Assisted suicide: Why the Euthanasia Slope Is Slippery
In a debate about euthanasia, I was once asked, by the husband of a woman who sought assisted suicide unsuccessfully before her painful death, what I would have had the doctors offer her in place of the quietus she sought.
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Last Monday, the New York state legislature passed a bill, now sitting on Gov. Kathy Hochul’s desk, allowing assisted suicide for people facing a diagnosis that gives them six months or less to live.
A few days before the vote, my colleague Katie Engelhart published a report on the expansive laws allowing “medical assistance in dying” in Canada, which were widened in 2021 to allow assisted suicide for people without a terminal illness, detailing how they worked in the specific case of Paula Ritchie, a chronically ill Canadian euthanized at her own request.
Many people who support assisted suicide in terminal cases have qualms about the Canadian system. So it’s worth thinking about what makes a terminal-illness-only approach to euthanasia unstable, and why the logic of what New York is doing points in a Canadian direction even if the journey may not be immediate or direct.
In a debate about euthanasia, I was once asked, by the husband of a woman who sought assisted suicide unsuccessfully before her painful death, what I would have had the doctors offer her in place of the quietus she sought. He implied that doctors always need to offer something: In most situations, that means care and treatment, but at the exceptional point when nothing further can be given, it’s legitimate to expect them to deliver something else.
This is the logic that undergirds laws that offer assisted suicide only to the terminally ill. It assumes that the dying has entered a unique zone where the normal promises of medicine can no longer be kept, a state of exception where it makes sense to license doctors to deliver death as a cure.
The problem is that a situation where the doctor tells you that there’s nothing more to be done for you is not really exceptional at all. Every day, all kinds of people are told that their suffering has no medical solution: people with crippling injuries, people with congenital conditions and people — like Ritchie — with an array of health problems whose aetiology science does not even understand.
All these people, no less than a dying woman with an inoperable tumour, are in a position where official medicine has nothing meaningful to offer them. It’s true that because they are not imminently dying, they may have a greater hope of some eventual breakthrough than a person with a terminal diagnosis. But it’s equally true that because they are not imminently dying, the scope and duration of their suffering are potentially far greater.
So a justification for suicide that emphasises the cry for help that medicine can’t answer, the need for control over the uncontrollable, the desire to cure suffering that doctors can’t relieve, will struggle to maintain terminal illness as a special category. There are just too many people in this exceptional position but with no endpoint to their pain.
I have some personal knowledge here, having lived for years with the chronic form of Lyme disease, a sickness whose existence is a matter of medical controversy, and that has no official cure.
If you haven’t had such a sickness, it’s possible to respond to the argument I’ve just sketched by saying, “Ah, well, at least we shouldn’t allow assisted suicide for conditions that might be psychosomatic or manifestations of mental illness; that’s an easy line to draw.” (Probably some people reading about Ritchie have that reaction.) Inside the world of chronic illness, though, such distinctions fall apart. Even if chronic Lyme disease were psychosomatic (I promise it is not), the person suffering agonising pain for some mysterious mental reason might reasonably feel more trapped than other sufferers, even further into the territory where medicine can’t help.
And then, too, the treatments that did help get me better were, from the point of view of the official consensus, much too untested or weird or risky for a respectable, consensus-driven doctor to safely recommend.
Whereas death is certain, reliable, even — from a certain perspective — safe. And official medicine likes certainty and reliability. The Canadian experience shows this clearly — that if the alternatives for a desperately suffering person are low-probability treatments that take a long time to work, some psychological or spiritual adaptation, or an option that’s guaranteed to deliver what it promises, the guaranteed option will begin to crowd out the more difficult alternatives.
That’s why if you offer that option under supposedly restricted conditions, the restrictions may not hold. Suffering is general and not limited; the dying are not a category unto themselves, and the case for a lethal solution will creep beyond the bounds you set.
In the end, you can have a consensus that suicide is intrinsically wrong, that suffering should be endured to whatever end and that doctors shouldn’t kill you. Or you can have an opening to death that will be narrow only at the start, and in the end, a wide gate through which many, many people will be herded.
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