The principle that human life is inviolable has been the keystone of medical ethics since Hippocrates, but it suffered setbacks in Anglo-American jurisprudence during the twentieth century. A range of movements for the right to kill oneself or other human beings—such as eugenics, abortion rights, and assisted suicide—undermined the inviolability principle.
Yet the principle is making a comeback. This is due in part to scholars who are rehabilitating it and defending it from attacks. But perhaps this is also due to the principle’s widespread intuitive appeal. To most people, it just makes sense that we should not kill ourselves and each other.
That intuition’s strength might also explain why advocates for the right to kill nearly always use euphemisms. If we all know or sense that an intentional act of killing is intrinsically evil, then these advocates can only persuade others by calling killing something else.
Indeed, in this respect, the assisted-suicide movement imitates tactics (and some strategies) of the eugenics movement of the Progressive era.
G. K. Chesterton once remarked, “Most Eugenists are Euphemists.” To eugenics advocates during the Progressive era, terms such as “social hygiene” and “non-punitive death” came off the tongue more easily than terms such as forced, surgical removal of the sexual organs and killing. Their obfuscations succeeded in part. Several states enacted laws authorizing sterilization of those deemed unworthy or unfit.
In his 1922 book Eugenical Sterilization in the United States, Harry Hamilton Laughlin gave an insider’s account of the fight for those programs. Laughlin held the offices of Eugenics Associate of the Psychopathic Laboratory of the Municipal Court of Chicago and Eugenics Director of the Carnegie Institute.
Laughlin intended his book to be both a history and a practical guide for lawmakers who would enact eugenics laws, judges who would uphold them, administrators who would implement them, and “individual citizens who, in the exercise of their civic rights and duties, [would] desire to take the initiative in reporting for official determination and action, specific cases of obvious family degeneracy.”
Laughlin used dual terminology, so his book is revealing. Where he was trying to describe something, he would use accurate terms. Where he was crafting arguments for persuading the public, he used the euphemisms then in circulation. Sterilization statutes were justified on the basis of “eugenical betterment” and “therapeutic value to the patient.” Culling the human race of undesirable families became “social hygiene.”
Laughlin referred to involuntary euthanasia as “non-punitive death.” Though he was not opposed to the practice in principle, he did not favor it as a first resort. He thought that “enlightened” states should prefer other “means of controlling the racial quality of future generations,” such as “regulation” of “birth-control, abortion, and infanticide.”
One of Laughlin’s motives for dissembling was his desire to circumvent the rule of law. He noted that criminals must be afforded due process before they can be punished. By contrast, “non-punitive types of taking away personal liberty in the interests of the public welfare” can be delegated to administrators and bureaucrats, who are given discretion to identify those who are “socially inadequate” and “degenerates.” Such measures, he insisted, “have no element of punishment in them.”
Laughlin was honest about his goal. In a representative passage he wrote, “Idiots, imbeciles, and degenerate criminals are prolific, and their defects are transmissible. Each person is a unit of the nation, and the nation is strong and pure and sane, or weak and corrupt and insane, in the proportion that the mentally and physically healthy exceed the diseased.” The task was to make the nation strong.
Laughlin and other eugenicists were so successful that they persuaded the most powerful American institutions not only to ratify but also to embrace their project. In 1927, the Supreme Court affirmed the forced sterilization of a young woman named Carrie Buck. Buck had been declared a mental defective and a potential menace under Virginia law. With only one dissent, the Court upheld that law.
Writing for the Court, Justice Oliver Wendell Holmes, Jr., wrote,
We have seen more than once that the public welfare may call upon the best citizens for their lives. It would be strange if it could not call upon those who already sap the strength of the State for these lesser sacrifices, often not felt to be such by those concerned, in order to prevent our being swamped with incompetence.
As for Buck, whose mother had also been declared feeble-minded and who had given birth to a child, Holmes concluded, “Three generations of imbeciles are enough.”
The stated goals of contemporary death rights advocates differ from those of Laughlin and Holmes. Today, the argument for rights to kill is grounded in personal autonomy, except when it is grounded in the often-contradictory goal of alleviating suffering. Nevertheless, the death rights movement still employs obfuscation. And this willingness to mislead, combined with the movement’s confusion about its ends and limiting principles, ought to be enough to make anyone wary of its project.
I recently received a letter from a lawyer at Compassion in Choices (formerly the Hemlock Society), an organization that has long advocated legalized assisted suicide. The lawyer had come across a law review article that I wrote about the distinction in private law between volitional and non-volitional suicides. She wrote to reprove me for the terms I had used in the article.
Ms. Ducker “invite[s me] to consider using the terminology ‘aid in dying’ to refer to the practice of a physician” who supplies drugs to a patient so that the patient can use the drugs to kill himself or herself. She continues, “It is increasingly recognized that referring to this practice as ‘physician-assisted suicide’ or ‘assisted suicide’ is inaccurate and misleading.”
“Assisting suicide remains a crime,” Ducker notes. She then scolds:
[T]he term ‘assisted suicide’ . . . is recognized as inaccurate, pejorative, and inappropriate when discussing the choice of a mentally competent terminally ill patient to seek to bring about a peaceful and dignified death. Words matter. I urge you to be aware of the significance of this terminology and to consider the use of accurate, value-neutral language on this sensitive topic in your future publications.
She also invites me to join “the American Public Health Association, the American Medical Women’s Association, the American Academy of Hospice and Palliative Medicine, as well as scholars . . . and members of the media, like the Associated Press,” who now use her “accurate and value-neutral terminology.” To demonstrate how a reasonable and enlightened scholar ought to respond to her plea, she includes a letter from a law professor at a highly ranked law school, who promises to get with her program.
I confess that I found these statements challenging, though not for the reasons that Ducker intended. In my article I used the term “assisted suicide” to refer to an event in which one person deliberately helps another person to engage in an act of self-destruction, which is also known as assisting a suicide, or assisted suicide. I naively assumed that my readers would want to understand what I was discussing.
I would like to consider that perhaps Ducker and I are describing different phenomena. She claims to use the term “aid in dying” to refer to the administration of drugs to a patient who, in her words, “wants to live.” Presumably, then, the drugs are administered for a purpose other than suicide, such as alleviating pain. The technical term for this is palliative care.
But no, she doesn’t seem to mean that, either. She informs me that “the practice of aid in dying (AID), as it occurs in Oregon, Washington, and Montana, refers to an accepted medical practice.” But palliative care is an accepted medical practice everywhere, and it is legal in all fifty states plus the District of Columbia. (Assisted suicide is permitted in Oregon and Washington, and its legal status in Montana is uncertain.)
Furthermore, Ducker informs me, the death in an aid-in-dying event “is planned.” In administering palliative care the physician does not act with an intention, much less a plan, to kill the patient.
So, it is impossible to avoid the conclusion that Ducker is trying to persuade me (is “persuade” even the right word here?) to stop using the term assisted suicide to refer to assisted suicide. It is not difficult to see why. I think she is correct that to describe assisted suicide as assisted suicide is not neutral toward her project; it is to expose her project for what it is.
Adam MacLeod is an associate professor at Faulkner University’s Thomas Goode Jones School of Law and a 2012-2013 Visiting Fellow of the James Madison Program at Princeton University.