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A Right to Suicide Does Not Entail a Right to Assisted Death

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Jtournal ofMedical Ethics 1997; 23: 51-54 J Med Ethics: first published as 10.1136/jme.23.1.51 on 1 February 1997. Downloaded from A right to suicide does not entail a right to assisted death Martin Gunderson Macalester College, St Paul, Minnesota, USA Abstract merely providing comfort or giving a person the Many people believe that it is permissible for people who means to commit suicide when there is no reason to are sufferingfrom terminal illnesses to commit suicide or suspect that the recipient wants to die. even that such people have a right to commit suicide. In this paper I address two central issues. First, I Some have also argued that itfollows that it is assume that it is permissible for a person to commit permissible for them, or that they have a right, to use the suicide and ask whether it follows that it is also assistance of another person. First, I assume that it is permissible for the person to employ an agent to permissible for a person to commit suicide and ask assist in the death. Second, I assume that people whether itfollows that it is also permissible for the person have a right to commit suicide and ask whether it to employ an agent to assist in the death. Second, I follows that the right holders have a right to employ assume that people have a right to commit suicide and an agent to assist with the death. My purpose is not ask whether itfollows that the right holders have a right to argue that suicide is morally permissible or that to employ an agent to assist with the death. I argue that there is a moral right to commit suicide, but to seecopyright. the permissibility ofsuicide does not by itself entail the what follows from these assumptions. permissibility of employing someone to assist in the There are, of course, other ways to argue for the suicide. I also argue that the right to commit suicide does right to (or the permissibility of) assisted death. It not by itselfentail the right to assisted death. Instead, might be argued on utilitarian grounds that it is whatfollows is that there is a right not to have necessary to prevent terrible suffering. It might also unreasonable restrictions placed on the means by which be argued that there is a right to health care and that one can exercise one's right to commit suicide. Whether assisted death should be seen as part of that right. a restriction is reasonable depends on the conclusion Whatever the merits of these arguments, I shall http://jme.bmj.com/ reached when one has weighed a number ofpolicy restrict myself to the claim that if it is permissible (or considerations. if there is a right) to commit suicide then it follows straightaway that it is permissible (or that there is a right) to employ an agent to assist with the death. Introduction There can be powerful reasons for considering suicide, such as unbearable pain and debilitating Permissibility and agents terminal illness that renders worthwhile human life In his book The End of Life: Euthanasia and Morality on October 1, 2021 by guest. Protected impossible.' If such reasons are not overridden by James Rachels argues that those who believe that countervailing moral considerations they provide a suicide is morally permissible are committed to the justification for suicide.' Some go further and claim view that assisted death is also sometimes permis- that we have a right to commit suicide.2 But it is not sible.4 Rachels begins with a general principle of always easy or even possible to commit suicide practical reason which he states in the following without help. In such cases the person who wants to manner: die may also want the assistance of another. Assisted death occurs when someone intentionally assists in "If it is permissible for a person (or if a person has causing another's voluntary death. This may involve a right) to do a certain action, or bring about a knowingly providing the means for another to certain situation, then it is permissible for that commit suicide or actually killing a person who person (or he or she has a right) to enlist the freely wants to die.3 It does not include such assistance as given aid of someone else in doing the act or bringing about the situation, provided that this does not violate the rights of third parties".5 Key words I shall call principles of this sort "agency prin- Bioethics; right to die; euthanasia; assisted suicide. ciples". Rachels states the caveat that using an agent 52 A right to suicide does not entail a right to assisted death J Med Ethics: first published as 10.1136/jme.23.1.51 on 1 February 1997. Downloaded from must not violate anyone's rights in order to avoid death.8 The social pressure to engage in assisted obvious counter-examples. As Rachels notes: death need not take the form of coercion or undue duress which would constitute a rights violation. It "if you invite me to your party, I may have the right might rather constitute a subtle form of societal or to attend, but not necessarily the right to have family expectation that influences choice. In short, someone else go in my place....". 5 there can be good consequentialist reasons for adopting a policy which does not permit assisted Rachels's caveat avoids such counter-examples, death, even though the reasons are not so funda- since using an agent in such a case would violate the mental as to involve rights. terms of the invitation and thereby the host's rights. I am not arguing that such policy considerations Rachels's agency principle lumps together having in fact constitute a compelling reason against the a right to do something and the permissibility of permissibility of assisted death or even that the doing something, but it is important to keep these factual claims on which they are based are true. I am distinct. I shall begin with an agency principle stated rather arguing that the plausibility of such claims solely in terms of permissibility. Rachels's argument needs to be taken into account in determining can then be outlined as follows: whether assisted death is permissible. It is simply not true that if suicide is morally permissible, then it 1. If it is permissible for a person to do a certain follows straightaway that it is also morally permis- action, then it is permissible for that person to enlist sible to use an agent to commit suicide as long as no the freely given aid of someone else in doing the act one's rights are violated. The argument that it or bringing about the situation, provided that the follows from the permissibility of suicide that rights of others are not violated.5 assisted death is also permissible requires a factual 2. Suicide is permissible. premise that the benefits gained by the use of 3. Therefore, it is permissible for a person who agents are not overridden by harmful consequences. wants to commit suicide to enlist the freely given aid Such a premise must be established by empirical of another to bring about his or her death as long as investigation and not simply by moral analysis. the rights of others are not violated. copyright. Let us assume that the second premise is true - that Rights and agents suicide is morally permissible. The main concern, The right to commit suicide, if it exists, is most then, is with the version of the agency principle plausibly construed as what H L A Hart calls a stated in the first premise. general liberty right, which correlates with a duty of A defender of the agency principle needs to worry all persons not to prevent the exercise of that right.9 not just about rights' violations in specific cases, but Few would argue that the right to commit suicide is about the consequences of adopting an agency a positive welfare right like the right to adequate http://jme.bmj.com/ principle in a given area. In the case of assisted medical care or shelter. None the less, I shall death, for example, many would argue that there are consider this possibility later. good utilitarian reasons for not allowing an agent to It might be thought that a stronger argument act on behalf of a person who wants to be killed. could be given for the agency principle by stating the Recent literature has highlighted three such principle in terms of rights rather than permissibility. concerns. First, it has been argued that allowing To see why this is tempting several features of liberty physicians to engage in assisted death would be rights need to be noted. First, a liberty right is not a on October 1, 2021 by guest. Protected harmful to the standards and role of the medical special right which arises out of a particular agree- profession.6 This harm does not necessarily involve ment or institution and which thus correlates with a the violation of anyone's rights, however. Even if duty of only some persons.'0 Second, liberty rights people have a right to a minimum level of medical do not correlate with a duty to help a person exercise care, they do not have a right that the medical pro- his or her rights. Even if there is a liberty right to fession adopt the most desirable standards of care or commit suicide it does not follow that anyone has a the highest possible values.
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