Abigail Hall Blanco, a research fellow at the Independent Institute, recently wrote a piece entitled “Assisted suicide is a personal choice” in which she defends the position that assisted suicide should be legal in a free society.
Before discussing this piece, it is important to clarify what Blanco probably means when she asserts that assisted suicide is a “personal choice.” After all, the statement may seem like a triviality: all humans are persons, and therefore all human choices are personal choices.
I suspect that what Blanco means to say is that assisted suicide should be legal because it is a free choice that only affects the person making it. In that sense, the subject and object of the choice are both the same person: The choice begins with the person and the effect ends in the same person.
Having made that clarification, let’s examine the three arguments Blanco makes to support her position. These arguments are counterpoints to claims allegedly made by opponents of assisted suicide.
First, she argues correctly against a claim that suicide is irrational:
Suicide is a choice like any other. If a person believes that the costs of living outweigh the benefits, then choosing death is perfectly rational.
Second, Blanco opposes the slippery slope argument and states that in places where assisted suicide is legal, there is no empirical evidence that the practice has reached “epidemic” proportions. Furthermore, she argues that assisted suicide and euthanasia are distinct, and that legalizing one does not entail encouraging the other.
Third, she argues that safeguards are in place to prevent “abuses of the law.” For example, in most places, assisted suicide is available only to the terminally ill, and only to patients who have undergone psychological evaluation.
Blanco then concludes:
The idea of assisted suicide makes many of us uncomfortable. However, living in a free society means we must respect other people’s choices. Part of living is dying. People should be free to choose.
I think that Blanco is mistaken. Legalizing assisted suicide does not bring us closer to living in a free society.
Before I counter her conclusion, however, I would like to point out that none of Blanco’s arguments actually support her final claim, even if those arguments are to be accepted at face value.
For example, whether assisted suicide is rational or not has no bearing on whether it is a personal choice that should be legalized. Many irrational choices are both personal and perfectly legal. If I choose to “knock on wood” to avoid tempting fate, that irrational choice starts and ends with me entirely. As far as I know, no one is arguing that knocking on wood should be made illegal.
Furthermore, whether the legalization of assisted suicide will increase the number of people seeking it or not also has no bearing on whether it is a personal choice that should be legalized. If assisted suicide is an acceptable personal choice for one person, there is no compelling reason to conclude that the number of eligible people seeking it should be small.¹
The same goes for Blanco’s point regarding safeguards in place to control the practice of assisted suicide. The existence of those safeguards has no bearing on whether assisted suicide should be legalized. In fact, as she points out parenthetically herself, “…we may argue that any adult should be allowed to end his or her life.”² Indeed, once assisted suicide is deemed acceptable, there is no reason that it shouldn’t be made available on demand to anyone.
Of course, Blanco may have done a poor job at building her case using straw man arguments, but she may still be correct in her conclusion. Should assisted suicide be legal in a free society?
I differ with Blanco on that position because Blanco overlooks the mechanism by which the legalization of assisted suicide takes place.
Assisted suicide is legalized as a medical practice in a context where medical care is regulated by the State. By virtue of this regulation, medical practices are permitted if and only if they intend to bring about a “good.” That means that the legalization of assisted suicide implies that it is an objectively good practice, even if the specific language of the legislation emphasizes the subjectivity of the decision.
In other words, the fact that a licensed medical doctor is required to carry out assisted suicide sanctions the virtue of the choice, since the State ostensibly licenses doctors to help patients and not to harm them. The net effect is that assisted suicide is not simply a personal choice that begins and end with the person using a doctor as a mere instrument for the action. Assisted suicide affects the entire medical profession, including those physicians who personally oppose it.
An indication of that effect is seen in many jurisdiction where assisted suicide has been legalized: rights of conscientious objection of physicians and hospitals are being challenged. In Canada, for example, demands are being placed on hospitals and physicians to enable patients who seek assisted suicide to obtain it, even if the providers find the practice morally objectionable. In Belgium, hospitals and nursing homes have been fined for refusing to carry out euthanasia.
Note, also, that the procedure by which a doctor assists the suicide of a patient is entirely extraneous to the art or science of medicine. Clearly, no expertise is needed to provide someone with an overdose of barbiturates. There are ways, therefore, by which societies could assist the suicide of patients without involving the mediation of a licensed professional. For example, a state could provide patients access to an automatic dispenser of barbiturates and with specific instructions on how to use the “remedy.” This underscores that the engagement of the physician in assisted suicide is primarily a legal, not medical role.
Of course, in a truly free society there would be no licensing of physicians by the State. And in such a society, the assisted suicide of a patient by an unlicensed doctor could not masquerade for anything other than what it really is: the direct or indirect consensual homicide of one person by another.
Footnotes:
1. I think Blanco is mistaken on the empirical evidence regarding the slippery slope. First of all, there are no mechanisms to accurately check the statistics since death certificates must state the terminal illness as the cause of death and may not in any way provide any indication that suicide or assisted suicide has taken plane. Secondly, there is also evidence that unassisted suicides have increased in the aftermath of assisted suicide legalization).
2. Blanco ignores the evidence from Belgium and the Netherlands where the so-called safeguards have greatly eroded over time.
[callout]This post is part of a series of articles on physician-assisted suicide.[/callout]
Is your argument against legalization based on the conclusion that assisted suicide requires and unwilling doctor to provide the service? Can that problem be solved by recognizing the physician’s right to choose his patients and his or her practice?
In the post, my argument is that once physician-assisted suicide is legalized, it becomes inevitably viewed as a “good.” It’s only a matter of time before physicians and hospitals who object are either required to refer patients (against conscience) or penalized. Such penalties have already been levied in Belgium and similar threat have occurred in Canada.