The Right to Die

Imagine being unable to take care of yourself. Imagine being in an insufferable amount of pain. Imagine knowing of a solution but being denied the right to accomplish it. That was the case of Ramón Sampedro, a Spaniard who, after suffering a diving accident in 1968, became paralyzed from the neck down. Living as a quadriplegic, he described, was “the most humiliating of slaveries: being a live head stuck to a dead body” (“A Suicide Tape” par. 5.) Sampedro fought for over 25 years for the right to an assisted suicide since he could not do it himself, but he was denied every time by major opposition groups within the Spanish court. However, in 1998, Sampedro had found his solution himself; he filmed himself committing suicide by drinking cyanide laced water, and shortly after, the video became public. This was a controversial event that sparked an already growing debate regarding assisted suicide, or the right to request a medical induced passing through a physician or doctor. There are many individuals like Sampedro who would prefer a quick and peaceful death in the form of euthanasia rather than live with a terminal illness or in a vegetative state, but opposition to this desire has made the practice legal in only 6 states in the United States and available in a small number of countries. However, this strips people of their rights to certain treatments and defies medical code, and because humans have personal autonomy and bodily integrity, people should have the right to assisted suicide.

The practice of assisted suicide- sometimes referred to as physician assisted suicide or PAS- is a practice that requires a doctor’s administration of a lethal drug to end one’s life and is done in only few parts of the world due to major opposition. Currently, the practice is legal in 6 states in the United States through Death with Dignity laws, but the practice comes with certain conditions. According to the Death With Dignity National Center, a nonprofit organization that expands the freedom of all qualified terminally ill Americans to make their own end-of-life decisions and promotes Death with Dignity laws around the United States based on the Oregon model, to qualify under Death with Dignity statutes, “you must be an adult resident of a state where such a law is in effect (CA, CO, OR, VT, WA); mentally competent, i.e. capable of making and communicating your healthcare decisions; and diagnosed with a terminal illness that will lead to death within six months, as confirmed by two physicians” (Death With Dignity.) This means that a person must be already going to die in order to receive an assist in suicide, and while this is only the beginning for implementing assisted suicide laws, people like Sampedro should be given the opportunity to die under a doctor’s care. Fortunately, doctors are in an agreement regarding the practice, so that the laws may be implemented in more states. The Medscape Ethics Report of 2014 found that 54% of U.S. based doctors surveyed agreed that physician-assisted suicide should be allowed, and while 31% disagreed, support for the measure has increased 8 percentage points since 2010 (Kane.) If more than half of U.S. based doctors agree with the practice, then this is indicative of a need for progression for bodily rights.

One of the main arguments against physician assisted suicide is that the practice goes against the Hippocratic Oath, a moral code that all practicing doctors take when they enter the medical field. This oath guides all medical practices and includes the statement, “I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.” However, the implications of the code can be interpreted. Steve Phillips, a medical practitioner of over 30 years, states, “Those prohibitions make it clear that there are moral standards which take precedence over the individual physician’s judgment,” implying that more than medical practice, there is a moral code that doctors must follow (Phillips, par. 3.) However, this is erroneous thinking because it divides a doctor from doing his job objectively and explicitly ignores a patient’s wishes. Sherwin Nuland, phD bioengineer, surgeon, and teacher of medicine at Yale, states, "If the prevention and relief of suffering are the aims of medical interventions--and not only the preservation or prolongation of life--it seems imperative to rethink our profession's reluctance to participate in euthanasia or even be present during an assisted suicide without legal guarantees of protection,” meaning that abiding to a dying patient’s wishes IS the moral thing to do because the aim of medical intervention is to relieve suffering. (Nuland, par. 8.) He also makes a point to state the archaic nature of the oath; it is over 200 years old, and it’s words cannot be used as “all-encompassing maxims to avoid the personal responsibility inherent in the practice of medicine” (Nuland par. 9,) signifying that each case is circumstantial and cannot be concretely defined by oaths.

Because the oath is seemingly violated, the next argument is that the issue lies not in giving the right of a person to die but in giving legal rights to a physician to kill. If we obtain the right to die, by extension, physicians have a right to ensure a safe and effective death just as we have the right to refuse medical treatment. In the United States, The New Jersey State Supreme Court decided the first right-to-refuse case in 1976 which recognized the right of at least competent adults to refuse even basic, life-sustaining medical care, like tubes supplying food and water (Gorsuch, par. 20.) Virtually every state in the nation afterwards adopted this case as a right to each individual receiving life-sustaining medical care. Given the widespread acceptance of such a right, the question follows whether assisted suicide and euthanasia must also be accepted. If patients have a right to tell their doctors to remove respirators or feeding tubes, they should also have a right to tell their doctors to administer lethal injections or medication. The Second Circuit, one of the United States thirteen courts of appeals, answered affirmatively to the statement, as did the federal district court in the Washington State litigation (Gorsuch, par. 22.) There are certain laws than encompass the conditions of a certain right, and just as we interpret and alter the Hippocratic Oath, we must interpret and alter those conditions. Furthermore, physician assisted suicide would not be murder on the physician’s side. The Merriam Webster dictionary defines murder as “the crime of unlawfully killing a person especially with malice aforethought.” Suicide is a conscious decision on one end while murder has malice. Assisted suicide would not be done with malice but with an intention to fulfill the patient’s explicit wishes; in fact, it is offering the more peaceful option so that people like Sampedro would not have to resort to drinking cyanide or poisoning themselves.

If a person wants to die, they will find a way to regardless of their resources just as not having the right to a physician assisted suicide did not stop Ramon Sampedro from eventually committing suicide, and the same follows suit for many patients because they are capable of making decisions. Figures disclosed under the Freedom of Information Act in England show that just over seven percent of suicides over the past five years involved people with a terminal illness, and more than 300 terminally ill people a year could be taking their own lives because there is no possibility of assisted suicide (Bingham, par. 1.) The argument is that suicide will happen anyway, so why not give people the option to end their lives ethically and without grim intent? Furthermore, according to Rolf B. Gainer, Ph.D., Diplomate ABDA Neurologic Rehabilitation Institute of Ontario Neurologic Rehabilitation Institute at Brookhaven Hospital, when suicide fails, there is a multitude of mental stressors that are added to the person’s psyche alongside physical factors. Things such as impaired awareness of deficits, social isolation, impaired-self regulation, mood state management problems, depression and despair (Gainer, Slide 20.) Considering we are looking at the percentage of terminally ill people who are committing suicide, the concern must be raised that if they are already predisposed to death, the drawbacks of a failed suicide are far worse to their health- which is what doctor’s claim to be saving- than if a secure assisted suicide were to be administered.

Above all else, we must consider our rights and bodily autonomy in order to effectively agree on what is best for an individual. In the United States, we as citizens gain our rights through constitutional laws. Currently, we have the right to marital privacy, procreation, abortion, pornography, and private consensual homosexual, and all of those rights fall under the guise of personal autonomy. Many of these rights are within the intention of “improving the quality of life,” (Justia.) One argument that can be made about the right to die is that it does improve the quality of one’s life by eliminating complete suffering. After all, only an individual can be the judge of their own pain levels, and in cases like Sampedro’s, a person should have full control in the activities one engages in based on how a solution they deem fit to the problem. In order to further our understanding of personal autonomy, we must look at the capability approach, a theoretical framework developed by economist-philosopher Amartya Sen who pioneered the approach, and philosopher Martha Nussbaum and a growing number of other scholars across the humanities and the social sciences who have significantly developed it. The approach encompasses two ideas: first, the idea that the freedom to achieve well-being is of primary moral importance, and second, that freedom to achieve well-being is to be understood in terms of people's capabilities, that is, their real opportunities to do what they have reason to value (Robeyns, par. 1-3.) A person like Sampedro is still a thinking individual despite being a quadriplegic, and no one can dehumanize an ill person who wants to do what they value, that is to die for peace. Furthermore, within the Capability Approach is the third capability, which is bodily integrity. It is defined as being able to move freely from place to place, to be secure against violent assault, including sexual assault and domestic violence, having opportunities for sexual satisfaction and for choice in matters of reproduction. There is an immense emphasis on personal autonomy and self-determination of one’s self; we all have rights to our body regardless of our physical state.

Bodily rights have come a long way; laws that have previously prohibited certain activities had been revoked, and we are on our way to free decision making. Take the Hippocratic Oath example again, except this time, consider its line, “I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy.” The original Hippocratic Oath condemned abortion, yet we now have legal abortion options throughout the United States as major pro-choice groups work to have the practice legalized federally. Neither medicine nor ethics is tied to concrete law, and ideas change based upon circumstances. Furthermore, laws on the legality of certain medical practices also do not originate from reading the Hippocratic Oath. Consider the Roe vs. Wade case. The Texas Court argued that the prohibition of abortion went against the first, fourth, ninth and fourteenth amendments that protected a person’s “zone of privacy,” and eventually, they deemed the term "broad enough to encompass a woman's decision whether or not to terminate her pregnancy." This decision involved myriad physical, psychological, and economic stresses a pregnant woman must face (McBride, par. 3.) Because we have to consider a person’s mental well being, we can not strictly adhere to any written law. If the decision of a once morally grey practice changed due to the state of a person’s mental and physical well being, shouldn’t the practice of physician assisted suicide be implemented throughout the United States? Why can’t we have the right to end our own lives peacefully? A person should not be condemned to the life they live if they deem their life insufferable or unbearable, and while assisted suicide isn’t for everyone- definitely not- rather than being about condoning suicide, this issue is about condoning choices.

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