Rights Theory, Liberty

Why Limit PAD to the Terminally Ill?

While catching up on the recent Cato Unbound conversations, I just read through Howard Ball’s lead essay and Philip Nitschke’s response about physician assisted death. Ball argues that a terminally ill patient’s interest in autonomy or the alleviation of suffering can justify granting her legal access to deadly drugs. In these cases, Ball claims that medical practitioners can permissibly write prescriptions for deadly drugs as well, but he confines his argument to the terminally ill.

In his response, Nitschke asks why access to deadly drugs should involve prescriptions or medical practitioners at all. Moreover, why limit the right to die only to terminally ill patients? I am sympathetic to Nitschke’s approach. While discussing places like Oregon and Washington that permit access to deadly drugs only under strict regulations, he points out that there may be a substantially greater number of patients who seek physician assisted dying than even these relatively permissive jurisdictions allow.

To get a sense of the patients that Nitschke is referring to, consider Don and Iris Flounders, an Australian couple who were members of Exit International, a right to die advocacy group founded by Nitschke. In a video statement Don and Iris explain their choice to travel to Mexico to buy deadly drugs so that they could choose the time and manner of their deaths. Though Don had incurable mesothelioma, Iris would not have qualified for physician assisted suicide under the regulations Ball supports, even though she was clearly competent and her decision to die was voluntary.

In the video statement Don reads,

We both very much resented the fact that we had to travel half way around the world just to have the choice. We should have been able to get this drug at our local pharmacy, to be put safely away just in case of the necessity in the future.

He then describes a federal raid on his home in search of the deadly drugs.

Like Nitzchke, I think that everyone should have the right to end their own lives and I am curious about why Ball restricts his argument only to terminally ill patients. Ball’s arguments in favor of legal rights to die for terminally ill patients also tell in favor of legal rights to die for others who would autonomously choose to die.

Furthermore, there is evidence that at least some non-terminally ill people like Iris Flounders and patients with progressive illnesses would value legal access to deadly drugs, but that allowing access would not significantly increase suicides in the general population. For example, deadly drugs are relatively more available in Mexico compared to other places, but Mexico has a comparatively low suicide rate. In addition, several right to die organizations in Switzerland offer assisted suicide to patients without specifying any medical preconditions for access. While some non-terminal clients like British composer Sir Edward Downes have ended their lives at the clinics, they have not set Swiss society on any slippery slopes towards a suicide epidemic as Ball predicts.

I suspect that much of the resistance to suicide for non-terminal people comes from the intuition that suicide is generally a terrible idea when one is not already facing death. For example, Danny Scoccia argues that “[healthy people] should be denied suicide assistance and hard paternalism explains why: the vast majority of them are better off alive than dead notwithstanding their belief to the contrary.”

I agree with Scoccia that suicide is very rarely the best choice for healthy adults, but it doesn’t follow that competent people should be denied access to deadly drugs just because it is a poor choice to use them.

Critics of PAD might respond that it is wrong for physicians or vendors to assist a healthy person in making a deadly choice even if it is their choice to make. Even if this is so, then we may ask why the physician-assisted suicide debate needs to involve physicians at all. Why is suicide considered a medical procedure that requires a physician? If a person chooses to refuse lifesaving treatment, or die at home from a terminal disease, or make a series of destructive and risky lifestyle choices that will ultimately cause her death, she need not consult a physician for permission to do so. Why should a physician’s authorization be required for people to end their lives with deadly drugs?

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Author: Jessica Flanigan
  • Peter Lewin

    Jessica’s discussion is right on target. I would only add that there are degrees and layers of individual rights violation when it comes to suicide, to wit:

    1. Prohibition of certain drugs

    2. Allowing doctors to be the gatekeepers for “prescription” drugs

    3. Allowing individuals to choose suicide only in terminal cases

    4. Considering suicide a “crime” in general (this one is the most crazy). So, theoretically, I can be convicted of trying to kill myself?

    All 4 should be scrapped, but surely we can agree that the scrapping of any of them is an improvement.

    Also, the following is interesting: “Danny Scoccia argues that “[healthy people] should be denied suicide assistance and hard paternalism explains why: the vast majority of them are better off alive than dead notwithstanding their belief to the contrary.”

    This presumes to know what is good for people better than they know themselves – crass paternalism.

    • From what I’ve heard the reasoning behind 4 is not to actually convict people that try to kill themselves, but to make it legal for police/first-responders to try and stop them against their will. Very often they aren’t in a healthy state of mind and will get better in the future and be glad they were stopped. Presumably the police would have no warrant to intervene if suicide weren’t illegal. But don’t take my word 100% on that.

    • Jessica Flanigan

      I agree with your judgment about paternalism but a lot of people seem to accept that some paternalism is permissible (e.g. seatbelt laws). I am against seat belt laws but I think those who favor them have similar reasons for objection to the legalization of deadly drugs. Elsewhere in my work I argue that physicians should not be empowered as gatekeepers for prescription drugs, for similar epistemic reasons as the ones you mention.

    • Reverend Draco

      It’s not Paternalism – it’s Slavery. It is the assumption that you are owned, and therefore, have no say in what is done to you.

      You are owned, so you will wear a seatbelt, as your owner commands – or else.
      You are owned, so you will not ingest certain substances, as your owner commands – or else.
      You are owned, so you will not make your own decision on when, where, and how you shall die. . .or else.

  • good_in_theory

    Something that has been on my mind recently is the right to die in the context of incarceration. If life incarceration and solitary confinement and so on are on the table, in-mates seem to me to be in special need of the right to determine whether they live or die.

  • Ford Oxaal

    It’s not your life. You are here by a gratuitous act of bounty on the part of a bounteous God. You do, however, own your sins — feel free to kill them off at any time.

  • Reverend Draco

    When you buy a car, you own it – nobody can tell you how long you have to keep it, or in what condition is has to be before you can get rid of it.

    The one thing that each person owns outright is their life. Nobody else has any right, whatsoever, to decide when, where, and under what conditions a person may end their life – unless, of course, that person is their Slave.

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