For opponents of assisted suicide and euthanasia, the central creed of the Hippocratic oath – to “do no harm” – looms large. Because physicians are professionally and morally required to only do good for their patients, the argument goes, assisted suicide is categorically disallowed, as death is the greatest harm of all. There is a problem, however: the Hippocratic Oath never contained this phrase. Instead, it has a curious alternative: “I will keep them from harm and injustice,” or in Greek, “ἐπὶ δηλήσει δὲ καὶ ἀδικίῃ εἴρξειν.”
In all its definitions, the Greek word δηλέομαι means to harm through a destructive act, whether to physically hurt a person, to lay waste to a land, or to break a treaty with another. Beyond mere physical harm, however, the physician also has the potential to bring his patient into a state of injustice. He may publicize his patient’s illnesses, embarrassing them. He may fail to treat an illness adequately, even if he has the competence to do so. He may overestimate his level of skill, and undertake a procedure that is beyond his ken. The doctor, as Hippocrates conceived him, was far more than a healer of trauma or a salver of wounds. While he could heal the body, his greatest duty was as a guardian against injustice, and healing was but a part of this.
This points to a broader conception of what the doctor is, or could be. A rigid conception of “do no harm” ignores that perceptions of harm must shift over time in a patient’s life, for example. The adult in his prime would be seriously harmed by a lethal injection, naturally, but the senior in his twilight years, suffering from debilitating diseases and on death’s door as it stands, would perhaps reap a benefit from such an injection: the many days of pain ahead could be cut short, and the absence of pain would thereby outweigh the few days of living that were left to him. To accept this reasoning not only as rational, but as moral and true, is to also accept that life admits of a broader definition than existence or animation. It is also human flourishing, enjoyment, capacity for action, and when these things are taken away the real motive power of a fully realized human life is snatched away also. Allowing people to take their lives, with the assistance of a doctor, is not a position that is anti-life, but one that is against existence for the sake of existence. The doctor who helps his patients take their lives is not acting against life, but is helping these people live – and die – in the way they find most advantageous.
This is not a new position to take, either. For an ancient perspective, witness Seneca’s letter to a friend:
You may consider that the same thing happens to us: life has carried some men with the greatest rapidity to the harbour, the harbour they were bound to reach even if they tarried on the way, while others it has fretted and harassed. To such a life, as you are aware, one should not always cling. For mere living is not a good, but living well. Accordingly, the wise man will live as long as he ought, not as long as he can. 5. He will mark in what place, with whom, and how he is to conduct his existence, and what he is about to do. He always reflects concerning the quality, and not the quantity, of his life. As soon as there are many events in his life that give him trouble and disturb his peace of mind, he sets himself free. And this privilege is his, not only when the crisis is upon him, but as soon as Fortune seems to be playing him false; then he looks about carefully and sees whether he ought, or ought not, to end his life on that account. He holds that it makes no difference to him whether his taking-off be natural or self-inflicted, whether it comes later or earlier. He does not regard it with fear, as if it were a great loss; for no man can lose very much when but a driblet remains. It is not a question of dying earlier or later, but of dying well or ill. And dying well means escape from the danger of living ill.
While some may find the comparison distasteful, this is the sort of mindset most pet owners take when preparing to euthanize the family dog. Fido has lived a good life, loved by his family, played with, adored, yelled at a few times but not excessively, but alas – a cancerous tumor has erupted on Fido’s right lung. Expensive and invasive surgery could give him another month, perhaps, but it would be a month of unremitting agony followed by a painful death. Why put a beloved creature through such needless agony, when a short and painless procedure can end it all immediately?
Many people have a disconnect between their lucid response to the pain of a family pet and their unhinged response to the pain of a human loved one. I would contend that this tension, while often cloaked in an appeal to rational arguments or religious tenets, is largely based on instinctual emotional distaste for death, and the fear of the unknown that it represents. That is not to say that there aren’t clear reasons to oppose it, but that empirically and rationally, there are stronger reasons in favor of it. I’ll go through some of the common arguments below:
- Assisted suicide will destroy the trust patients have in their doctors. The physician Leon Kass wrote in the 1990s, “the patient’s trust in the doctors’s wholehearted devotion to the patient’s best interests will be hard to sustain once doctors are licensed to kill.” Fellow physician Mark Hall countered in the 2000s “Our study shows that only about 20% of people believe they would trust their physician less if euthanasia were legalized… The empirical support is weak for those who confidently assert that legalizing physician-assisted death would undermine trust in physicians for most people in the United States.”
- Allowing doctors to legally kill their patients will provide a perverse incentive for insurance companies to encourage these practices. Like the other arguments, there is conflict on this point: one fact sheet states “It is well documented that the legal option to choose aid-in-dying is not related to finances. End of life choices are relevant only AFTER all curative or other treatments have been tried.”
- Related to this, legalizing assisted and voluntary suicide will inevitably lead to involuntary suicide. According to the head of the Euthanasia and Guidance Organization, “In the Netherlands we have a living laboratory in which the euthanasia experiment in being conducted, and it is claimed that active non-voluntary and involuntary euthanasia are openly practiced there, exactly as predicted by the slippery slope argument. But the claim of the open and common practice of involuntary euthanasia has been often repeated but has never been substantiated, and indeed has been repeatedly challenged.”
Quote sources: http://euthanasia.procon.org
Beyond the empirical evidence that assisted suicide is not the bugbear it is purported to be, there is also the moral argument in its favor: the human being, by virtue of having a ruling reason, is entitled to dispose of himself in the same way he disposes of his property or his time. While there are clear and logical restrictions that must be placed on this freedom, such as against harming others, or harming oneself in a state of mental unbalance or insanity, this is certainly not the case for most assisted suicides. People at the end of their lives are not mentally unbalanced when they want to end their miserable time on earth, but acting completely rationally.
In full disclosure, I went through several drafts of this post attempting to justify my instinctual reaction against the very idea of suicide, before I realized I could not do so on rational and consistent grounds. It would be in tension with my other beliefs, in personal liberty and freedom of choice, and also – don’t tell anyone – my belief in the ultimate dignity of the human being, in life and in death. Assisted suicide is an intellectual and moral no brainer.