Finding common ground on questions like euthanasia and Physician Assisted Suicide (PAS) will never be possible, given the strong religious convictions that many Christians, Jews and Muslims have always had against any form of self-destruction. For them, suicide is a sin and killing is always wrong, except of course in wartime situations or when the state has to use force in policing and maintaining order. Their views are based on the Bible or other sacred writings as well as strongly-held religious traditions and convictions, and therefore are not going to change quickly or easily. According to the U.S. Supreme Court, assisted suicide is not a right, and it remains illegal in most states. Liberal Oregon is one exception to this rule, and even though its law permitting PAS was challenged in the courts for many years, in the end the Supreme Court did not forbid the states from passing such laws altogether. Poor quality care in hospitals and nursing homes at the end of life makes suicide appealing to many people, especially those with painful and lingering terminal illnesses which contemporary medicine cannot cure (Snyder and Kaplan 2002). Liberal and libertarian advocates of euthanasia would assert that adult patients are free and autonomous individuals whose choices must be respected by the medical profession, even though artificial shortening of lives might not even be necessary in the majority of cases. They insist that euthanasia and PAS should be in place with proper ethical and legal safeguards to prevent abuse, such as family members who wish to kill elderly or incapacitated family members to inherit their money and property. Physicians who have strong moral and religious objections should not be required to participate and perhaps the majority will not. PAS and general end-of-life care might well become a specialty or sub-specialty of geriatric medicine, offering palliative care to most patients with an option of PAS or euthanasia at some point.
Probably the strongest argument in favor of euthanasia is the liberal or libertarian one that would permit adults to have complete control over their lives and bodies, up to the point where they can even chose to end their lives. Perhaps the real rights revolution has its origins with 19th Century libertarians like John Stuart Mill, who rejected all religious dogmas in the application of laws, customs and morality. Mill argued that the main duty of the state was to leave individuals alone in whatever life choices they made, including sexual behavior, drug and alcohol consumption or even suicide (Mill 1859). Christianity and all other major monotheistic religions have always regarded suicide as a sin, an offense against God and an antisocial action that damages the family and the entire human community. Many modern philosophers like Immanuel Kant have also argued that human life has intrinsic worth and value, and that this should be considered a universal principle. It is the secular basis for many ideas about basic human rights, but opponents of abortion and euthanasia would grant this same right-to-life in unborn children, the mentally ill and those with terminal diseases. In the Western world of the last 30-40 years, however, Mill’s principles have been gaining ground, especially due to the influence of feminism, and various gay rights and civil rights movements. These have brought about the overturning of laws against abortion and homosexuality, and many other restrictions over individuals based on gender, color, ethnicity or sexuality. In the United States to be sure there has also been an intense conservative backlash movement against these changes, led by the Catholic Church and evangelical Protestants. These churches that are on record opposing gay rights and the decriminalization of abortion also strongly oppose euthanasia and PAS, on the grounds that they are forbidden by the Bible.
Religious critics of euthanasia also point out that Nazi Germany also permitted the state-sanctioned killing of the handicapped and mentally ill and that this in turn became the precursor to a broader policy of genocide. Americans doubt that it could happen here, but Germany was also a modern, ‘advanced’; Western nation—possibly the most ‘advanced’ in many areas—yet under certain political, economic and social stresses any country could take an extreme turn and become morally derailed. No such Nazi or fascist regime has again come to power in any developed nation since 1945, but the social stresses and strains of the current recession do have many similarities to the 1930s Depression, which was the main reason fascism came to power at that time (Kater 2002). Opponents of euthanasia and PAS therefore have a point when they assert that once society decides that certain lives are unworthy of living or intrinsically less valuable than others, then society and the medical profession could be embarking on a slippery slope that would end in a nightmarish scenario. Free choice for all individuals sounds like a great democratic ideal, and in modern times the choices available have multiplied greatly thanks to technology. For the Founders of the United States, only adult white males were guaranteed certain basic rights such as life, liberty and property, as well as freedom of speech and religion, but these did not necessarily apply to women, slaves, Native Americans, Catholics or members of other minority groups, of course. In the 20th Century, there has been a rights revolution that went far beyond anything envisioned by Thomas Jefferson, James Madison or even Benjamin Franklin—the most democratic of the Founders. Yet under the pressure of severe economic difficulties the U.S. might easily revert to its racist past and begin targeting the poor and minorities for rationing and euthanasia measures, both out of prejudice and the desire to inflict social control and austerity measures on the lower classes.
In my opinion, leaving the decisions about euthanasia and PAS purely to bureaucrats, economists, lawyers and politicians would be a serious mistake, precisely because they would tend to regard these as utilitarian and cost-saving measures. This does not mean that they would take extreme measures like those in Nazi Germany of that their ideology would be based so much on racism and Social Darwinism. In reality, though, we do live in a racist society and also one with extreme differences in wealth and income, ruled by elites who are great eager to increase their own wealth while imposing heavy punitive and austerity measures on the poor, the working class and members of minority groups. They also seem to regard the growing population of Baby Boomer seniors as an unwanted social and economic burden, and perhaps might look to PAS and euthanasia as money-saving measures. Only the fact that many religious people would be forced to oppose such measures by whatever means necessary would prevent them from taking actions like these, and even in Nazi Germany the opposition of the churches forced Hitler to scale back his ‘euthanasia’ program. Had they shown as much opposition to the extermination of the Jews, in fact, the Holocaust might have been prevented as well. In any event, given high unemployment, budget deficits and poor economic conditions, the tendency of this society to economize on the backs of the poor, minorities, the elderly and other vulnerable groups is definitely becoming more pronounced. All this talk about individual rights and free choice is fine, except that in America these could turn out to be a Trojan horse that will serve as cover for much harsher policies and ideologies that resemble fascist-style Social Darwinism. After all, the Nazis came to power in 1933 during the Great Depression, and similar movements are going to revive all over the world if the current economic situation continues to worsen. For this reason, I remain dubious about euthanasia and PAS, and what forms they might ultimately take in a highly racist and unjust society like this one. I am also very skeptical of the medical profession as a whole, which is mostly driven by money and profits. It has never offered very good care to the poor and minorities in this society because no money could be made from them, and the only reason the elderly receive better treatment today is because of Medicare. As the budgets for all these entitlement programs tighten in the years ahead, there will be more incentive to simply get rid of the poor and elderly on accounting and cost/benefit grounds. Far from alleviating human suffering, PAS might turn out to be a method for expanding it exponentially once the door has finally been opened.
Kater, Michael. “Criminal Physicians in the Third Reich: Toward a Group Portrait” in Nicosia, F.R. and J. Huener (eds). Medicine and Medical Ethics in Nazi Germany: Origins, Practices, Legacies. Beghahn Books, 2002, pp. 77-92.
Mill, John Stuart. On Liberty. London, 1859.
Snyder, L. and A.L Kaplan. “Finding Common Ground” in Synder and Kaplan (eds). Assisted Suicide: Finding Common Ground. Indiana University Press, 2002.