(Kayleigh Wright wrote this article as Staff Editor of the Kentucky Law Journal. It was first published in the Kentucky Law Journal and is used here with permission. Currently Kayleigh is a marketing manager with LeaderOne Financial. Editor’s note: physician aid in dying or medical aid in dying are the more commonly used terms for “physician-assisted suicide” used in this article.)
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As a society, we deem healthcare decisions as some of the most private and personal information one has. We accept that it is up to the discretion of the individual and their acting physician to create a medical plan best suited for their needs. It’s easy to support these decisions knowing that the individual is doing what is best for them in light of informed medical advice, but once this private decision results in the phrase “physician-assisted suicide”, heads start to turn. Why is that? Each process essentially involves the private decision of making a medical treatment plan with your doctor. It is society’s perception of suicide, paired with the logical longstanding belief that your doctors are here to save your life, not take it away, that closes the door on the conversation. There is no fundamental right to Physician-Assisted Suicide (PAS), but when applied to certain situations, doesn’t this interfere with one’s right to die with dignity, or the right to choose to refuse certain medical treatments? Justice Ginsberg thought so.
In Washington v. Gluksberg, a United States Supreme Court decision held that a state ban on PAS was not a violation of one’s liberty interest under the Due Process Clause of the 14th Amendment. Glucksberg identified four state interests, with the preservation of human life at the top of the list. Seven years prior to this decision, Cruzan v. Missouri Health Department held that a person of sound mind has a constitutionally protected liberty interest in refusing medical treatment. Justice Ginsburg in Gluksberg points out the conflicting law in these cases and notes how Gluksberg might be applied differently in another context.
The right a person has to freely exercise their privacy rights through personal decision-making is one they have in the family, sexual activity, and reproductive choices, including the right to procreate, using contraceptives, and abortion. It is also one a terminally ill patient should have with regard to medically ending their own life. Privacy is a right each person should have when it comes to making important decisions concerning their life. These important decisions people make have been protected by the Supreme Court as fundamental rights. Cruzan protected one of these fundamental rights, allowing a person the privacy decision to choose to end their life support. Here, the Supreme Court said this choice to die is a fundamental right. The question then lies, what is fundamentally the difference between a doctor pulling a plug on a machine that provides lifesaving nutrients to a person that could potentially stay “alive” on it for years, and a doctor prescribing pills to a person with mere days or months to live to end their unnecessary suffering. Both are affirmative acts by physicians with the intent to end their life, but only one is a fundamental right.
Terminally ill patients are given an expected life span of 24 months or less. They often suffer severe pain at the end of their time and are hospitalized, painfully awaiting their fate. There is a clear distinction in allowing PAS regarding terminally ill patients, who have days, weeks, or at most, months to live, and non-terminally ill patients who might have many years ahead of them. The state’s interest in preserving human life is not as compelling as Gluksberg claims because there is no ability to preserve a terminally ill patient. Supporters of PAS view this as the doctors killing the pain, not the patient.
Hospice is a type of palliative care for people during their final moments. It is intended to provide patients comfort through what can be a physically, or even mentally painful process. Hospice is for people who are terminally ill, or who have decided to exercise their right to refuse medical treatment, and it is clear they will not survive their illness. Hospice prepares you for your final moments, but often the treatments given are not enough to end the pain and suffering felt. In this case, the state’s interest in preserving life, a life that’s inevitably ending within the coming days, is outweighed by the personal interest of PAS. If terminally ill patients have the right to deny life-sustaining treatment, then they should also be afforded the right to choose PAS to obtain a more humane and compassionate death.
The right to terminate your life is albeit the right to choose your destiny. It is a right every individual should have. The government’s interest in the preservation of human life isn’t as strong when that life is terminally ill. I believe it is the title that is hindering implementation and support of PAS in society. There is such a negative connotation around the word “suicide,” and the thought of a doctor aiding one is unable for many to comprehend. Slowly, as society becomes more inclusive it will grow to support PAS, but this will take time, and possibly rebranding, to develop.
Final Exit Network (FEN) is a network of dedicated professionals and caring, trained volunteers who support mentally competent adults as they navigate their end-of-life journey. Established in 2004, FEN seeks to educate qualified individuals in practical, peaceful ways to end their lives, offer a compassionate bedside presence and defend a person’s right to choose. For more information, go to www.finalexitnetwork.org.
Payments and donations are tax deductible to the full extent allowed by law. Final Exit Network is a 501(c)3 nonprofit organization.
Rebranding is certainly the solution. As Faye Girsh has reminded me several times, over the years, going back to the ’90s, several attempts have been made and failed. I led such an attempt with an international working group growing out of the WFRTDS’s 2014 meeting in Chicago. It struggled and came up with “death with dignity.” A minority came up with a new word, “dignicide.” The task’s force’s report was given at the WFRTDS’s 2016 Amsterdam meeting. No success. No interest in dignicide. The effort has died. Yet, with strong leadership, dignicide had a life for a while, in North Carolina. It died there, too, because leadership was lacking elsewhere. Bottom line, nothing will work unless the leadership of the national right-to-die movement strongly supports the rebranding. For a copy of the task force’s report write me at VermilionSim@gmail.com.
Note the irony: Death under all the MAiD laws is declared not suicide, and aiding the MAiD death pursuant to the laws is not assisted suicide. But no name is given. If the law declares it is not suicide, what is it? The vacuum is there. Let’s fill it.
Bill Simmons
I don’t know what the terminology should be. I do think that there has to be a review process to prevent people from electing to die because they have depression or other mental illnesses. If you meet the standard hospice six month certification it should be a choice. BUT, how can a person with dementia decide? They are not able to do it beforehand, they must make this decision with full cognition. Who makes the decision to initiate comfort care in the hospital? I wish people would stop saying “pull the plug” It is crude and inaccurate. BTW I am currently a hospice chaplain, previously I have served as a hospital chaplain in a large trauma center and have attended many deaths.
A person should be able to register their wish in advance and appoint a State or individual with Power of Authority to act as specified by an individual to have death carried out. A dementia or coma patient should be able to be terminated if written or video demonstration of the persons wish is defined. A Justice of the Peace should be capable of authorizing death in completing an individuals expressed wish.
Final Exit Network and The Good Death Society Blog have long opposed the use of the word “suicide” to describe the rational, well-considered choice of a person to end life on their own terms when facing intolerable suffering.
See these blog posts:
• Medical Aid In Dying Is Still Called “Assisted Suicide”; An Anthropologist Explains The Problem With That – The Good Death Society Blog
• Words Matter – The Good Death Society Blog
• Is the Word “Suicide” Appropriate in the End-of-Life Context? – The Good Death Society Blog
• Is there a better word than suicide? – The Good Death Society Blog
With all due respect to Kayleigh Wright and Bill Simmons, most of us around our country who are directly involved in advocating for and implementing “medical aid in dying” feel strongly that we have coalesced around that terminology. That is what is defined as the specific medical practice authorized in many of our current laws and in most proposed laws being considered around the country. We are even making progress in getting media outlets to utilize that terminology. PAS is language that our loyal opposition uses to disparage our efforts because suicide is such an emotionally and negatively charged term in our society. I appreciate Gary’s further clarification and links in his good comment. And finally, language always matters, but I would submit that the further expansion of medical aid in dying is not about “rebranding” as much as it is about mobilizing the political will to enact a law that by all accounts is supported by a strong majority of those asked the question.
Public opinion polls show that seven out of ten Americans support medical aid in dying. If the will of the people prevails, more laws should pass.