Mark Miller, C.Ss.R. Ph.D.
Most proponents of assisted suicide recognize how dangerous it might be to change the law and allow some people to end their lives with the assistance, presumably, of a physician. Hence, they argue that any change in the law must also incorporate sufficient safeguards for the most vulnerable, particularly, the handicapped, the elderly, the depressed and those influenced by others.
Perhaps I have not been paying close enough attention, but I have yet to hear what kind of safeguards really would protect the vulnerable in our society. Most proponents of assisted suicide argue that the most important aspect of the issue is the free choice of the individual. Safeguards must be in place to ensure that a person is making a free choice.
What kind of safeguards can society put in place? Legally, I suspect, the only way to determine if a decision is truly free and autonomous is to examine what I call external aspects of the decision. A person would have to be legally competent (which is sometimes notoriously difficult to determine, especially in cases of depression), aware of the consequences of a decision, and under no external coercion.
Would such legal protection then safeguard vulnerable people? Well, unfortunately, the one aspect of free choice which is most significant is the motive of the person. And here the law must depend totally on a) the patient’s expressed wishes or b) the assisting person’s (presumably, a doctor) claims about the patient’s wishes. However, it is precisely at this point that the tough questions are raised. How could the law, or even a doctor, ever determine if, for example, family members were subtly coercing a person to choose death? How often does a doctor recognize depression in a dying patient and treat the depression rather than the request for death? How can any outsider evaluate the fears of a patient, fears of not being cared for or of being abandoned, fears of pain and suffering, fears of losing control?
Ultimately, so-called free choices would be nothing other than the expressed will of a person. Society might be able to put up a few road blocks to prevent people from unwisely ending their lives (although, if it is a free choice, why would society have any say whatsoever?). We could restrict requests to the dying (which is often very difficult to determine), to those who are suffering (which includes all of us at one time or another), or to a persistent request (if we are going to agree with the request at some time, why drag it out?), or to those who could prove themselves in a court of law as making a competent choice (but nobody proposes this because it would be too complicated and too costly).
In the Netherlands the ‘safeguards’ which allow physicians either to assist a suicide or actively end a life are quite porous. The patient must make a free choice. How a doctor determines that this is a free choice, I do not know. Dutch physicians often brag about the fact that most requests for death (seven out of eight, according to some studies) are not granted. What they are less clear about is how they determine who is ready to die. Furthermore, it is a fact that at least 1000 patients per year are put to death without any request whatsoever (Remmelinck Report, 1991).
The patient also has to be in a terminal condition. Although there is no way most doctors have of determining how long a patient will live, there is an assumption that as soon as a terminal condition is diagnosed (even if there might be years of valuable life ahead) the patient is a potential candidate.
A patient must make a persistent request. However, there are statistics which suggest that 49% of patients are killed after their first request.
A patient must be in unbearable pain or suffering. Unbearable pain as the physiological manifestation of dis-ease in our bodies, almost without exception, can be controlled by drugs today. Unbearable suffering? First, since we all suffer at one time or another, the unbearable aspect of the definition becomes extremely important. However, the only person who can testify to the ‘unbearability’ has to be the patient himself or herself. How could anybody question that? And, second, a natural sympathy for anybody suffering from cancer or AIDS or Alzheimer’s or any of a host of other ultimately fatal illnesses raises a great deal of fear in outsiders. Our sympathy for their ‘unbearable suffering’ will probably be easy to manipulate by any person who really wanted to die. Why would anybody question such a claim?
Furthermore, what kind of safeguards could protect against a Charter of Rights that does not allow discrimination of any sort? Accordingly, I believe it would only be a matter of time before some people would claim that it is unfair that a physician is allowed to help a terminally ill patient but not somebody who is simply fed up with life but doesn’t want to make a mess committing suicide. And if it is all right to ask a physician’s assistance so that I might take my own life, then should I become either incompetent or incapable of doing the deed why can’t I make my desires known in a living will. Hence, we move beyond assisting a suicide to active euthanasia.
I do not know whether or not this can be called a slippery slope. I do know, however, that some people will not stop short of a law and a society that allows death on demand. Not only do I not believe that our society is capable of putting safeguards in place for those who want nothing to do with this evil, I fear that there will be no political will to enforce safeguards particularly where physicians and our trust in them is concerned. Safeguards may sound reasonable. To me they are nothing more than a subterfuge for opening the door to legal killing. Human ingenuity will do the rest.