By Michael Cook
Don’t imagine that euthanasia’s slippery slope is like a long water slide at a theme park in which you hurdle ever downward, ever faster, until you are hurled into a pool. It’s more like moving from Duluth to Montreal through the St Lawrence Seaway – you slowly glide along, enter a lock, descend, glide, enter a lock, descend, glide and so on through 15 locks to the Atlantic.
As far as the right to die is concerned, building each of these legal locks is arduous and time-consuming, but eventually you reach open sea.
In a recent article in the American Journal of Bioethics, several prominent American bioethicists set out a blueprint for another lock in California’s descent towards an unregulated right-to-die.
California, like other American states, permits assisted suicide. But boundaries do exist. Patients have to fulfill certain requirement and have to die according to state-approved protocols.
One requirement is that patients who want to die must administer the lethal drug themselves. So a woman who has the drug but cannot swallow it or inject herself cannot take advantage of the law. This could happen if a person in a terminal stage of cancer is too weak. Or it could happen if patients have a degenerative disease like ALS and cannot move their limbs.
This “injustice” denies some people the “right to die”.
The bioethicists argue that this requirement is tantamount to discrimination against persons with disabilities. It “creates an underclass of terminally ill patients who, due to their substantially impaired motor function, cannot access a medical procedure legally provided to more-able-bodied terminally ill patients.”
The deficiencies in California’s End of Life Option Act, became obvious, they contend, in a case decided in a federal court in 2022. Three terminally ill patients with neuromotor disabilities and four aid-in-dying physicians sued to be able to receive aid-in-dying.
The judge was sympathetic, but dismissed the case, albeit with great reluctance. He wrote that there is a boundary between assisted suicide and euthanasia which cannot be legally traversed. “The accommodation that the plaintiffs seek—to permit physicians to administer aid-in-dying medication—would traverse this boundary… it would transform the benefit under the act into something else entirely.”
The authors of the AJOB article conclude: “today’s aid-in-dying laws unjustly disenfranchise terminally ill patients with advanced neurologic diseases that impair movement and strength. As they rapidly approach their deaths, these patients deserve equal rights to all end-of-life options.”
The bioethicists’ reasoning is terribly dangerous; it’s like an acid which dissolves everything it touches.
The effect of arguments based on discrimination is to take California (and other states) down the St Lawrence Seaway one lock at a time until it reaches Montreal and the open sea. First, for patients with ALS. Then for patients who are too young. Then for patients who are too depressed. Then for patients who are too demented. The “right to die” equivalent of Montreal is a constitutionally guaranteed right to die for everyone who wants it. (Which, by the way, is just about what they already have in Montreal.)
This article was accompanied by a number of commentaries. Scott Kim, a bioethicist with the National Institutes for Health, was one of the few who argued against the right to die.
He pointed out that arguments for equal opportunity for assisted suicide are never-ending in principle. There is always someone whose situation lies on the other side of the boundary between being allowed to die and not being allowed to die.
For example, the German Federal Constitutional Court ruled in 2020 that “the right to a self-determined death … is guaranteed in all stages of a person’s existence”. This sounds far more permissive than California, but the problem of discrimination still exists. The Bundestag is attempting to draft legislation to implement the Court’s ruling, but proposals on the table only apply to people who are autonomous and competent.
What if they are not competent? Aren’t people with dementia, mental illness, or very young children being excluded?
In short, the boundaries of assisted suicide and euthanasia will keep expanding no matter how permissive the law appears to be.
Supporters of assisted dying believe that it is wrong that some people are allowed to die, and others are forced to stay alive. Dr. Kim agrees. There should be radical equality – no one should be allowed a “right to die”. Here are his eloquent words:
There is of course another way of achieving true universal equality among all persons regarding assisted dying. And that is to prohibit all intentional termination of human life, even upon request, by a private citizen. What this conclusion suggests is that it is not some absolute inviolability of human life that need ground arguments against assisted dying. It is about showing equal respect for all human life. An absolute prohibition is the only truly principled basis for treating every human being’s life equally.
So there are three choices: assisted dying with contested boundaries stabilized by a democratic process, which is in turn susceptible to influence of inequalities of power, privilege, and economic resources; assisted dying with no boundaries, an egalitarian dystopia; and finally, assisted dying for none, based on a human rights achievement thousands of years in the making—a deep commitment to the equality of all human lives.
Editor’s note Michael Cook is editor of Mercator where this first appeared. Reposted with permission.