Roger M. Kligler, a 64-year-old Falmouth resident with metastatic prostate cancer, filed a lawsuit this week arguing for his right to obtain a lethal dose of medication from a physician to end his life on his own terms and to avoid unnecessary suffering. This calls into question Kligler’s legal and ethical claims to such a decision.
We must assess whether an individual’s right to die is protected by the Constitution. In the landmark 1997 Supreme Court case of Washington v. Glucksberg, Warren Glucksberg and physicians argued that assisted suicide and the right to die is protected by the due process clause of the Fourteenth Amendment. Although the district and circuit courts upheld this opinion, the Supreme Court disagreed. In his decision, Chief Justice William Rehnquist ultimately concluded that the matter is at odds with the history and tradition of the American nation, that the “right” to die necessitates a right to assistance in doing so, and that there is legitimate governmental interest in the preservation of the life of individuals.
According to this ruling, Kligler does not have a legal claim to deciding his own death. There are several problems with this. First, cases like these expose the weakness of traditionalist interpretations of the Constitution. That validating a claim to physician-assisted suicide would “reverse centuries of legal doctrine and practice,” as Rehnquist wrote, is a paltry excuse for dismissal and in fact establishes a dangerous precedent of legal orthodoxy. For matters such as these, we must adopt a “living” interpretation of the Constitution, one that appropriately acknowledges changing temporal and contextual attitudes (we think differently about social issues now than we did in the early 20th century). The argument for state interest in the preservation also falls flat because it subordinates “medical and personal needs” for strictly “medical needs.” This logical framework advocates for the prolongation of unwanted suffering. Rehnquist’s claim about a tacit secondary right to assistance in death may be valid, but does not bear importance because procedures are performed by willing physicians complicit with the desires of the patient. As with most Supreme Court rulings, what we see here is the imposition of the personal morality of the justices.
The Enlightenment philosophy of John Stuart Mill is frequently invoked in matters of bioethics and medical law for purposes of justifying patient autonomy. Mill’s declaration that “over his body every individual is sovereign,” seems reasonable enough; that an individual should decide what he wants done to his body seems self-evident. I think it applies well to cases of physician suicide and validates (at the very least) Kligler’s ethical claim to his decision to die. A retired physician, Kligler has the mental capacity to make a reasonable and informed decision about his own body that trumps any state interest in preservation of life.
The precedent for removing treatment or not even starting treatment in the case of terminal illness is well established; such practice is legally permissible and ethically justifiable. Yet, all methods of willing euthanasia fall within the scope of murder and are considered by some to be ethically reprehensible. To me this represents a logical inconsistency insofar as there appears to be a morally irrelevant distinction between removing means to life and deciding to end one’s life by active means. It is this same ethical framework that forces me to struggle with the permissibility of requesting direct lethal injection (significantly distinct from prescribed lethal medication) in cases of competent terminally ill individuals. Autonomy and self-determination must be honored, but I’m not quite sure what the limits ought to be.
A legitimate counter-argument is that physician-assisted suicide is a slippery slope that will implicate the elderly, the impoverished, and other underrepresented minority groups. Moreover, statistics show that most people who seek out physician-assisted suicide are plagued with mental illness, usually depression. However, it seems that stringent background assessments of patients suspected to be mentally ill or members of a “targeted” group will correct for this possible danger.
Ultimately, the popular conception of the purpose of medicine, “saving lives,” is a reductionist take on the enterprise. If this were the case, medicine is always doomed to fail. Instead, the goal of medicine is to treat illnesses that have the possibility of improvement and to alleviate suffering. Physician-assisted suicide and its correlates fall under the umbrella of the latter category.
Featured Image by Kelsey McGee / Heights Editor