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repository.law.umich.edu/cgi/viewcont…
ncbi.nlm.nih.gov/pmc/articles/PMC5102187
ncbi.nlm.nih.gov/pmc/articles/PMC5102187
Certainly everyone should strive not to be offensive to others, but whether one is offended or not, partly depends upon the person potentially offended. To offend someone is to attack, violate, or cause resentful displeasure to a person. This presupposes that the one offended recognizes the attack, violation, or resentment, and so the argument vis-à-vis assisted suicide is that when one willfully kills oneself, or requests to be killed, every other human being should rightfully be offended. Why? Because subsumed in the action of one killing oneself (or requesting to be killed) is the implied announcement that one's life (human life) is somehow not as valuable as it otherwise would be if one were not in a position to seek one's death (For to value life contradicts the act of killing, and if one values life, one does not commit suicide or ask to be killed.). To assert that one values human life, and at the same time to commit suicide is contradictory and illogical. So, to kill oneself (willfully, i.e., to distinguish this form of suicide from suicide in association with mental illness or other clinical pathology) necessarily devalues human life. And, because we are all human beings, therefore, every human being is (or should be) resentful of his or her life being devalued.
Now some may grant that killing oneself is an expression of devaluing life, but only that individual person's life, and no one else's, arguing therefore, that there is no basis for one's willful suicide (or its request) to be offensive to anyone else. The fundamental problem, however, with this reasoning is that human beings are relational (natural law). It is part of the essence of being human to exist in a relationship to another. According to Thomas Aquinas, the third precept of the natural law is “an inclination to good, according to the nature of his reason … thus man has a natural inclination … to live in society” (Aquinas 1948, I–II, q. 94, a. 2). And Aristotle viewed a particular relationship, that of friendship, to be a virtue and “most indispensable for life” (Aristotle 1962/1980, bk. 8, ch. 1). Indeed the very origin of an individual necessitates the relationship of two other human beings—a mother and a father—and a human being exists in relationships with others by his or her very nature. Human beings then are always, and essentially a part of a community of persons, and as such because of this connection with others (as part of humanity), when another person kills him- or herself or allows him- or herself to be killed, life for every other human being is cheapened (devalued). Such an action says to some degree, that life is not worth it; and although the effect on others may be seemingly miniscule, the more it happens the greater the effect on others (like compounding interest on money). Moral actions very much and very often have consequences for others, even when there appears to be no connection.7
Now some may grant that killing oneself is an expression of devaluing life, but only that individual person's life, and no one else's, arguing therefore, that there is no basis for one's willful suicide (or its request) to be offensive to anyone else. The fundamental problem, however, with this reasoning is that human beings are relational (natural law). It is part of the essence of being human to exist in a relationship to another. According to Thomas Aquinas, the third precept of the natural law is “an inclination to good, according to the nature of his reason … thus man has a natural inclination … to live in society” (Aquinas 1948, I–II, q. 94, a. 2). And Aristotle viewed a particular relationship, that of friendship, to be a virtue and “most indispensable for life” (Aristotle 1962/1980, bk. 8, ch. 1). Indeed the very origin of an individual necessitates the relationship of two other human beings—a mother and a father—and a human being exists in relationships with others by his or her very nature. Human beings then are always, and essentially a part of a community of persons, and as such because of this connection with others (as part of humanity), when another person kills him- or herself or allows him- or herself to be killed, life for every other human being is cheapened (devalued). Such an action says to some degree, that life is not worth it; and although the effect on others may be seemingly miniscule, the more it happens the greater the effect on others (like compounding interest on money). Moral actions very much and very often have consequences for others, even when there appears to be no connection.7
One of the issues brought up in the debate over physician-assisted suicide is the slippery slope argument: If physician-assisted suicide is made legal, then other things will follow, with the final end being the legalizing of euthanasia for anyone for any reason or no reason. The experience of other countries shows that this is not theoretical. The Netherlands is an example of the slippery slope on which legalizing physician-assisted suicide puts us. In the 1980s the Dutch government stopped prosecuting physicians who committed voluntary euthanasia on their patients (Jackson 2013, 931–932; Patel and Rushefsky 2015, 32–33). By the 1990s over 50 percent of acts of euthanasia were no longer voluntary. This is according to the 1991 Remmelink Report, a study on euthanasia requested by the Dutch government and conducted by the Dutch Committee to Study the Medical Practice Concerning Euthanasia (Euthanasia.com 2014; Patients Rights Council 2013a; Van Der Maas et al. 1991). In 2001 euthanasia was made legal. And in 2004 it was decided that children also could be euthanized. According to Wesley Smith, in a Weekly Standard article in 2004, “In the Netherlands, Groningen University Hospital has decided its doctors will euthanize children under the age of 12, if doctors believe their suffering is intolerable or if they have an incurable illness.” The hospital then developed the Groningen Protocol to decide who should die. Smith comments,
It took the Dutch almost 30 years for their medical practices to fall to the point that Dutch doctors are able to engage in the kind of euthanasia activities that got some German doctors hanged after Nuremberg. For those who object to this assertion by claiming that German doctors killed disabled babies during World War II without consent of parents, so too do many Dutch doctors: Approximately 21% of the infant euthanasia deaths occurred without request or consent of parents. (Smith 2004)
Euthanasia in the Netherlands went from illegal but not prosecuted, to legal, to including children. And it is not stopping there (Schadenberg 2013). Now, in 2011, Radio Netherlands reported that “the Dutch Physicians Association (KNMG) says unbearable and lasting suffering should not be the only criteria physicians consider when a patient requests euthanasia.” The association published a new set of guidelines, “which says a combination of social factors and diseases and ailments that are not terminal may also qualify as unbearable and lasting suffering under the Euthanasia Act.” These social factors include “decline in other areas of life such as financial resources, social network, and social skills” (RNW 2011). So a person with non-life threatening health problems but who is poor or lonely can request to be euthanized.
In another example of the slippery slope to which physician-assisted suicide leads, in 2002 Belgium “legaliz[ed] euthanasia for competent adults and emancipated minors.” In February of 2014, Belgium took the next step:
Belgium legalized euthanasia by lethal injection for children…. Young children will be allowed to end their lives with the help of a doctor in the world's most radical extension of a euthanasia law. Under the law there is no age limit to minors who can seek a lethal injection. Parents must agree with the decision, however, there are serious questions about how much pressure will be placed on parents and/or their children. (Patients Rights Council 2013b)
Some say that the US state laws concerning physician-assisted suicide are very restrictive and so there is no chance of erosion such as has happened in the Netherlands or Belgium (Intelligence Squared 2014b, 34). Yet, if there is no moral or philosophical basis for PAS laws in the common good, then there is no telling how far changes to PAS laws will go in the future, and no stopping the changes.
It took the Dutch almost 30 years for their medical practices to fall to the point that Dutch doctors are able to engage in the kind of euthanasia activities that got some German doctors hanged after Nuremberg. For those who object to this assertion by claiming that German doctors killed disabled babies during World War II without consent of parents, so too do many Dutch doctors: Approximately 21% of the infant euthanasia deaths occurred without request or consent of parents. (Smith 2004)
Euthanasia in the Netherlands went from illegal but not prosecuted, to legal, to including children. And it is not stopping there (Schadenberg 2013). Now, in 2011, Radio Netherlands reported that “the Dutch Physicians Association (KNMG) says unbearable and lasting suffering should not be the only criteria physicians consider when a patient requests euthanasia.” The association published a new set of guidelines, “which says a combination of social factors and diseases and ailments that are not terminal may also qualify as unbearable and lasting suffering under the Euthanasia Act.” These social factors include “decline in other areas of life such as financial resources, social network, and social skills” (RNW 2011). So a person with non-life threatening health problems but who is poor or lonely can request to be euthanized.
In another example of the slippery slope to which physician-assisted suicide leads, in 2002 Belgium “legaliz[ed] euthanasia for competent adults and emancipated minors.” In February of 2014, Belgium took the next step:
Belgium legalized euthanasia by lethal injection for children…. Young children will be allowed to end their lives with the help of a doctor in the world's most radical extension of a euthanasia law. Under the law there is no age limit to minors who can seek a lethal injection. Parents must agree with the decision, however, there are serious questions about how much pressure will be placed on parents and/or their children. (Patients Rights Council 2013b)
Some say that the US state laws concerning physician-assisted suicide are very restrictive and so there is no chance of erosion such as has happened in the Netherlands or Belgium (Intelligence Squared 2014b, 34). Yet, if there is no moral or philosophical basis for PAS laws in the common good, then there is no telling how far changes to PAS laws will go in the future, and no stopping the changes.
In medicine, we talk much these days about a “good death,” not necessarily one that is completely free of suffering, but a dying process in which we are attendant to pain and symptom management, optimize clear decision making, and affirm the whole person in as dignified a manner as possible. Importantly, this can often be effectively accomplished through incorporation of palliative care services. Palliative care is a healing act adjusted to the good possible even in the face of the realities of an incurable illness. Cure may be futile but care is never futile (Pellegrino 2001). With appropriate utilization of palliative care, far fewer patients would be driven by fear to request that physicians actively end their lives via PAS/E.
Proponents of assisted suicide and euthanasia posit the scenario of uncontrollable pain as a straw man for advancing their cause. Such proponents apparently view death as the ultimate analgesic. In fact, in medical practice today, pain relief is almost always possible given modern therapeutics in analgesia and the medical specialty of pain management. Since pain can be alleviated, there is no basis to assert a need for PAS because of intractable pain. This may explain in part why many requests for PAS are no longer related to or initiated because of intolerable pain, but because of fear of such intolerable pain. Further, closely related to a patient's fear of intolerable pain, and sometimes associated with a patient's fear of being abandoned (Coyle 2004), is a patient's request for PAS because of not wanting to burden others. This too poses a curious contradiction, for on the one hand there is not wanting to be a burden on a loved one, and on the other hand a fear of being alone and abandoned. Such a contradiction, once considered and coupled with the fact that pain can be addressed successfully through optimal palliative care implementation, enhances the power of this argument against PAS/E.
The Oregon law was enacted on the basis of intolerable pain — no one should be forced to endure pain that is uncontrollable and unendurable. Most of us can sympathize with that, but the law is not restricted to pain, and it is not pain that is the top reason people choose physician-assisted suicide in Oregon. The state's “Death with Dignity Act Annual Report” for 2014 shows that the top reason is “losing autonomy” (Oregon Public Health Division 2015, 5). Concern about pain was not even the second or third reason: “Less able to engage in activities making life enjoyable” and “Loss of dignity.” It was ranked sixth out of seven, above only financial concerns, and included not only “inadequate pain control,” but also “concern about it.” These patients were not necessarily in uncontrollable pain themselves, however they were concerned about it (as are we all). But even that concern did not rank high on their list of reasons that they wanted to commit suicide. Even if the line drawn is unbearable pain, how can that be restricted to only physical pain? Who can judge that mental anguish is not unbearable pain? Or that economic distress (or anything else that causes anguish) is not unbearable pain?
Proponents of assisted suicide and euthanasia posit the scenario of uncontrollable pain as a straw man for advancing their cause. Such proponents apparently view death as the ultimate analgesic. In fact, in medical practice today, pain relief is almost always possible given modern therapeutics in analgesia and the medical specialty of pain management. Since pain can be alleviated, there is no basis to assert a need for PAS because of intractable pain. This may explain in part why many requests for PAS are no longer related to or initiated because of intolerable pain, but because of fear of such intolerable pain. Further, closely related to a patient's fear of intolerable pain, and sometimes associated with a patient's fear of being abandoned (Coyle 2004), is a patient's request for PAS because of not wanting to burden others. This too poses a curious contradiction, for on the one hand there is not wanting to be a burden on a loved one, and on the other hand a fear of being alone and abandoned. Such a contradiction, once considered and coupled with the fact that pain can be addressed successfully through optimal palliative care implementation, enhances the power of this argument against PAS/E.
The Oregon law was enacted on the basis of intolerable pain — no one should be forced to endure pain that is uncontrollable and unendurable. Most of us can sympathize with that, but the law is not restricted to pain, and it is not pain that is the top reason people choose physician-assisted suicide in Oregon. The state's “Death with Dignity Act Annual Report” for 2014 shows that the top reason is “losing autonomy” (Oregon Public Health Division 2015, 5). Concern about pain was not even the second or third reason: “Less able to engage in activities making life enjoyable” and “Loss of dignity.” It was ranked sixth out of seven, above only financial concerns, and included not only “inadequate pain control,” but also “concern about it.” These patients were not necessarily in uncontrollable pain themselves, however they were concerned about it (as are we all). But even that concern did not rank high on their list of reasons that they wanted to commit suicide. Even if the line drawn is unbearable pain, how can that be restricted to only physical pain? Who can judge that mental anguish is not unbearable pain? Or that economic distress (or anything else that causes anguish) is not unbearable pain?