Assisted Suicide, Euthanasia, and the Law
Kaveny, M. Cathleen, Theological Studies
Is it ever morally right intentionally to kill innocent human beings in order to spare them the suffering that continued life would bring? If so, under what circumstances? If not, why not? Furthermore, which courses of action count as intentional killing in the context of medical decision making? When is it morally acceptable to forgo certain medical care, although it will likely prolong a patient's life? When it is permissible to seek certain treatment, despite the fact that it will probably hasten a patient's death?(1)
These are the first-order moral questions raised by the closely related matters of assisted suicide and euthanasia. They are not unfamiliar to the readers of this journal. In recent years both Lisa Sowle Cahill and John Paris have discussed here bioethical issues relating to the end of life. Cahill devoted the majority of her attention to the controversial issue of whether or not artificial nutrition and hydration may be withheld or withdrawn from patients in a persistent vegetative state; she also probed contemporary discussions of whether taking active steps to end a patient's life might be justified in exceptional cases. Paris delved more deeply into the latter question, offering a brief history of the euthanasia movement in Europe and the United States, as well as an unsettling critique of the practice of euthanasia in the Netherlands.(2)
In the years following Cahill's and Paris's discussions, the fervor of the national debate over assisted suicide and euthanasia has not abated. Instead, it has been recast in legal, individualistic terms, in a manner disturbingly reminiscent of our intractable social battles over abortion. No longer at the forefront of the discussion is the question when, if ever, it is morally right for dying or seriously ill individuals intentionally to take their own lives. Instead, the issue occupying center stage is whether they should have a legal right to do so, and if necessary to enlist the aid of a physician willing to prescribe the lethal dose.
Three events have hardened this shifting tenor of the national discussion of physician-assisted suicide and euthanasia. First, Dr. Jack Kevorkian's crusade to provide lethal assistance to persons seeking to end their own lives has gained momentum, as well as the appearance of impunity. Kevorkian has now facilitated the deaths of nearly 50 individuals, many of whom were not in the last stages of terminal illness, but plagued with chronic, degenerative afflictions such as Lou Gehrig's or Alzheimer's disease. In August 1996, Kevorkian's assistance at the death of Judith Curren, a 42-year-old woman suffering from obesity and chronic-fatigue syndrome, provoked sustained criticism by both opponents and supporters of legalizing assisted suicide. While opponents perceived this case to be emblematic of the dangers entailed by the practice, proponents contended that only legislation and regulation will curtail the abuses of mavericks like Kevorkian.(3) Second, in 1995, Oregon became the first state to legalize physician-assisted suicide. In 1995-1996, bills were introduced in at least 15 other states to allow "aid-in-dying."(4) Finally, in 1996, two federal courts of appeals proclaimed a new constitutional right protecting some types of physician-assisted suicide.
What should be the appropriate stance of the criminal and civil law toward various types of physician-assisted suicide and euthanasia? This question is extremely complex. At the heart of the matter, of course, are the moral questions alluded to in our opening paragraph. However, the resolution of the moral issue in and of itself does not dictate sound law. In some cases, a society might rightly choose not to punish acts it believes to be seriously immoral. Conversely, a society might decide to enact a blanket prohibition against certain types of behavior, despite the fact that they might be morally permissible in certain cases. Key factors in the decision about criminalization include whether the behavior in question directly harms only the individual performing it or others as well, how widely supported the moral judgment about that behavior is, whether the prohibition will be an effective deterrent, the level of resources required to enforce it, and the probability that it can be enforced equitably. …