Should euthanasia or physician-assisted suicide be legal?
The PRO and CON statements below give a five-minute introduction to the debate over euthanasia and physician-assisted suicide. (Read more information about our one star to five star Theoretical Expertise Rankings.)
PRO: "The right of a competent, terminally ill person to avoid excruciating pain and embrace a timely and dignified death bears the sanction of history and is implicit in the concept of ordered liberty. The exercise of this right is as central to personal autonomy and bodily integrity as rights safeguarded by this Court's decisions relating to marriage, family relationships, procreation, contraception, child rearing and the refusal or termination of life-saving medical treatment. In particular, this Court's recent decisions concerning the right to refuse medical treatment and the right to abortion instruct that a mentally competent, terminally ill person has a protected liberty interest in choosing to end intolerable suffering by bringing about his or her own death.
A state's categorical ban on physician assistance to suicide -- as applied to competent, terminally ill patients who wish to avoid unendurable pain and hasten inevitable death -- substantially interferes with this protected liberty interest and cannot be sustained."
CON: "The history of the law's treatment of assisted suicide in this country has been and continues to be one of the rejection of nearly all efforts to permit it. That being the case, our decisions lead us to conclude that the asserted 'right' to assistance in committing suicide is not a fundamental liberty interest protected by the Due Process Clause."
PRO: "At the Hemlock Society we get calls daily from desperate people who are looking for someone like Jack Kevorkian to end their lives which have lost all quality... Americans should enjoy a right guaranteed in the European Declaration of Human Rights -- the right not to be forced to suffer. It should be considered as much of a crime to make someone live who with justification does not wish to continue as it is to take life without consent."
-- Faye Girsh, EdD
Senior Adviser, Final Exit Network,
"How Shall We Die," Free Inquiry
CON: "Activists often claim that laws against euthanasia and assisted suicide are government mandated suffering. But this claim would be similar to saying that laws against selling contaminated food are government mandated starvation.
Laws against euthanasia and assisted suicide are in place to prevent abuse and to protect people from unscrupulous doctors and others. They are not, and never have been, intended to make anyone suffer."
-- Rita Marker, JD
Executive Director Kathi Hamlon
International Task Force on Euthanasia and Assisted Suicide
"Euthanasia and Assisted Suicide: Frequently Asked Questions," www.internationaltaskforce.org
PRO: "Especially with regard to taking life, slippery slope arguments have long been a feature of the ethical landscape, used to question the moral permissibility of all kinds of acts... The situation is not unlike that of a doomsday cult that predicts time and again the end of the world, only for followers to discover the next day that things are pretty much as they were...
We need the evidence that shows that horrible slope consequences are likely to occur. The mere possibility that such consequences might occur, as noted earlier, does not constitute such evidence."
-- R.G. Frey, DPhil
Professor of Philosophy, Bowling Green State University
"The Fear of a Slippery Slope," Euthanasia and Physician-Assisted Suicide: For and Against
CON: "In a society as obsessed with the costs of health care and the principle of utility, the dangers of the slippery slope... are far from fantasy...
Assisted suicide is a half-way house, a stop on the way to other forms of direct euthanasia, for example, for incompetent patients by advance directive or suicide in the elderly. So, too, is voluntary euthanasia a half-way house to involuntary and nonvoluntary euthanasia. If terminating life is a benefit, the reasoning goes, why should euthanasia be limited only to those who can give consent? Why need we ask for consent?"
-- Edmund D. Pelligrino, MD
Professor Emeritus of Medicine and Medical Ethics, Georgetown University
"The False Promise of Beneficent Killing," Regulating How We Die: The Ethical, Medical, and Legal Issues Surrounding Physician-Assisted Suicide
PRO: "Over time the Hippocratic Oath has been modified on a number of occasions as some of its tenets became less and less acceptable. References to women not studying medicine and doctors not breaking the skin have been deleted. The much-quoted reference to 'do no harm' is also in need of explanation. Does not doing harm mean that we should prolong a life that the patient sees as a painful burden? Surely, the 'harm' in this instance is done when we prolong the life, and 'doing no harm' means that we should help the patient die. Killing the patient--technically, yes. Is it a good thing--sometimes, yes. Is it consistent with good medical end-of-life care: absolutely yes."
-- Philip Nitschke, MD
Director and Founder, Exit International
"Euthanasia Sets Sail," National Review Online
June 5, 2001
CON: "The prohibition against killing patients... stands as the first promise of self-restraint sworn to in the Hippocratic Oath, as medicine's primary taboo: 'I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect'... In forswearing the giving of poison when asked for it, the Hippocratic physician rejects the view that the patient's choice for death can make killing him right. For the physician, at least, human life in living bodies commands respect and reverence--by its very nature. As its respectability does not depend upon human agreement or patient consent, revocation of one's consent to live does not deprive one's living body of respectability. The deepest ethical principle restraining the physician's power is not the autonomy or freedom of the patient; neither is it his own compassion or good intention. Rather, it is the dignity and mysterious power of human life itself, and therefore, also what the Oath calls the purity and holiness of life and art to which he has sworn devotion."
-- Leon Kass, MD, PhD
Addie Clark Harding Professor, Committee on Social Thought and the College, University of Chicago
"Neither for Love nor Money," Public Interest
PRO: "We'll all die. But in an age of increased longevity and medical advances, death can be suspended, sometimes indefinitely, and no longer slips in according to its own immutable timetable.
So, for both patients and their loved ones, real decisions are demanded: When do we stop doing all that we can do? When do we withhold which therapies and allow nature to take its course? When are we, through our own indecision and fears of mortality, allowing wondrous medical methods to perversely prolong the dying rather than the living?
These intensely personal and socially expensive decisions should not be left to governments, judges or legislators better attuned to highway funding."
CON: "Cases like Schiavo's touch on basic constitutional rights, such as the right to live and the right to due process, and consequently there could very well be a legitimate role for the federal government to play. There's a precedent--as a result of the highly publicized deaths of infants with disabilities in the 1980s, the federal government enacted 'Baby Doe Legislation,' which would withhold federal funds from hospitals that withhold lifesaving treatment from newborns based on the expectation of disability. The medical community has to have restrictions on what it may do to people with disabilities - we've already seen what some members of that community are willing to do when no restrictions are in place."
-- Stephen Drake. MS
Research Analyst, Not Dead Yet
"End of Life Planning: Q & A with Disabilities Advocate," Reno Gazette-Journal
Nov. 22, 2003
PRO: "Assisting death in no way precludes giving the best palliative care possible but rather integrates compassionate care and respect for the patient's autonomy and ultimately makes death with dignity a real option...
The evidence for the emotional impact of assisted dying on physicians shows that euthanasia and assisted suicide are a far cry from being 'easier options for the caregiver' than palliative care, as some critics of Dutch practice have suggested. We wish to take a strong stand against the separation and opposition between euthanasia and assisted suicide, on the one hand, and palliative care, on the other, that such critics have implied. There is no 'either-or' with respect to these options. Every appropriate palliative option available must be discussed with the patient and, if reasonable, tried before a request for assisted death can be accepted...
Opposing euthanasia to palliative care... neither reflects the Dutch reality that palliative medicine is incorporated within end-of-life care nor the place of the option of assisted death at the request of a patient within the overall spectrum of end-of-life care."
-- Gerrit Kimsma, MD, MPh
Associate Professor in Medical Philosophy Evert van Leeuwen, PhD
Professor in Philosophy and Medical Ethics
Center for Ethics and Philosophy at Free University in Amsterdam (Amsterdam, Netherlands)
"Assisted Death in the Netherlands: Physician at the Bedside When Help Is Requested"
Physician-Assisted Dying: The Case for Palliative Care & Patient Choice
CON: "Studies show that hospice-style palliative care 'is virtually unknown in the Netherlands [where euthanasia is legal].' There are very few hospice facilities, very little in the way of organized hospice activity, and few specialists in palliative care, although some efforts are now under way to try and jump-start the hospice movement in that country...
The widespread availability of euthanasia in the Netherlands may be another reason for the stunted growth of the Dutch hospice movement. As one Dutch doctor is reported to have said, 'Why should I worry about palliation when I have euthanasia?'"
-- Wesley J. Smith, JD Senior Fellow in Human Rights and Bioethics, Discovery Institute
PRO: "Even though the various elements that make up the American healthcare system are becoming more circumspect in ensuring that money is not wasted, the cap that marks a zero-sum healthcare system is largely absent in the United States... Considering the way we finance healthcare in the United States, it would be hard to make a case that there is a financial imperative compelling us to adopt physician-assisted suicide in an effort to save money so that others could benefit..."
-- Merrill Matthews, Jr., PhD
Director, Council for Affordable Health Insurance
"Would Physician-Assisted Suicide Save the Healthcare System Money?," Physician Assisted Suicide: Expanding the Debate
CON: "Savings to governments could become a consideration. Drugs for assisted suicide cost about $35 to $45, making them far less expensive than providing medical care. This could fill the void from cutbacks for treatment and care with the 'treatment' of death."
PRO: "One concern has been that disadvantaged populations would be disproportionately represented among patients who chose assisted suicide. Experience in Oregon suggests this has not been the case. In the United States, socially disadvantaged groups have variably included ethnic minorities, the poor, women, and the elderly. Compared with all Oregon residents who died between January 1998 and December 2002, those who died by physician-assisted suicide were more likely to be college graduates, more likely to be Asian, somewhat younger, more likely to be divorced, and more likely to have cancer or amytrophic lateral sclerosis... Moreover, although 2.6 percent of Oregonians are African American, no African American patients have chosen assisted suicide."
-- Linda Ganzini, MD, MPH
Professor of Psychiatry and Medicine Senior Scholar, Center for Ethics in Health Care at Oregon Health & Science University
"The Oregon Experience," Physician-Assisted Dying: The Case for Palliative Care and Patient Choice
CON: "It must be recognized that assisted suicide and euthanasia will be practiced through the prism of social inequality and prejudice that characterizes the delivery of services in all segments of society, including health care. Those who will be most vulnerable to abuse, error, or indifference are the poor, minorities, and those who are least educated and least empowered. This risk does not reflect a judgment that physicians are more prejudiced or influenced by race and class than the rest of society - only that they are not exempt from the prejudices manifest in other areas of our collective life.
While our society aspires to eradicate discrimination and the most punishing effects of poverty in employment practices, housing, education, and law enforcement, we consistently fall short of our goals. The costs of this failure with assisted suicide and euthanasia would be extreme. Nor is there any reason to believe that the practices, whatever safeguards are erected, will be unaffected by the broader social and medical context in which they will be operating. This assumption is naive and unsupportable."
PRO: "Guided by our belief as Unitarian Universalists that human life has inherent dignity, which may be compromised when life is extended beyond the will or ability of a person to sustain that dignity; and believing that it is every person's inviolable right to determine in advance the course of action to be taken in the event that there is no reasonable expectation of recovery from extreme physical or mental disability...
BE IT FURTHER RESOLVED: That Unitarian Universalists advocate the right to self-determination in dying, and the release from civil or criminal penalties of those who, under proper safeguards, act to honor the right of terminally ill patients to select the time of their own deaths; and...
BE IT FINALLY RESOLVED: That Unitarian Universalists, acting through their congregations, memorial societies, and appropriate organizations, inform and petition legislators to support legislation that will create legal protection for the right to die with dignity, in accordance with one's own choice.
CON: "As Catholic leaders and moral teachers, we believe that life is the most basic gift of a loving God- a gift over which we have stewardship but not absolute dominion. Our tradition, declaring a moral obligation to care for our own life and health and to seek such care from others, recognizes that we are not morally obligated to use all available medical procedures in every set of circumstances. But that tradition clearly and strongly affirms that as a responsible steward of life one must never directly intend to cause one's own death, or the death of an innocent victim, by action or omission...
We call on Catholics, and on all persons of good will, to reject proposals to legalize euthanasia."
PRO: "Living wills can be used to refuse extraordinary, life-prolonging care and are effective in providing clear and convincing evidence that may be necessary under state statutes to refuse care after one becomes terminally ill.
A recent Pennsylvania case shows the power a living will can have. In that case, a Bucks County man was not given a feeding tube, even though his wife requested he receive one, because his living will, executed seven years prior, clearly stated that he did 'not want tube feeding or any other artificial invasive form of nutrition'...
A living will provides clear and convincing evidence of one's wishes regarding end-of-life care."
-- Joseph Pozzuolo, JD
Professor, Neuman College Lisa Lassoff, JD
Associate, Reed Smith Jamie Valentine, JD
Associate, Pozzuolo & Perkiss
"Why Living Wills/Advance Directives Are an Essential Part of Estate Planning," Journal of Financial Service Professionals
CON: "Not only are we awash in evidence that the prerequisites for a successful living wills policy are unachievable, but there is direct evidence that living wills regularly fail to have their intended effect...
When we reviewed the five conditions for a successful program of living wills, we encountered evidence that not one condition has been achieved or, we think, can be. First, despite the millions of dollars lavished on propaganda, most people do not have living wills... Second, people who sign living wills have generally not thought through its instructions in a way we should want for life-and-death decisions... Third, drafters of living wills have failed to offer people the means to articulate their preferences accurately... Fourth, living wills too often do not reach the people actually making decisions for incompetent patients... Fifth, living wills seem not to increase the accuracy with which surrogates identify patients' preferences."
-- Angela Fagerlin, PhD
Core Faculty Member, Robert Wood Johnson Clinical Scholar Program, University of Michigan Medical School Carl E. Schneider, JD
Chauncey Stillman Professor for Ethics, Morality, and the Practice of Law, University of Michigan Law School
"Enough: The Failure of the Living Will," Hastings Center Report