“Freedom,” “Choice,” and Physician-Assisted Suicide

The supporters of physician-assisted suicide are indefatigable in their quest to legalize the practice in the United States, and they are co-opting the conception of freedom, as understood by the prevailing political thought during the American founding, to support their cause.

In the United States this year, the legalization of physician-assisted suicide has advanced with rapidity. Two states—New Jersey and Maine—legalized physician-assisted suicide in 2019, and the practice officially went into effect in Hawaii after legislation was passed there last year.

Physician-assisted suicide is now legal in nine states and the District of Columbia (the number of states includes Montana, where legislation has not been passed but where the state’s highest court found no statutory illegality in a physician prescribing a suicide cocktail). Further, the incremental slippery slope effect revealed itself again this year in Oregon, the first state to have legalized assisted suicide. At the end of July, the Oregon governor signed into law legislation that removes waiting periods for assisted suicide. Individuals who, according to the testimony of one physician, are likely to die before fifteen-day and two-day waiting periods, can now receive immediate physician-assisted suicide.

As the malignant practice of physician-assisted suicide spreads, both in terms of acceptance into law and in the predominant secular social ideology of the time, it is crucial to diagnose the thinking underlying, and propelling, the movement. It is critical that Americans understand the philosophical underpinnings of this movement against life. For in order to halt the advance of assisted suicide legalization, Americans must know how the country has arrived at the point where pharmacies in ten United States jurisdictions are today dispensing suicide cocktails aimed at killing citizens of their state or district.

The “Freedom” to Kill

Consider a fundraising email sent to subscribers of the euphemistically named physician-assisted suicide advocacy group, “Death with Dignity.” The email, sent under the name of the group’s executive director, Peg Sandeen, was disseminated on the morning of Independence Day, July 4, 2019, with a subject line of “Declare Independence.” The letter begins with this quotation, which itself is a guiding philosophical statement for the group: “The greatest human freedom is to live and die according to our own desires and beliefs.” The letter then attempts to interpret the political thought of the American formative period and conclude that physician-assisted suicide is in accord with the republic’s founding principles: “Like our country, death with dignity rests on the principles of autonomy and self-determination.”

These statements co-opt American freedom as envisioned by the founders. The American founders sought limited state law, for the fears at the time resulted in a focus on the construction of checks on government’s power to dictate moral law. The ideas that the prevailing American thought of the formative period is somehow supportive of legalized physician assisted-suicide, and that the founders intended to form a nation that recognized no moral limits or duties, are both rather extreme interpretations of that thought. Perhaps some people desire to remake the nation in such images, but this was not the intention. The founders persevered through war and the political and many practical ramifications of independence so that future Americans may have life. There is no dignity in death by suicide and no dignity in giving up hope on life.

The contention of the so-called “Death with Dignity” group is that individuals should have the right to assisted suicide because they “have the liberty to act free from interference by government or religion.” Physician-assisted suicide is state-permitted, insurance-covered, pharmacist-dispensed murder of the self by aid of physician prescription. The state has no duty to endorse this sterile killing process. The state does, however, have an interest in protecting citizens’ lives. It is presupposed in the Declaration of Independence that liberty and the pursuit of happiness, both understood rightly, require life. A human corpse can neither enjoy liberty nor pursue happiness.

The Decline of Moral Guides

Writing in 1957, Russell Kirk argued that love of, and attachment to, community are native to the American spirit. “Our city, township, and county governments; our flourishing voluntary associations; our innumerable fraternal and charitable bodies—these are the forms which have been realized by our desire for true community.” Indeed, it is necessary that the six communal institutions—the nuclear family, the extended family, the neighborhood, the church, the voluntary association, and the employment/workplace association—are healthy, for government cannot by its nature alone teach morality without devolving into totalitarianism. Although the framers sought to construct a system that would check the people’s immediate passions, because sovereignty ultimately lies with the people, government often legislates according to the current mores. There may be a delay in instituting ideals, but social ideals that persist are likely to be codified into law over time. If the communities are not inculcating moral values, then the people’s tastes for positive law will reflect this deficiency.

When communal institutions decline, two of the effects are increased focus on the self (individualism) and calls for additional individual freedom and autonomy.

The American framers worked to create a republic that would endure. To their credit, the republic has lasted for over two hundred years. For this accomplishment, long-term world history will remember them. One of their miscalculations, however, was their assumption that the six communal institutions would forever endure and check the passions of the people. They did not consider fully what would happen when the six communal institutions faltered. The result is libertinism and license. Thus, the republic falls into disorder, and without order a republic cannot subsist.

Autonomy and Choice

Among the logical results of the faulty first principle of autonomy is the West’s increasing social acceptance of physician-assisted suicide. Consider more of the email mentioned above, which says that “the work we do . . . [is to] make sure every American dying from a terminal illness can, after pursuing happiness all their life, decide how they die.”

The argument is based on the secular philosophy that takes autonomy as a first principle, stressing the preeminence of individual choices in decision-making. The choice principle that underlies many contemporary political and social arguments is a deleterious philosophical influence on the average man. For proper moral philosophy does not prize choice over all; rather, it asks whether a choice is good or bad. Simply choosing a particular end does not mean that this end is a good one.

When one argues that physician assisted-suicide is a personal and public good because it is a person’s “choice” to live or die, this argument proves neither the goodness of the act nor whether the choice is a dignified one.

The supporters of physician-assisted suicide are indefatigable in their quest to legalize the practice in the United States, and they are coopting the conception of freedom, as understood by the prevailing political thought during the American founding, to this end. Americans who understand the dangers of physician-assisted suicide must continue to oppose its legalization vigorously, while also being cognizant that the battle will be a difficult one. For the arguments supporting assisted suicide fit neatly with preexisting presuppositions of contemporary philosophical thought, making further inroads probable. Mainstream newspapers, magazines, and journals have begun running pieces glorifying the practice of assisted suicide. The stage is being set for widespread acceptance of the practice.

Exalting the freedom to choose anything, over all else, will not end well. Russell Kirk does not mince words: “The enemy to all custom and convention ends in the outer darkness, where there is wailing and gnashing of teeth. The final emancipation from religion, the state, moral and positive law, and social responsibilities is total annihilation: the freedom of deadly destruction.”

In suicide by legal physician prescription, there is no respect for the self or for others, there is no sense of the dignity of the self or of others, and there is most certainly no compassion. In physician-assisted suicide, there is only hopelessness, mercilessness, vanity, emptiness, and loneliness.

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