Euthanasia III
Michael A. Gillette, Ph.D.

Two important counter-arguments were presented in last month's newsletter regarding physician assisted suicide. Last month I outlined the most common argument against physician assisted suicide -- the slippery slope. I argued that the push toward physician assisted suicide is not likely to devolve into involuntary euthanasia because it originates in a concern for patient autonomy. While earlier experiences with euthanasia, such as that with the Nazis, sought to withhold medical care in order to save money and resources, the American desire for physician assisted suicide grows up out of concern that medicine can, in special circumstances, be more of a burden than a benefit. In the present circumstance the death of the patient is desired by the patient for his/her own good, and not by another party for the sake of some secondary beneficiary.

Although this historical claim may be accurate, it does not meet two specific objections that have already been mentioned. First, it does not make the slide toward financial incentives disappear, and second it does not deal with a probable change in the doctor-patient relationship if physicians are allowed to intentionally bring about the death of their patients.

The objection based on financial motives can be understood in two distinct ways. First, we might worry that with the rising cost of medical care in this country, that a patient would be concerned that by prolonging his life he would generate significant costs that would then have to be paid by his family. The patient might not wish to leave such a burden for his family, and might forego medical treatment out of a sense of fiscal responsibility.

This first version of the first argument is compelling, but not entirely convincing. It surely would seem unfortunate that a patient might be faced with a choice between continued care and avoiding an intolerable burden for his family. It seems that the financial concern could become so predominant in the patient's thought process, that the patient could be considered as acting under duress when foregoing life-sustaining treatment. This decision under duress is surely not free, and should be considered morally suspect.

In response to this argument, however, we must keep firmly in mind that individuals make sacrifices daily in order to save their families from harm. Great financial burden is a harm, and it is not clear why the choice of a patient to forego a very expensive treatment in order to provide better opportunities for his family is anything less than heroic. The choice may be tragic in some sense, but it is still heroic and ought not to be considered immoral. The evil in this case, if there is one, is not in a patient's choice to give up his life for his family's well-being, but that society creates a situation in which such a choice is necessary. Notice, however, that this argument now has nothing to do with physician assisted suicide. Surely the argument is just as compelling in the case of foregoing care as it is in the request for active euthanasia. This becomes a problem of the allocation of scarce resources, then, and not an argument about active euthanasia.

The cost containment issue is serious even if physician assisted suicide is not legalized. The cost issue does not seem to be unique to active euthanasia, and is therefore morally irrelevant to the present discussion. If we are upset by the necessity of heroic acts on the part of patients, that is because we have chosen not to fund their hospital care, not because we have legalized physician assisted suicide. Cost, in this sense, does not generate an argument against physician assisted suicide.

The second formulation of the cost argument is more serious. That argument is based on the prediction that people other than the patient himself will order the euthanasia in order to save money. Either, the physician assisted suicide will be State ordered to save resources, or some member of the patient's family will order the death of the patient to avoid amassing debt. If this is the concern, however, then we are no longer discussing physician assisted suicide; we are now discussing physician assisted murder.

In response to this argument, there is little that can be said except to once again refer to last month's historical argument concerning patient autonomy. Are we capable, as a nation, to protect people from murder? While murders obviously do happen, and the perpetrators of such crimes often do escape justice by fooling the jury into believing their innocence, that does not show that we are experiencing a complete breakdown of our justice system. To restrict freedom to the degree that murder would be impossible is intolerable. We try to stop murders from happening, but we recognize that some will take place anyway. We accept that as a by-product and acceptable cost of living in a country that would rather let a guilty person go free than send an innocent person to jail.

Why not say the same thing about physician assisted suicide? In assuming innocence until guilt is proven, some will get away with murder. That, however, is preferable to assuming guilt and sentencing innocent people to avoidable suffering.

All that is left now is the discussion of the doctor-patient relationship.