in which they are perfectly capable of making their own decisions? In On Liberty, John Stuart Mill cautions, "A person should be free to do as he likes in his own concerns, but he ought not be free to do as he likes in acting for another, under the pretext that the affairs of the other are his own affairs." (2)
A distinction is often made between hard (or strong) paternalism, which would permit intervening because of a belief that those doing the intervening know what is best for others, and soft (or weak) paternalism, which would permit intervening to secure an outcome consistent with the values held by those who are being coerced. Because of deficiencies in our decisionmaking processes or failures of the will, we sometimes act in ways at odds with our own deeply held values and desires, or fail to do things mandated by these values. In such cases, coercive intervention can have the salutary effect of forcing us to do what in fact we really want to do.
In a thoughtful little book published three decades ago, Joel Feinberg, commenting on John Stuart Mill's strong defense of individual liberty, observes, "Nevertheless, there are some actions that create a powerful presumption that an actor in his right mind would not choose them." The stronger the presumption, "the more elaborate and fastidious should be the legal paraphernalia required, and the stricter the standards of evidence," if that presumption is to be overridden. And what of suicide? Feinberg comments, "The desire to commit suicide must always be presumed to be both nonvoluntary and harmful to others until shown otherwise. (Of course, in some cases it can be shown otherwise.)" (3)
There is a good deal of wisdom in Feinberg's approach. Suicide and attempted suicide often are acts of desperation by individuals who, as a result of mental illness or other distorting factors, are not in full command of their senses. In such cases, an ethic that values life and affirms the dignity of each person mandates intervention to prevent self-destruction. …