"The real thing
that we're going to be debating is about life, and as the freest
nation in the world, are we going to abandon the principle that
life has value?"
Representative Tom Coburn (R- Okla.), a supporter of a measure
passed by the House of Representatives to Congress to overturn
Oregon's law allowing physician-assisted suicide, said these
words on Jim Lehrer's News Hour, last October 27.
Is it possible that Representative Coburn really cannot see
the flagrant contradiction between wishing the United States
to be "the freest nation in the world" and insisting on ramming
the belief that life has value down the throats of terminally
ill people who have made careful, considered, and well-grounded
decisions that they do not want to continue to live?
In his celebrated essay On Liberty, John Stuart Mill wrote:
.
. . the only purpose for which power can be rightfully exercised
over any member of a civilised community, against his will,
is to prevent harm to others. . . Over himself, over his own
body and mind, the individual is sovereign.
No
nation can claim to be "the freest nation in the world" if it
overrides this principle on such an important matter as the
right to decide when and how one dies. On that basis, the Netherlands
and Switzerland are freer nations than the United States, because
the citizens of those nations are able to receive assistance
from physicians in ending their lives.
If Mill's principle were generally accepted in the United States,
it would provide a clear basis, not only for accepting the law
for which the citizens of Oregon have twice voted, but for getting
rid of all laws prohibiting physician-assisted suicide and voluntary
euthanasia. For what could be a plainer case of denying the
sovereignty of individuals over their own mind and body than
a law that tells competent adults that they must continue to
live beyond the point at which they see any value in doing so?
It is sometimes claimed that patients who are terminally ill
cannot rationally or autonomously choose euthanasia, because
they are liable to be depressed, or their minds may be clouded
by medication. It is curious, however, that people who make
this claim do not argue against the right of terminally ill
patients to refuse life-sustaining treatment or to receive pain
relief that is liable to shorten life. Indeed, the bill that
the House of Representatives passed that seeks to prohibit the
use of federally approved substances for the purposes of physician-assisted
suicide specifically allows for the use of pain relief that
is foreseen to shorten life. But the patients who refuse treatment
or request life-shortening pain relief are also terminally ill
and are making choices that will, or may, end their lives earlier
than they would have ended if the patients had chosen differently.
To support the right of patients to make these decisions, but
deny they should be allowed to choose physician-assisted suicide
or voluntary euthanasia, is to assume that a patient can rationally
decide to refuse treatment or receive life-shortening doses
of pain relief (and that doctors ought, other things being equal,
to cooperate with this decision) but that the patient cannot
rationally choose voluntary euthanasia. There is no logic in
this view. The question is whether a patient can rationally
choose an earlier death over a later one (and whether doctors
ought to cooperate with these kinds of end-of-life decisions),
and that choice is made in either case. If patients can rationally
opt for an earlier death by refusing life-supporting treatment
or by accepting life-shortening palliative care, they must also
be rational enough to opt for an earlier death by physician-assisted
suicide or voluntary euthanasia.
Peter
Singer is the author of Animal Liberation, Practical Ethics,
How Are We to Live?, and Rethinking Life and Death.
