Assisted Suicide

I

Introduction

Assisted Suicide, a person’s voluntary suicide with help from another individual. A suicide is an intentional, self-caused death. Individuals who elect to kill themselves with the assistance of another person typically have an incurable illness or are experiencing extreme physical suffering.

The term assisted suicide may also refer to the act of providing an individual with the means to commit suicide, knowing that the recipient plans to use these means to end his or her own life. If a doctor provides medications or other means of committing suicide with the understanding that a patient may intentionally use them to end his or her own life, this action is referred to as physician-assisted suicide. The remainder of this article deals primarily with physician-assisted suicide.

II

Circumstances and Methods

Some people who face acute illness wish to refuse treatments offered by doctors, even if refusing such treatment may cause them to die. Like people who commit suicide, patients who refuse treatment often intend to end their lives because of their grim prospects for a healthy recovery. On the other hand, many people who desire assisted suicide seek relief from their suffering and do not seek death as an end in itself. Therefore, distinguishing a suicide from a refusal of treatment merely by the patient’s intention can be difficult. Nonetheless, the belief that those who commit suicide with a physician’s assistance are in a very different category from those who simply refuse treatment is widely held.

Assisted suicide also differs from euthanasia, in which a person other than the patient ends the patient’s life as painlessly as possible for merciful reasons. Euthanasia may be active, such as when a doctor administers a lethal dose of medication to a patient, or passive, such as when life-sustaining treatment is withheld or removed. In either case, someone other than the patient is the final cause of the patient’s death. Assisted suicide involves a more direct action by the person who dies than does euthanasia. For example, in a case of assisted suicide, although a physician may prescribe a lethal dose of medication, the patient administers the medication to himself or herself.

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III

The Assisted Suicide Debate

Since ancient times philosophers have contemplated the concept of a merciful and acceptable death. However, individual choice in dying did not become a widespread social issue and legal concern until recently. As technological advances in medicine have enabled doctors to keep patients alive for longer periods of time, legal rights to forgo medical intervention have developed.

Although a mentally competent patient’s right to refuse treatment is now widely accepted, until the 1970s physicians and lawmakers disputed the propriety and legality of treatment refusal. Doctors typically assumed control over a patient’s length of hospitalization and type of treatment. Often no serious discussion of alternatives took place. A patient who refused a useful life-sustaining treatment was considered to have requested something medically unacceptable. This view changed during the 1970s, when the right to refuse treatment was established by various court cases. Today the dispute over patient autonomy extends beyond the right of treatment refusal to issues of active euthanasia and assisted suicide.

People who believe that assisted suicide should be legalized maintain that individuals should have control over the timing and manner of their own deaths. Some argue that actively bringing about one’s death is no different legally than refusing life-sustaining treatment. However, opponents contend that legalizing assisted suicide will cause many problems. They fear that vulnerable individuals may be coerced into suicide as a result of financial pressure or fear of burdening their families. Religious opposition to assisted suicide is often based on the belief that God, not humans, should make the choices regarding death.

The legalization of assisted suicide has been a subject of intense public debate. In the early 1990s, the actions of retired Michigan pathologist Jack Kevorkian brought extensive attention to the issue. Kevorkian began to help suffering individuals end their lives with a “suicide machine” he designed. The device administered an anesthetic and then a lethal injection of potassium chloride through an intravenous line. Although prosecutors in Michigan have charged Kevorkian for various crimes, juries consistently refused to convict him for his assistance in the deaths of numerous individuals. However, in 1999 a jury found Kevorkian guilty of second-degree murder and delivery of a controlled substance. In this case Kevorkian himself administered lethal drugs to an incurably ill person who Kevorkian indicated had asked to be put to death. Kevorkian was sentenced to 10 to 25 years imprisonment. In 2007 he was released on parole after serving eight years of the sentence.

Kevorkian’s actions provoked sustained controversy. His opponents viewed him as a maverick operating outside mainstream medicine and without legal precedent. They maintained that neither the constitutional right to privacy nor any other recognized legal right supports the practice of assisted suicide. However, those who supported Kevorkian’s actions contended that no valid distinction can be drawn between the acts of disconnecting life-support equipment and connecting equipment designed to cause death. They viewed the patient’s right to control his or her medical treatment and time of death as the sufficient justification in both cases.

IV

Legal Aspects

In the United States and Canada, a mentally competent patient has a legal right to refuse treatment. A valid refusal obligates the physician to forgo treatment, even if honoring the refusal will result in death. A physician’s compliance with the refusal is never considered a legal offense, and how the death occurs as a result of the refusal is irrelevant. However, the law also attempts to distinguish between allowing a person to die and assisting a person to die. Laws permit the former under many circumstances and typically prohibit the latter.

Assisting suicide has long been a crime in both the United States and Canada. However, in 1994 and again in 1997 voters in Oregon approved a law allowing physician-assisted suicide. In 2008 voters in Washington approved a similar law. Governments have often punished suicide assistance as a form of murder or manslaughter and have sometimes specifically defined the action as a separate offense. For instance, in response to Kevorkian’s activities, in 1993 the Michigan legislature adopted a law prohibiting suicide assistance and making it a felony punishable by up to four years in prison. Today the majority of U.S. states have legislation defining suicide assistance as a felony, punishable by several years in prison. (Several other states continue to punish assisted suicide under the common law, which is based on judicial decisions rather than on specific statutes.) The Criminal Code of Canada also prohibits suicide assistance, providing for up to 14 years in prison as punishment. However, in recent years those who favor legalizing assisted suicide in the United States and Canada have challenged the constitutionality of these laws.