Assisted Suicide and Euthanasia are Fundamental Rights

A Real-Life Story of Dying With Dignity by Physician-Assisted Suicide

The PBS show, “Frontline,” documented the story of Craig Ewert, a 59-year old American with Lou Gehrig’s disease who chose to die by assisted suicide in Zurich, Switzerland in September, 2006.

Assisted suicide is legal in the U.S. for residents of Washington, Oregon and Montana; and for citizens of Switzerland, Belgium, Netherlands and Luxembourg (where euthanasia is also legal). In physician-assisted suicide, the physician writes the prescription for the lethal medication, but the patient administers it. In euthanasia, someone else administers the lethal medication with the patient’s consent. But it is only in Switzerland that non-citizens can seek physician-assisted suicide.

Mr. Ewert first considered suicide only five months after his diagnosis, when he “had deteriorated enough.” As his wife was doing his morning shave, a task he could no longer perform himself, he said “You can only watch so much of yourself drain away before you say this is an empty shell. Once I become completely paralyzed, I will take in some nutrients through a tube in my stomach and I will have to excrete and be cleaned and washed. And it’s painful.”

The Ewerts, who had settled in England, sought help through a Swiss organization called Dignitas, which caters only to foreigners seeking assisted suicide. In compliance with Swiss Law, Mr. Ewert himself activated a timer on his breathing-assistance device (using his teeth) to cause it to stop working so it wouldn’t continue to ventilate him after his own respirations ceased. Given his love of music, Mr. Ewert wanted a recording of the First Movement of Beethoven’s Ninth Symphony to play during his final journey. He and his wife kissed and said goodbye to each other, then he drank a lethal-strength prescription sedative. Within minutes, he peacefully fell asleep. The ventilator turned off. And he never reawakened.

Assisted Suicide is Legal But Not a Right

Unfortunate for advocates for the right to die, bills being considered by the Swiss legislature this year may place more legal restrictions on right-to-die organizations in Switzerland.

The concern over Switzerland’s “Suicide Tourism” has come about recently because of controversies concerning Dignitas and such cases like the assisted suicides of a rugby player that had become paralyzed and a couple in which one spouse was relatively healthy.

In Washington and Oregon, assisted suicide is legal because the majority of voters approved it, and court challenges upheld the law.

In Montana, the newest state to permit physician-assisted suicide, the state supreme court ruled on Dec. 31, 2009 that physicians who write lethal prescriptions for mentally competent, terminally-ill patients, would be shielded from homicide liability. The court declined to rule on the constitutionality of the issue.

Because assisted suicide is not recognized as an absolute right, not everyone who wants to end his or her life has been able to. As an example, in Switzerland, a couple who wanted to die together was declined services because the husband, who had serious heart disease, was not considered sick enough and his wife was healthy. Months later, the wife unexpectedly died of cancer, and the husband continues to survive without her. They were unable to fulfill their wish to die together as they had lived---inseparable from the start.

The Religious Right Continues to Oppose Assisted Suicide and Euthanasia

Not surprisingly, the Religious Right remains opposed on Christian religious grounds to physician-assisted suicide and euthanasia. This was reiterated at the Religious Right’s September, 2009 summit called the “Manhattan Declaration” where Orthodox, Catholic and Evangelical Christian leaders drew the line in the sand on their well-known positions on social issues.

What About the Religious Left?

While the Religious Right opposes physician-assisted suicide and euthanasia for biblical reasons, the religious left seems to oppose it on “social” grounds.

In a 2007 Pew Forum interview, self-called “Progressive” theologian Robert P. Jones argues that assisted suicide/euthanasia could end up being performed in a biased fashion on the poor, disabled, or those without health insurance. That is, they could be pressured into choosing to prematurely end their lives for financial or social reasons. He said, “in our current health care context we can't justly implement it in a way that doesn't lead to increased risk to the disadvantaged and the vulnerable in society.”

But when asked by the interviewer, “Is there any evidence in Oregon that the sorts of problems that you've raised have actually occurred?”, Jones answers,
“On their face, the official reports out of Oregon so far don't seem to indicate that these sorts of problems have occurred.”

Ezekiel Emmanuel, a physician-ethicist and close advisor to the Obama Administration on health care policy, wrote in 1997 about his opposition to the right to die. He argues, first, patients do not need physician-assisted suicide or euthanasia because, “Patients who are being kept alive by technology and want to end their lives already have a recognized constitutional right to stop any and all medical interventions, from respirators to antibiotics.” And second, survey data show that a “significant majority of Americans oppose physician-assisted suicide and euthanasia except in the limited case of a terminally ill patient with uncontrollable pain.”

The only statement I could find from Obama was when he was questioned during the presidential campaign about physician-assisted suicide. He said, “I am in favor of palliative medicine in circumstances where someone is terminally ill. ... I'm mindful of the legitimate interests of states to prevent a slide from palliative treatments into euthanasia. On the other hand, I think that the people of Oregon did a service for the country in recognizing that as the population gets older we've got to think about issues of end-of-life care.”

What's Wrong With Arguments Against the Right To Die?

As far as the Religious Right’s intransigent opposition to assisted suicide and euthanasia, their argument is entirely based on religion beliefs about what God says. If their argument were to prevail legally, it would be an horrific violation of the separation of church and state (a quest they appear never to give up on).

Ezekiel Emmanuel’s arguments derive from pragmatism and collectivism when he says that patients can refuse life-sustaining care anyway (and then supposedly die), and that society should do what the majority wants according to polls. What about what the individual wants? Mr. Ewert said, “If someone wants to take their own life, you may not think it’s a good reason, but it’s that person’s life.” Nothing in Dr. Emmanuel’s argument says that an individual owns his own life.

Theologian Robert Jones is making a theoretical allegation that the poor, disabled and uninsured will be unjustly pressured to prematurely end their lives because of economic circumstances or perceptions of their “value” as human beings (in the case of the disabled). He provides no evidence to support this absurd and inflammatory position.

As far as Obama, he doesn’t know what he’s talking about. Palliative Care is a specialty medical service that deals with the relief of symptoms and stress associated with serious illness, regardless of the prognosis. Palliative care has nothing whatsoever to do with assisted suicide or euthanasia, and it is ridiculous to consider some possible “slide” from Palliative Care to assisted suicide/euthanasia. His ignorant argument is a nothing, and no more can be said of it.

The Right To Die is a Corollary of the Right to Life

Assisted suicide in the U.S. and Europe, and euthanasia in Europe are not Constitutionally-protected. The U.S. Supreme Court in 1997 ruled unanimously that assisted suicide is not Constitutionally-protected, but up to the states to decide. In Europe, laws were enacted by parliamentary law and subject to revision.

Ayn Rand said, “There is only one fundamental right (all the others are its consequences or corollaries): a man’s right to his own life."

As well-stated by Thomas Bowden in a 2007 Op-Ed,

The Declaration of Independence proclaimed, for the first time in the history of nations, that each person exists as an end in himself. This basic truth--which finds political expression in the right to life, liberty, and the pursuit of happiness--means, in practical terms, that you need no one's permission to live, and that no one may forcibly obstruct your efforts to achieve your own personal happiness.

I would argue that the right to die is a corollary of the right to life. A free person does not belong to God, to the State, to the medical establishment or to anyone else. If a rational, competent person decides that life is not worth living because of illness, suffering, loss of a loved one, untreatable hopelessness, or whatever reason, then that person has the right to end his or her life. Just as one should be left free to pursue rational values that do not violate others' rights, one should be free to terminate their life on their terms (excluding obvious instances when that's not possible, like getting struck by lightening or a bus).

The right to choose one’s own death (if such a choice becomes possible) is as absolute as the right to one’s own life. Period.

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The Christian Ideal: Suffering

I'm simply overwhelmed to read Tony Judt's account of a single night stuck in the prison of his body, ravaged by ALS (a.k.a. Lou Gherig's disease). Here's how he describes his basic condition:

By my present stage of decline, I am thus effectively quadriplegic. With extraordinary effort I can move my right hand a little and can adduct my left arm some six inches across my chest. My legs, although they will lock when upright long enough to allow a nurse to transfer me from one chair to another, cannot bear my weight and only one of them has any autonomous movement left in it. Thus when legs or arms are set in a given position, there they remain until someone moves them for me. The same is true of my torso, with the result that backache from inertia and pressure is a chronic irritation. Having no use of my arms, I cannot scratch an itch, adjust my spectacles, remove food particles from my teeth, or anything else that--as a moment's reflection will confirm--we all do dozens of times a day. To say the least, I am utterly and completely dependent upon the kindness of strangers (and anyone else).

Please, go read the whole thing. While I don't know what Mr. Judt's own religious views are, I regard his life as a clear demonstration of the life-hating brutality of Christian doctrine. To wit:

Christianity regards suffering like that of Mr. Judt as not merely noble and elevated, but positively divine. It's not good to live fully, happily, robustly according to Christianity: it's good to suffer and die. That's what Jesus taught -- and then he lived and died by that ideal.

Christianity regards the body as a vile, despicable prison that leads a person's divine soul astray into the dark depths of sin. Mr. Judt is positively lucky, as his body really is a prison: he cannot indulge pleasures of the flesh, not even the seemingly minor ones like scratching his own itches.

Christianity regards Mr. Judt's life as God's property, not as his own. So Mr. Judt must be forbidden by law from ending his own life, if and when it becomes intolerable. If anyone attempts to help him end his life, that person should be imprisoned as a murderer. As a bonus, if Mr. Judt manages to end his own life somehow, the loving Christian God will consign him to the torments of hell for all eternity.

Of course, many Christians do not live by such dark principles. They are kind, decent people, loathe to see anyone suffering from such a tragic condition. They might even support stem-cell research, and even assisted suicide. To that extent, their values are more American -- loving science, seeking happiness, and upholding individual rights -- than Christian.

As Leonard Peikoff states in his essay Religion Versus America:

It is time to tell people the unvarnished truth: to stand up for man's mind and this earth, and against any version of mysticism or religion. It is time to tell people: "You must choose between unreason and America. You cannot have both. Take your pick."

If there is to be any chance for the future, this is the only chance there is.

Amen, brother!

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A Terry Schiavo Case in Italy

Remember in 2005 when then-President Bush rushed back to Washington to get the Republican-dominated Congress to intervene directly in the Terry Schiavo right-to-die case? Terry Schiavo had been in a persistent vegetative state for 15 years, alive only because she was receiving nutrition through a feeding tube. Her husband and legal guardian--who knew she would never want to live like that--fought Terry's staunchly Catholic family in the court system for years over her right to die in such a circumstance. A Florida state appeals court agreed with Terry's husband and allowed the feeding tube to be removed in spring of 2005.

Out of all legal options, the family went to the top of the political ladder, and got President Bush and his religious-right powerhouse in Congress to counteract that ruling. Congress passed, and Bush signed, emergency legislation, sending the case back to the federal court. But wisely, the federal court did not overrule the previous decision. The feeding tube was not reinserted, and Terry was allowed to die.

The case was a sickening display of not only the breach of the separation of powers as well as the separation of church and state, but also of how quickly and deeply one's personal life can be penetrated by a government. A federal appeals court judge in Atlanta quite eloquently admonished Congress and the White House for acting “in a manner demonstrably at odds with our Founding Fathers’ blueprint for the governance of a free people — our Constitution.”

Fast forward to 2009, and there is an eerily similar kind of family nightmare in Italy. A 37-year old woman, Eluana Englaro, has been in a coma since a car crash in 1992. Her father, who claims that her daughter would not want to live in such a vegetative state, has spent years petitioning the Italian court system to allow her to die. Finally, doctors were allowed to implement a medical protocol for withdrawing Eluana's artificial nutrition--that is, until Prime Minister Silvio Berlusconi, after consulting with the Vatican, issued an emergency decree stating nutrition cannot be withdrawn.

Magnifying the absurdity of the Italian government's and Vatican's interference in the private lives of these citizens is the Prime Minister's justification for his decree: physically at least, Eluana was "in the condition to have babies."

Allow me to elucidate. Irregardless of the comatose woman's inability to consent to anything, the Italian Prime Minister and the Vatican are in effect saying that it would be acceptable for someone to impregnate this woman, have her body incubate a fetus, then deliver it; but to allow her to die a natural and dignified death by withdrawing artificial nutrition would be immoral, despite what Eluana would have wanted.

Cardinal Tarcisio Bertone, who pleaded with Berlusconi to not permit Eluana to die, told him "We have to stop this crime against humanity." (I must say, I find it ludicrous and ironic that the religious institution responsible for the horrific crimes of the medieval Crusades and the systematic enabling of pedophilia in the priesthood has the audacity to say anything about crimes against humanity.)

In these two right-to-die cases, Terry and Eluana were young when they suffered their irreversible brain damage and had not made their wishes explicitly known in writing. But those closest to them and legally responsible for making decisions on their behalf have a better idea than the government or the Church about whether or not they would want to linger for decades in an unconscious state.

Even more fundamentally important than the ethics of proxy medical decision-making is the right to die. I think this right is a corollary of Ayn Rand's concept of the right to life: "There is only one fundamental right (all the others are its consequences or corollaries): a man's right to his own life."

In their quest to take away the right-to-die, the Vatican and America's Religious Right are basically taking away the right to life, claiming your life belongs to God, not to you. This religious view is the reason the Schiavo family fought Terry's right to die; this was the reason they took their case to a President who actively promulgated religious initiatives; and this is what the Italian father is fighting.

Your right to life includes your right to end your life according to your values. If you would not want to be kept alive for decades in a comatose state--and your proxy decision makers know that--then they have the ethical and legal obligation to carry out your wishes. And any governmental or church interference with that right is an immoral and egregious offense to the citizens of a society obligated to uphold their Constitutional rights.

An update: Eluana died Monday Feb. 9 as the Italian legislators debated her case. The Italian government plans to continue to push for an anti-right--to-die law.

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