The Perils of Assisted Suicide

St. Thomas Aquinas, who originated the Principle of Double Effect. (We'll get to that at the end.)
St. Thomas Aquinas, who originated the Principle of Double Effect. (We’ll get to that at the end.)

One of the things people don’t realize about the pro-life movement is that “pro-life” is more than a euphemism for “anti-abortion.” There is a coherent philosophical outlook that underlies both the opposition to abortion and, for example, the opposition to legalized physician-assisted suicide. In both cases, there is a combination of (1) a deep-rooted belief that each human life has value, regardless of the capacity of the person in question and (2) a concern for the dignity and rights of society’s most vulnerable.

It is true that most of the pro-life movement is focused on the abortion issue most of the time, but that’s entirely natural: there are roughly 1 million abortions every year. That’s currently the biggest issue. But the movement also opposes legalizing physician-assisted suicide, and a couple of articles do a good job of explaining why.

First, from the Federalist, there is My Mom Just Died Of Brain Cancer. Here’s Why She Opposed Assisted Suicide. The article, by Mary Karner, explains why her mother Dr. Maggie Karner “used her last days on Earth” to campaign against physician-assisted suicide. The root of this opposition stems from the pro-life philosophy that I already mentioned. In an op-ed, Maggie Karner wrote that:

My brain may be cancerous, but I still have lots to contribute to society as a strong woman, wife and mother while my family can daily learn the value of caring for me in my last days with compassion and dignity.

The idea that a person’s dependence can be a blessing is a crucial and vital aspect of genuine humanism. We are not only valuable when we are strong and capable. We are also valuable when we are weak and incapable, because it is then that we give others the opportunity to sacrifice and to serve. Dr. Maggie Karner was not in denial. She didn’t think that, despite her debilitating and terminal diagnosis, she could keep positively contributing to her community or her family. She knew that, eventually, she would not be able to do so. But she understood that even then, she still had a vital role to play in the interdependent web of human society. Mary Karner agrees:

I’m here to say that she was right. No matter how hard it was and still is. She was so right. And the greatest honor of my life was to care for my mom in her last days.


Maggie Karner made another point as well. She raised the specter of a slippery-slope:

How long will it be before the right to die quickly devolves into the duty to die? What does this mean for all who are elderly, or disabled, or just wondering if they’ve become a burden to the family?

The important thing with slippery-slope arguments is to test them. Is the slope really slippery? And that brings us to the second article. This one is from the National Review: Assisted Suicide Increases Other Suicides. Wesley J. Smith states his thesis clearly:

I believe that assisted suicide advocacy pushes suicide generally because it communicates the message that self-termination is an acceptable way to end one’s suffering.

And then he backs it up with data. A new study in the Southern Medical Journal states find that, when physician-assisted suicide is legalized, there is an associated hike in self-inflicted suicide. This finding really underscores the risk Dr. Maggie Karner warned about: physician-assisted suicide isn’t just about providing a merciful death to those with terminal conditions. It changes the way we look at suicide. We are, as Smith writes, “becoming a pro-suicide culture.” This is inevitable. Once solution is seen as a good thing in some cases, as a solution, it is impossible for the scope of problems to which suicide is the answer not to begin to increase. And as it does, suicide will subtly shift from a mercy killing on behalf of someone who is suffering to an obligation of the old and the sick.

Humane societies care for their vulnerable members. They do not grease the slide towards death and call it mercy.

Two final points.

The first is that the pro-life attitude towards the law is far more nuanced than most critics would realize. The conventional logic is that the pro-life movement wants to ban abortion (for example) in order to coerce women into having children. This is so obvious that it seems strange to even question it. And yet, that’s not actually the case at all. Making something illegal is in fact almost never first and foremost an attempt to coercively modify human behavior. The criminal justice system does not exist to control behavior, but to provide consequences. Neither our laws nor our law enforcement agencies are set up to (for example) coerce people into not stealing or raping or murdering, but rather to catch and punish those who do after the fact. If we get a deterrent effect from that: great. But if we were actually in the business of enforcing laws via coercion, we’d have to start by getting rid of civil liberties.

On the contrary, the pro-life movement–and social conservatives in general–understand that “the law has a pedagogical function.” (That’s Smith citing U.C. Irvine professor of psychiatry Aaron Kheriaty.) In other words, there is a feedback mechanism between law and morality. It is impossible to legislate morality and foolish or insidious to try, but it is equally foolish or insidious to pretend that morality does not influence the law, or that laws do not influence morality. The biggest problem with Roe v. Wade is not that it formally permitted abortion, but rather that by enshrining abortion as a Constitutional right (in the United States the Constitution is our secular scripture) it essentially sacralized it. In a nation where abortion has been legalized gradually through the democratic process, the idea of “choice” would make much more sense because the law would have organically reflected people’s changing beliefs and would therefore reflect the nuanced and complex nature of abortion as a moral situation. But in a country where the highest court in the land determines that our founding document view abortion as a fundamental and inalienable civil right, all such nuance and complexity is wiped away.

Similarly, legalizing physician-assisted suicide (especially using “rights” rhetoric and especially if the courts are heavily involved) , will profoundly change the moral view of suicide in our nation, and that change will not be neatly contained within the category of suicides legally carried out by a physician. That’s what the evidence already demonstrates.

The second is an important clarification. The pro-life position holds that suicide is usually immoral, but it does not mandate that a person must be kept alive by all means necessary. This is a common false-choice fallacy, and it is simply not true. First–speaking legally–the right to refuse medical treatment (including the right to have someone with legal authority refuse it on you behalf) is an ancient aspect of our common law tradition. Second–speaking morally–the pro-life movement generally recognizes the Principle of Double Effect. Read the article for the full details, but here is the Cliff Notes version: you can’t deliberately kill someone to ease their suffering, but you can give them potentially lethally doses of pain medication if your sincere intent is to relieve suffering and not to bring about their death. In other words, the pro-life opposition to intentionally killing sick people doesn’t mean you have to make them suffer unnecessarily to keep them alive.

Just thought I’d get that one clarified, since I’ve seen it misunderstood (intentionally or not) on such a regular basis.

4 thoughts on “The Perils of Assisted Suicide”

  1. Lots of interesting bits in this piece–thank you for it! Let me focus on this one: the reasoning seems to be that, should we introduce suicide as a legitimate tool, we will broaden the scope of our use of it. I would be more confident that this is a reliable argument form if it were applied consistently to whatever means one considers.

    To choose another recent controversy, if bakers successfully use the courts to defend their rights to refuse service to gay couples seeking wedding cakes, this increases the probability that others will use the courts to defend other putatively religious rights. I have the impression that there’s near unanimity that this is an undesirable way of securing accommodations for religious observance, but I didn’t encounter that point in any of the discussions I saw.

    I think I have seen this argument used about debt-ceiling “hostage-taking” and consumer boycotts for ideological reasons, so it’s certainly not unique to this context. But the fact that it’s not a concern universally applied in all circumstances makes me wonder whether it has problems we aren’t sufficiently experienced with it to notice. One possibility: can the slope be slippery in both directions? In this case, we’re worried that if suicide is legally legitimate, we’ll broaden its use. But if founding law on religious belief is legitimate, won’t we also encourage more attempts to impose one’s religion on the law?

    I recall hearing about an explanation for how implications work in language which was effectively destroyed by a paper which examined how the same explanation would work equally well if language had an entirely different set of implications. I wonder whether something of this sort might be in play here. It’s not that the argument doesn’t have substantial plausibility, but that perhaps its plausibility can be equally harnessed for a variety of conclusions. That’s a pretty roundabout criticism of the argument, but, if accurate, it would seem to diagnose a legitimate concern that framing might matter more than substance.

  2. Kelsey-

    Two things to keep in mind.

    First–and most important–this slippery slope argument in this case is not merely speculative. It is backed up by empirical data. In those states that have legalized PAS (physician-assisted suicide) non physician-assisted suicide rates have increased.

    Second, the counter-example (with religious exemptions) doesn’t work because we actually have had quite a lot of back-and-forth over centuries about what religious accommodation does or doesn’t entail. It’s not plausible to suggest a slippery slope with regards to a debate over an issue where we’ve already been debating for centuries and have gone back and forth.

    In other words, we’ve already got a dense forest of checks, balances, tests, and precedent when it comes to religious liberty and accommodation. That makes it hard for either side to claim a slippery slope with regards to change in either direction.

    But legalizing suicide would be a first. We don’t have the checks, balances, tests, and precedents (legally or socially) to inhibit a slide thereafter..

  3. Regarding the data, here’s the conclusion listed in the abstract of the article cited by the National Review piece you linked, bold type mine: “Legalizing PAS has been associated with an increased rate of total suicides relative to other states and no decrease in non assisted suicides. This suggests either that PAS does not inhibit (nor acts as an alternative to) nonassisted suicide, or that it acts in this way in some individuals but is associated with an increased inclination to suicide in other individuals.” This does not support the claim that non-PAS rates have increased.

    “It’s not plausible to suggest a slippery slope with regards to a debate over an issue where we’ve already been debating for centuries and have gone back and forth.” – Is it your view that PAS is not an issue on which we’ve been debating for centuries or have gone back and forth? I find that view a bit of a surprise–a brief Google search suggested to me that the first law making PAS illegal was passed in my own state of New York in 1828. I also regard the current spate of defenses of rights of religious exercise as novel in our history, but I suppose that claim could always be made about the specific form in which a familiar pressure exerts modern influence. But the claim that it’s difficult for either side to make slippery slope claims on religious liberty seems to be at odds with much of what I’ve read from both sides over the past few years. Again, much of that has been pretty crap writing, so perhaps all of the slippery slope arguments fell into that category.

    But suppose you’re correct, and we’re just now exploring PAS for the first time. That very fact suggests that the effect in question is one we’ve as yet no experience counteracting. The conclusion one would be tempted to draw from an empirical result that legal PAS increases unassisted suicide (were one to exist) is that legalizing it elsewhere will continue to have similar effects. But, if that effect does exist, we’ve only just begun to recognize it and try to find ways to counteract it. Keeping PAS illegal actually creates the very situation which makes you want to keep it illegal–it keeps us from developing such checks on this effect. Legalizing it allows us to explore how to rein in its undesirable side effects.

    Maybe that’s not so bad for your argument. After all, the claim that we’ve inadequate data about whether PAS increases suicide generally, and no idea how to stop it from having that effect if it does, might be reason enough not to allow it. But it’s a very different argument from the claim that we have evidence of an effect and good reason to think it’s unstoppable.

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