State legislatures across the United States are considering “Death with Dignity” laws allowing “Physician-Assisted Suicide” (PAS) or “Physician-Aid in Dying” (PAD) for patients with terminal illness and a life expectancy of six months or less. Oregon, Washington, and Vermont have already legalized such procedures, and in California a similar “End of Life Option Act” has been proposed. Similar laws are already operational in countries like Belgium and the Netherlands, and have been proposed for deliberation across the Western world in places like Germany and the United Kingdom.
The argument for PAD is it allows people suffering through debilitating terminal illnesses to control how they die, offering relief from suffering and letting them maintain their dignity.
Supporters of PAD think dignity requires personal choice. Rational choice is a distinguishing element of human life; unlike other animals that act purely on instinct, humans exercise free will. Is not autonomy part of human dignity?
In the words of Jena Johnson, an “end-of-life counselor” for Compassion and Choices in Portland, a “good death” is “a death in which a person’s wishes for the end of his or her life are respected and carried out. No matter what those wishes are.” The editors of The Economist argue in the lead editorial (June 27 edition) for the “right to die with a doctor’s help at the time and in the manner of your own choosing.” They argue against “moral absolutists” who say, “deliberately ending a human life is wrong, because life is sacred and the endurance of suffering confers its own dignity.” The magazine counters: “Liberty and autonomy are sources of human dignity, too. Both add to the value of a life.”
In contrast, the Judeo-Christian view grounds human dignity in the teaching that humans are created in the image of God and therefore intrinsically valuable. This is a more inclusive, arguably firmer foundation, but let us accept humans’ intelligence or “autonomy” as our distinctive feature and source of dignity, since “Death with Dignity” defenders prefer this formulation. As the Enlightenment philosopher Immanuel Kant helps us understand, PAD is inconsistent even with this conception of human dignity.
In The Metaphysics of Ethics, Kant grounds human dignity in autonomy, as do the editors of The Economist. The human person is worthy of treatment as an end or good, not merely a means to another end, by virtue of possessing a rational will:
Now I say that man and every reasonable agent exists as an end in himself, and not as a mere mean or instrumental to be employed by any will whatsoever, not even by his own, but must in every action regard his existence, and that of every other Intelligent, as an end in itself.
On this basis, Kant concludes that human dignity rules out behaviors that demean or fail to respect human persons, and imparts a “duty owed” to self and others. Ethical and legal provisions against murder and theft are obvious examples of justified restrictions on behavior toward persons.
The principle of human dignity rules out suicide, as Kant explains: “He who proposes to commit suicide, has to ask himself if his action be consistent with the idea of humanity as an end in itself.” He writes:
The man who destroys his organic system to escape from sorrow and distress, makes use of his person as a mean toward the supporting himself in a state of comfort and ease until the end of life. But humanity is not a thing, i.e., is not that which can be dealt with as a mean singly, but is that which must at all times be regarded as an end in itself. I am therefore not at liberty to dispose of that humanity which constitutes my person, either by killing, maiming, or mutilating it.
To purposefully end one’s life is a failure to render a duty owed to a human person, even when natural death is imminent. Even if personal choice is central to human dignity, as “right to die” defenders argue, choosing death violates that dignity.
PAD will set a dangerous precedent, eroding the acceptance of duties owed that the principle of human dignity demands. Indeed, while The Economist scoffs at the “slippery slope” arguments of PAD’s opponents, James Mumford notes that the magazine “manages to slide down that slope in the course of its own 1,200 word leader.” The editors argue that PAD should also apply to patients suffering from chronic disabling conditions, or “mental pain”:
The hardest question is whether doctor-assisted dying should be available for those in mental anguish. No one wants to make suicide easier for the depressed: many will recover and enjoy life again. But mental pain is as real as physical pain, even though it is harder for onlookers to gauge. And even among the terminally ill, the suffering that causes some to seek a quicker death may not be physical. Doctor-assisted death on grounds of mental suffering should therefore be allowed.
The inexorable moral logic of choice threatens to expand its domain. It is a seductive logic, especially combined with “compassion.” Without the corollaries of duties owed and curtailment of behaviors that fail to respect human dignity, the logic of choice leads almost inevitably to acceptance of any choice – including suicide or murder.
This is a difficult and sensitive issue, and the intense suffering of patients with terminal illnesses and their families is devastating. Palliative care should be applied, and there is a clear distinction between declining treatment or life-support and PAD. But equating human dignity with unfettered choice, justifying doctor-administered death, is contrary to the principle of human dignity, even in the limited Kantian sense that underlies the “Death with Dignity” movement.
Though well intentioned, “Physician-Aid in Dying” is inconsistent with the very appeal to human dignity its supporters make. There may be a case for PAD, but it is not grounded in respect for human dignity. “Death with Dignity” laws in fact deny human dignity properly understood: regard for human life as intrinsically worthy of respect. Those who wish to preserve human dignity must oppose the trend toward acceptance of so-called “Death with Dignity.”