A Death of One’s Own

PRINCETON – Dudley Clendinen, a writer and journalist, has amyotrophic lateral sclerosis (ALS), a terminal degenerative illness. In The New York Times earlier this year, he wrote movingly both of his current enjoyment of his life, and of his plan to end it when, as he put it, “the music stops – when I can’t tie my bow tie, tell a funny story, walk my dog, talk with Whitney, kiss someone special, or tap out lines like this.” A friend told Clendinen that he needed to buy a gun. In the United States, you can buy a gun and put a bullet through your brain without breaking any laws. But if you are a law-abiding person who is already too ill to buy a gun, or to use one, or if shooting yourself doesn’t strike you as a peaceful and dignified way to end your life, or if you just don’t want to leave a mess for others to clean up, what are you to do? You can’t ask someone else to shoot you, and, in most countries, if you tell your doctor that you have had enough, and that you would like his or her assistance in dying, you are asking your doctor to commit a crime. Last month, an expert panel of the Royal Society of Canada, chaired by Udo Schüklenk, a professor of bioethics at Queens University, released a report on decision-making at the end of life. The report provides a strong argument for allowing doctors to help their patients to die, provided that the patients are competent and freely request such assistance. The ethical basis of the panel’s argument is not so much the avoidance of unnecessary suffering in terminally ill patients, but rather the core value of individual autonomy or self-determination. “The manner of our dying,” the panel concludes, “reflects our sense of what is important just as much as do the other central decisions in our lives.” In a state that protects individual rights, therefore, deciding how to die ought to be recognized as such a right. The report also offers an up-to-date review of how assistance by physicians in ending life is working in the “living laboratories” – the jurisdictions where it is legal. In Switzerland, as well as in the US states of Oregon, Washington, and Montana, the law now permits physicians, on request, to supply a terminally ill patient with a prescription for a drug that will bring about a peaceful death. In The Netherlands, Belgium, and Luxembourg, doctors have the additional option of responding to the patient’s request by giving the patient a lethal injection. The panel examined reports from each of these jurisdictions, with the exception of Montana (where legalization of assistance in dying occurred only in 2009, and reliable data are not yet available). In The Netherlands, voluntary euthanasia accounted for 1.7% of all deaths in 2005 – exactly the same level as in 1990. Moreover, the frequency of ending a patient’s life without an explicit request from the patient fell by half during the same period, from 0.8% to 0.4%. Indeed, several surveys suggest that ending a patient’s life without an explicit request is much more common in other countries, where patients cannot lawfully ask a doctor to end their lives. In Belgium, although voluntary euthanasia rose from 1.1% of all deaths in 1998 to 1.9% in 2007, the frequency of ending a patient’s life without an explicit request fell from 3.2% to 1.8%. In Oregon, where the Death with Dignity Act has been in effect for 13 years, the annual number of physician-assisted deaths has yet to reach 100 per year, and the annual total in Washington is even lower. The Canadian panel therefore concluded that there is strong evidence to rebut one of the greatest fears that opponents of voluntary euthanasia or physician-assisted dying often voice – that it is the first step down a slippery slope towards more widespread medical killing. The panel also found inadequate several other objections to legalization, and recommended that the law in Canada be changed to permit both physician-assisted suicide and voluntary euthanasia. Surveys show that more than two-thirds of Canadians support legalization of voluntary euthanasia – a level that has held steady for several decades. So it is not surprising that the report received strong backing in the mainstream Canadian media. What is more puzzling is the cool response from the country’s political parties, none of which indicated a willingness to support law reform in this area. There is a similar contrast between public opinion and political (in)action elsewhere, including the United Kingdom, Australia, New Zealand, and several continental European countries. Why, when it comes to dying, do democratic institutions so often fail to translate what people want into legislation? I suspect that, above all, mainstream politicians fear religious institutions that oppose voluntary euthanasia, even though individual believers often do not follow their religious leaders’ views. Polls in various countries have shown that a majority of Roman Catholics, for example, support legalization of voluntary euthanasia. Even in strongly Catholic Poland, more people now support legalization than oppose it. In any case, the religious beliefs of a minority should not deny individuals like Dudley Clendinen the right to end their lives in the manner of their own choosing. Peter Singer is a professor of bioethics at Princeton University and Laureate Professor at the University of Melbourne. His books include Animal Liberation, Practical Ethics, The Expanding Circle, and The Life You Can Save. Copyright: Project Syndicate, 2011.www.project-syndicate.org