Right to Liberty, Property, and...Death?

            End-of-life care has been a hot topic of debate for quite a while now, in many different contexts. With recent health care delivery reforms, practitioners and policy makers have been debating the pros and cons of making options like do not resuscitate (DNRs) more available instead of spending thousands to prolong lives, usually not for very long, in uncomfortable conditions. 75% of Americans die in a hospital bed, though most would rather die at home, and there is debate as to whether the quality is more important than quantity when it comes to life—adults should be encouraged to think about their end-of-life options, write wills, and seek out DNRs while they are still able-minded, so family members and physicians don’t have to make these hard decisions later (usually unwanted prolongation of life).

             Some may argue that “letting” patients amounts to assisted suicide, and now a more explicit example of this “assisted suicide” is being evaluated in the English judicial system. Tony Nicklinson, a 58-year-old stroke victim who now suffers from “locked-in syndrome,” or complete paralysis from the neck down, has sought legal protection for any doctor who may assist his suicide – although in his case, this would amount to murder, as Nicklinson is incapable of performing any suicidal action. The case will be heard in court, now that a judge has permitted it, and he and his wife are getting the word out about their pursuit of the “right-to-die.” The evaluation of this case requires not only a defining of the line between assisted suicide and murder, but between end-of-life decisions like DNRs or “pulling the plug” of unconscious patients and assisted suicides.

            Suicide in our culture is a crime, though often one without a defendant, and so assisting a suicide is also criminalized. Why is this? Suicide is unacceptable and scary to us because it is a reflection of our society; it reminds us that we live in a world that may not be worth it, in communities that can make some devalue their life to dangerous levels and may not offer enough support to those who are a hazard to themselves. This is obviously different from the image of a beloved grandparent, unconscious in a hospital, being kept alive by various machines—but who has lived a full life, and whose natural time of passing has clearly come. It’s a hard decision to make, and a hard time in any family, but it is one that has come to be socially acceptable (although some argue the decision to end life should come before one ends up uncomfortably hooked up to countless tubes, and this can only happen if we as a society becomes more comfortable the fact that everyone dies).

But Nicklinson’s case is an ambiguity—he is not unconscious, and in some ways is very much alive, his handicap being only a physical one (though very severe). But he, in his aliveness and consciousness, wants the right to commit suicide, and to seek out help should he make that decision but find himself incapable of carrying it out. This is not the suicide we typically associate, which is often seen as a tragic and irrational response to pressures that could have been otherwise dealt with. This is a calculated decision which, while made under the pressure of intense frustration and suffering, can be seen as a retroactive DNR – Nicklinson himself said (through electronic boards—he cannot speak), “If I had my time again, and knew then what I know now, I would not have called the ambulance but net nature take its course.” Then there is the added complication that a doctor would have to technically commit murder to respect his wishes, which is both illegal and against the medical code of ethics. So, should Nicklinson be allowed to commit suicide, given that he is currently alive and as well as he can be, breathing, pumping blood, and thinking on his own, but requiring assistance for essentially all other functions?

I think if Nicklinson can get a loved one to assist him in his suicide, the assistant should not be persecuted legally. We have to assume that, even if Nicklinson’s judgment is clouded by his suffering, a loved one would be able to judge the situation best, and would only help if he/she believed it was truly the best decision. A doctor could not perform this function—death is still a very personal matter in our society, and many of the issues with end-of-life care is rooted in the fact that it is hard for any external, authority figure (doctors, hospitals, the government) to interfere in something so personal. We can never expect a doctor to go around performing assisted suicides, even after careful consideration, and even if they believe the patient does have a “right-to-die,” because doctors (in our society) have made a commitment to the right to life. Legal protection for a loved one as an assistant to suicide (in a very clear, almost public situation) may be called for, but protection for doctors in this role is too big of a value shift. Doctors protect life until they can no longer, and the only debate regarding end-of-life in this sense is how we should define “can no longer extend life” (whether quality should come into play), but they cannot “prematurely” end a life that is under no threat, no matter how poor the quality of that life may be, without changing the role of the doctor and opening entirely new ethical debates and “medical” practices.

http://www.bbc.co.uk/news/uk-17336774

http://www.cbsnews.com/video/watch/?id=6754650n&tag=contentBody;storyMediaBox