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Reader's response in the Court of Thinking concerning the spring issue focus on "assisted suicide and the right to die."


The right to die and assisted suicide are quite distinct issues, both practically and philosophically. Conflating them can only confuse thinking about them. The right to die rests on and follows from the belief that a person owns himself or herself. A person has the right to kill oneself because one's life is one's own. Assisted suicide is the very different event when a person or a group of persons actively kill another person who wants to die. (I am not discussing situations in which a very ill person wants to die and heroic medical measures are discontinued and/or nature is let to run its course, which seem to me not to raise the same kind of issues that active killing does.) The late Charles Alan Wright, one of the distinguished American legal scholars of the 20th Century (and one of the most liberal Republicans I have known), convinced me that the problem with active killing of a would-be suicide is that since "someone has to decide" and the undiscoverable motives of that someone can be murderous, to legalize assisted suicide is to legalize murder. I concur with Dr. Margaret Somerville's emphasis on the positive value, for society, of an invariant rule that physicians be committed to life and opponents of death and dying. I agree with Wesley J. Smith's concern that in this age of HMOs and the high cost of medicine, the providers of medical care have a profit motive to kill the very sick and that conceivably this might find its way into policies that push medical decisions in that direction. The deeper and inherent conflict of interest in actively assisted suicide, though, abides in the intimate power of close family members in their influential and obviously relevant communications with the physician or physicians attending a very ill relative. Here the most dangerous cliche would be the gauzy idea that closest family members can be assumed to have nothing but love and concern for their suffering kinsperson. Usually we can assume that's so, but it is also a commonplace that among some close relatives there is impatience, rivalry, distrust, strong dislike, or hate, there are scores to settle, and beyond that realm there are the astronomical costs of ongoing intensive medical care and the possibility of greed or need for assets that will be inherited upon the death of the ailing one. Most people are too decent to seek, for selfish reasons, to have their ailing relatives actively killed, but even then, given the complexity and subtlety of the elements entering into such a huge question, the influence of unconscious motivations cannot be ruled out by words in laws or regulations. The unavoidable problem with actively assisted killing is that the person who does it or sanctions a doctor's doing it may have concealed, possibly resisted, but inexpungeable mean or selfish motives that result in legalized, but unpunishable murder. An economist friend of mine, the late Clifton Grubbs, once asked me to help him get a paper he had written, "The Solution Mystique," published. I could not, but his thesis was brilliant: that Americans think there's a solution for everything, but that in fact there are many problems for which there are no solutions. My position (and Wright's) here opens up such a solutionless problem, because it leaves a person who wishes to die alive and suffering. It is an incredible failure of the medical profession that only in recent years has the alleviation of pain been established as a primary duty of medical care. Surely the alleviation of the pain of a gravely ill person is the doctor's high duty, equalled only by his or her duty to save the life of the patient if that can be done. On such questions as marijuana in medical care or whether to give morphine to terminally ill patients (except perhaps for those few for whom lucidity is the prime value of surviving), the alleviation of pain trumps all other considerations. Fighting for social policy along these lines is the least we owe to the suffering persons who want to die, but whose active killing we continue to prohibit because legalizing that would foreseeably create a realm of legalized murder. It is in the context of these thoughts that I believe that legalizing actively assisted suicide would violate the respect for human life which helps us hold back the violence of the cosmos and would poison an unpredictable number of family histories down through the generations. But I say so with trepidation, the subject is so terrible, and the imaginable situations of suffering are without limit. Ronnie Dugger

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