In the United States, physician-assisted suicide is legal in six states and Washington, DC. Washington implemented the practice just this past summer, but the spending bill passed by the House in September would block the District from spending money on the law. Activist judges in the state of California have allowed assisted suicide to continue despite efforts to halt the practice. In a surprising decision for such a politically progressive state, New York’s highest court ruled in September that individuals have no state constitutional right to physician-assisted suicide. The New York ruling follows the 1997 Washington v. Glucksberg Supreme Court decision that found that the Fourteenth Amendment’s due process clause did not, as the plaintiffs argued, provide a right to assisted suicide.
Despite the decision in New York, the advocates of assisted suicide are sure to continue their assault on human life in the name of autonomy. The fight against the legalization of assisted suicide must continue, but one cannot and must not rely on court decisions and legislative victories, for these successes are based on ephemeral sentiments and are subject to swift change. Proper positive law, or man-made law, as Thomas Aquinas argued, always must reflect what is required by natural law and higher laws.
In order to protect the sick and disabled—who are among the weakest and most vulnerable members of society—one must act on what is known to be true. A philosophical analysis can help one to understand what is true about medicine, and why the medical profession must refuse to traffic in death.
Physicians Cannot Serve Two Ends
In the Nicomachean Ethics, Aristotle argues that the purpose of medicine is health. For Aristotle, if the physician brings health to his patients, he attains his end as a physician in the best way possible, hence he can be considered an excellent physician.
Aristotle would consider the intentional killing of a patient to be outside the purview of actions geared toward the physician’s proper end. A good physician’s actions will aim at achieving the health and longevity of a patient, not his hastened death.
If physician-assisted suicide is legal and socially accepted, the physician who believes in the practice and is willing to choose it is no longer geared solely toward achieving one end: the health of his patient. Rather, the physician now has a choice in ends: the health of the patient or the death of the patient. No man, however, can serve properly two antithetical or conflicting ends.
Consider the following analogy. It is both illogical and impossible for a runner to aim simultaneously to win a marathon and to lose a marathon. One’s actions must be in accord with one’s willed end. The runner cannot act in order to reach the finish line while also acting in order not to reach the finish line. If the runner wants to win the marathon, he will choose to run well; if he does not want to win, he will choose to run poorly. He cannot choose both of those ends at once.
Nor can the physician serve two ends simultaneously. He cannot truly and wholeheartedly work toward bringing his patient to health if he can choose at any time to give up that pursuit and suggest rather that the patient choose death instead. Health requires life. A dead man can be neither healthy nor unhealthy. The two ends—to bring health to the patient or to bring death to the patient—are in opposition. The physician cannot serve both ends.
The psychological effect of knowing that there is an option of suggesting assisted suicide when treatment becomes difficult will affect even the most disciplined physician. For the physician will always know, when faced with a patient who is difficult to treat or to cure, that there is another choice available. If he is willing to use the assisted suicide option, he cannot be devoted fully to the patient’s life.
Physicians who are truly opposed to this choice of ends are the ones who save lives. Jeannette Hall, a woman in Oregon, where physician-assisted suicide is legal, wrote a public letter about her experience of being diagnosed eleven years earlier with cancer and having been told that she could be expected to live for only six months to one year longer. She considered the option of committing assisted suicide, but her physician personally did not believe in this option and encouraged her to fight, which she ultimately did. The woman wrote succinctly: “If my doctor had believed in assisted suicide, I would be dead. I thank him and all my doctors for helping me to choose ‘life with dignity.’” In a later interview–conducted now fifteen years after her initial diagnosis–the woman was still very much alive. Her physician was also interviewed and he expressed strong opposition to assisted suicide. In his words: “I didn’t go into medicine to kill people . . . If [a physician is] writing a prescription for lethal drugs, he’s writing a prescription to kill the person.”
Science, Medicine, and Philosophy
Physicians must not forget that science continues to reveal that sick people are neither useless nor hopeless. Just this September, it was reported in a science journal that a man who has been in a persistent vegetative state for the last fifteen years has regained observable medical consciousness after receiving nerve therapy stimulation of his vagus nerve. The man has begun responding to exterior stimuli and is understanding, and reacting to, others’ requests. The authors of the study conclude that their results “challeng[e] the belief that disorders of consciousness persisting after 12 months are irreversible.” Indeed, “hopeless causes” are considered as such only insofar as the current knowledge says that they are “hopeless.” Diseases and ailments that just one generation ago were “hopeless” are today treated successfully, thus allowing patients to live long and fulfilling lives.
Consider the testimony of Michael Egnor, a neurosurgeon who describes a brain surgery that he conducted on a woman with a tumor. The surgeon writes that after he removed much of the woman’s cerebral frontal lobe, she was still able to speak with him in a coherent manner. The neurosurgeon asks: “How, then, is it possible to converse with someone while removing the large portions of her brain that serve thought and reasoning?” He argues that the answer lies in philosophy’s understanding of the existence and function of the immaterial part of man’s soul.
Physicians who question the usefulness of disabled patients should immerse themselves in the Aristotelian-Thomistic understanding of potentiality and recall that, because medical knowledge is nowhere near complete, current beliefs in outcomes are but hypotheses ready to be challenged by truth.
In the United States, the death of the sick and disabled under the guise of physician-assisted suicide is not fit to be positive law. Lovers of truth must fight vigorously against legal recognition of the practice of assisted suicide.
Gerard T. Mundy teaches philosophy at a private liberal arts college in New York.