A Right to Life means a Right to Die on your own terms

This article was made by Netanya Weinberger. You can talk with her on our Discord!

I am no bird; and no net ensnares me; 

I am a free human being with an independent will, which I now exert to leave you.

-Charlotte Bronte, Jane Eyre, Chapter XXIII

Physician-assisted suicide is the practice of a physician prescribing a medication to a patient at the patient’s request that will terminate the patient’s life when the patient takes it. Supporting it is supporting the “right to die”. The right to die is a controversial topic, but one that can be ultimately boiled down to the primacy of the individual in a free society. Informed consent, bodily autonomy, and personal liberty are part and parcel to liberal civilization, and those are not shed simply because you are sick or are interacting with the healthcare system. Respect for patient autonomy and choice requires allowing competent and informed patients to make decisions about their own bodies, even if it will result in death. For at least the time being, death is inevitable for all humans. Why deny the right to choose when and how?

This is not revolutionary or without precedent. It is already established that patients have the right to deny care, even lifesaving care, if they are of decision-making capacity. The only hesitation is because of a somewhat arbitrary line that somehow assisting a patient in carrying out their wishes is worse than standing back and letting the patient suffer. Not all suffering is controllable; many disease processes cause immense pain and suffering far worse than any death can be imagined.  Palliative care is good but ultimately limited in its effectiveness because of the nature of dying, especially because the primary driver of patients pursuing physician-assisted suicide is not physical pain. Evidence from states where physician-assisted suicide is legal, like Oregon, shows that patients are primarily motivated not by pain alone, but by loss of autonomy, dignity, and control over their lives. Palliative care does not help with this; in fact, nothing really can because they are mostly unavoidable in the final entropy in the end of one’s life. It is also expensive and resource-intensive to keep terminally ill and suffering patients alive and comfortable. When the patient with end-stage cancer, worsening neurodegenerative disease, or an Alzheimer’s diagnosis says they’ve had enough, who are we to say otherwise? Forcing them to stay alive is harm, more harm than allowing a peaceful and dignified death. As clinicians, our place is not to tell people how to live their lives. It is to give them the means and ability to live happy and healthy lives. It would be just as vain and ridiculous to ban red meat to reduce heart attacks or to ban alcohol to prevent cirrhosis as it is to ban or prevent suicide in these patients.

It must be ensured that the patient is competent and aware of their decision and its irreversibility, and that the patient remains firm in their decision through multiple checks, as this is a reasonable safeguard against deciding to die on impulse. There is also the potential tragedy of revolutionary treatment being discovered that could have saved the patient if they had not died early. The Canadian method of coercing patients to accept physician-assisted suicide to reduce wait times and alleviate a burden on the healthcare system is also particularly distasteful. But, if the patient is made aware of this and their decision remains, that should be respected and the role of a healthcare provider should pivot from treating their incurable disease to making sure their final wish is fulfilled. 

There is a duty to alleviate suffering, not necessarily extend life at all costs. In the end, our interventions are not actually prolonging life, they are prolonging death. Life itself is simply matter that has active biological processes and is not in and of itself something to be preserved. A life of suffering and imminent death is certainly not something to be needlessly extended, especially when the patient is choosing to die. We are trained to save lives, yes, but preserving life at all costs is futile and ultimately does harm to the patient as an actual human being and not just simply a system of tissues and cells.