NLA REVIEW

Assisted Suicide

WINTER 1996

By Prof. Charles E. Rice

The Supreme Court this term will review two Circuit Court decisions holding unconstitutional laws in Washington and New York prohibiting assisted suicide. The Ninth Circuit, in Compassion in Dying v. Washington, held that there is "a liberty interest in choosing the time and manner of one's death" that outweighs the state's interest in forbidding assisted suicide. "We see no ethically or constitutionally cognizable difference," said Judge Stephen Reinhardt for the 8-3 majority, "between a doctor's pulling the plug on a respirator and his prescribing drugs which will permit a terminally ill patient to end his own life." The ruling by the Second Circuit, in Quill v. Vacco, was based on the narrower ground that the New York statue denied equal protection of the laws by permitting patients on life support systems to hasten their death by withdrawing those systems and denying the right of patients not on life support systems to cause their death by lethal drugs. It would seem a good bet that the Supreme Court will approve some form of assisted suicide. Public approval of Dr. Jack Kevorkian generally runs at about 70% or higher. Jurors in Pontiac, Michigan, who acquitted him in one of his trials, asked for his autograph, had their pictures taken with him and made arrangements to meet him for dinner.

Dr. Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, warns that we are on a slippery slope. "Let nobody think that this is an argument about putting to death people with terminal cancer," Dr. Caplan said. "That will last about five minutes. Then it will move to, 'I don't want to be alive with Alzheimer's disease. I'm not terminally ill, but by the time I am I will not be able to ask for help in dying.' " Or, he said, there would be people saying, "My mother always said she didn't want to be kept alive if she had Alzheimer's disease."

Predictably, the "right to commit suicide" will be extended-to an incompetent person for whom the "rational" decision will be made by others. Such decisions are now legally made with respect to the withdrawal of food and water from incompetent patients. And the extension to active euthanasia is predictable. If you were a terminal AIDS or other patient, would you not prefer, as a "rational" choice, a painless exit by injection rather than a prolonged and painful death resulting from the withdrawal of food and water? And if such a patient, or an inform octogenarian, declines to choose death when such is the "rational" choice, would not that irrationality indicate his incompetence so as to allow others to make that "rational" choice for him?

In its review of Compassion in Dying and Quill, the Supreme Court ought to reconsider its 1990 ruling in Cruzan v. Director, Mo. Dept. of Health. All of these cases involve the intentional killing of an innocent person who cannot in any way be described as an aggressor.

In Thornburgh v. American College of Obstetricians and Gynecologists, Justice Stevens stated that "the permissibility of terminating the life of a person could scarcely be left to the will of the state legislatures." 476 U.S. at 779. In Roe vs. Wade, the court conceded that if "the fetus is a 'person' within the language and meaning of the fourteenth amendment... the appellant's case, of course, collapses." Id. at 156. 410 U.S. 113,157 n.54 (1973). The governing principle he" is that a fourteenth amendment "person" does not hold his life subject to the will of the legislature as to whether another shall be legally permitted to kill him. Roe v. Wade held that the preborn child is not a fourteenth amendment "person", whether or not he is a human being. Roe's recognition of the right to kill the preborn nonperson has an obvious bearing upon the subsequent allowance by courts of intentional killing in the right-to-die context.

When a state protects innocent, non-aggressor persons in general by forbidding them to be intentionally killed by another, it ought to be held to deny equal protection of the law for the state to exclude from that protection some such persons because they are terminally ill or because they have asked to be killed. Cruzan, Quill, and Compassion in Dying do not involve the question of whether a competent person has constitutional right to commit suicide b his own unassisted hand. Apart from th incongruity that would be involved in state trying to impose a criminal penalty on a person who successfully kills himself by his own hand, the state clearly has constitutional authority to forbid a person to attempt suicide by his own hand. See Cruzan, 497 U.S. at 298-300 (Scalia, J., concurring). Otherwise, one would have to affirm a constitutional right to alienate the unalienable right to life. However, the limited issue involved in Cruzan, Quill ant Compassion in Dying is the question of whether the state may rightly withdraw criminal sanctions from a person who intentionally kills another because the victim has consented to his own homicide.

"Generally, it may be said that consent by the victim is not a defense in a criminal prosecution. The explanation most commonly given for this rule is that a criminal offense is a wrong affecting the general public, at least indirectly, and consequently cannot be licensed by the individual directly harmed. Thus, it is no defense to charge a murder that the victim, upon learning of the defendant's homicidal intentions, furnished the defendant with the gun and ammunition." Wayne R. LaFave &Austin W. Scott, Jr., Criminal Law 408 (1972) (footnotes omitted).<./DL>

It can be difficult to distinguish legitimate withholding or withdrawal of medical treatment, including termination of the administration of food and water that no longer sustains the life of a patient near death, from actions which are homicidal in intent. The law should not require that excessive treatment be given to impede the act of dying. There comes a time when a person has done all that is reasonably required of him to preserve and prolong his life, nature should be allowed to take its course, and the proper judgments of physicians and family should be respected. In context, a person should be allowed to die a natural and dignified death.

In what situations, then, should the law interfere? We can safely enumerate two. First, it should do so in cases involving the circumstances presented in Quill and Compassion in Dying. These cases should be considered unlawful per se since they always involve the intentional killing of an innocent non-aggressor person. Even if the victim asks to be killed or is terminally ill or even imminently dying, it would violate the equal protection clause to exclude him from the protection against intentional killing generally provided by state prohibitions of homicide. Second, the law should forbid the Cruzan-type case because it too involves intentional killing, as shown by three factors common to such cases:

  1. The patient in the Cruzan-type case is not dying or near death. Nancy Cruzan, for example, had a life expectancy of 30 years;

  2. These type cases do not involve the withdrawal of medical treatment, including food and water provided by tube, that is burdensome, dangerous, extraordinary, or disproportionate to the expected outcome. In Cruzan, the administration of food and water by tube was effective in sustaining Nancy Cruzan's life. It was therefore not useless even though it obviously would not correct her underlying condition; and

  3. The action in question, the withdrawal of medical treatment, was taken with the specific intent to cause the death of the patient. The motive or purpose of the action may have been to relieve the patient of life considered burdensome or useless, but the clear and specific intent was to achieve that purpose by means of intentionally killing the patient. A permissible intention, on the other hand, would be to ease the excessive pain caused by the medical treatment itself.

In these two classes of cases, assisted suicide and the Cruzan-type case, the patients involved are all "persons" within the meaning of the fourteenth amendment and are innocent non-aggressors. Clearly, if the fourteenth amendment guarantee of equal protection means anything, it must mean that such persons cannot be excluded from the protection of state homicide laws by permitting them to be intentionally killed by others in any situation.

That assisted suicide will soon be legalized in some form in the United States and elsewhere is a foregone conclusion. We are nearing the pit at the bottom of the slippery slope. Opponents of abortion have argued that the depersonalization and legalized execution of the unborn child would lead to similar treatment of his grandmother and his defective elder brother or sister. But the roots of euthanasia are deeper than abortion.

With the contraceptive pill in the 1960s, man assumed the role of arbiter as to whether and when life shall begin. In contraception, as John Paul II pointed out, men and women "claim a power which belongs solely to God: the power to decide, in a final analysis. the coming into existence of a human person. They assume the qualification not of being cooperators in God's creative power, but the ultimate depositaries of the source of human life." Audience, Sept.17, 1983. But if man is the arbiter as to whether and when life shall begin, there is no inherent reason why he should not act as the arbiter of when it shall end, as in abortion and euthanasia.

Moreover, the contraceptive ethic is premised on the idea that there is such a thing as a life not worth living and that man has the right to enforce his own judgment in that regard. If he enforces that judgment as to prospective life through contraception, it ought not to be surprising if he enforces it as to existing life through abortion and euthanasia.

Legalized surgical abortion, since 1973, has ended the lives of more than 30 million potential taxpayers. Early abortions, caused by pills, IUDs and other abortifacients, have ended the lives of many times that number. By 2050, one American in 20 will be age 85 or over and one in five will be over 65. The fertility rate in this country has been below the replacement level of 2.1 children per woman contraceptive for two decades. In 1900, there were 10 times as many children below 18 as there were adults over 65. By 2030, there will be slightly more people over 65 than under 18. "In fact, the population is aging because both fertility rates and mortality rates are below their long-term historic averages." Samuel H. Preston, "Children Will Pay," N.Y. Times Magazine, Sept. 29, 1996. We should not tee surprised when the secular, relativist, contraceptive society turns to euthanasia as a remedy for the problems caused by the increasing proportion of old people which itself is a result of the anti-life ethic.

ABOUT THE AUTHOR

Professor Charles E. Rice teaches at Notre Dame University School of Law, South Bend, Indiana

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