California’s End of Life Option law went into effect June 9. The law permits a physician to prescribe lethal medication to a patient with a terminal illness.
The law defines a terminal illness as “an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, result in death within six months.”
For some, this is a welcome expansion of the right to die with dignity. For others, it is a sign of a “culture of death.” In any case, the new law invites reflection on the meaning of dying and living well.
As the law went into effect, a lawsuit was filed aiming to block it. The plaintiffs include the American Academy of Medical Ethics, a conservative group that also is opposed to abortion and homosexuality.
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The lawsuit contends terminal diagnoses often are not reliable. It states, “The business of prognosticating a patient’s future lifespan is inherently limited, if not altogether flawed.”
The lawsuit also worries that interested parties may coerce people into taking the suicide medication. Health care facilities or legal heirs may have a vested interest in seeing people die.
But the law makes it a felony to force someone to take the lethal medication. And it stipulates only one of the two mandatory witnesses can be an interested party.
The lawsuit views suicide as a mental health problem, connected to depression. From this perspective, suicide is irrational and people requesting it need psychological help, not access to deadly medicines.
This may explain why the California law maintains that the end of life option is not suicide. The law states, “Self-administration of an aid-in-dying drug is not suicide.” It explains, “Action taken in accordance with the act shall not constitute, among other things, suicide or homicide.”
The word “suicide” is laden with moral, emotional and legal significance. It remains illegal in California to abet a “suicide,” though the new law allows a doctor to prescribe “end of life” medication.
The euphemistic language of the legislation is unfortunate. It avoids the main ethical question, which is whether suicide is ever rational and morally permissible.
Some think suicide is always immoral. The Catholic tradition teaches that suicide is as wrong as murder. It rejects God’s sovereignty and refuses the commandment of self-love. Pope Francis recently argued that physician-assisted suicide was part of a “throwaway culture” linked to the “triumph of selfishness.”
Others disagree. A variety of traditions connect suicide to self-respect and rational autonomy. The Japanese code of the samurai – the bushido code – included ritual suicide in the face of dishonor. The ancient Roman Stoics had a similar idea.
The Stoic philosopher Seneca advised against clinging to life. He said, “The wise man will live as long as he ought, not as long as he can.” He concluded, “ It is not a question of dying earlier or later, but of dying well or ill.”
There is no middle position in this conflict of morals. Some believe death should be freely chosen and that it is better to die well than to live poorly. Others view suicide as inherently sinful. On the one hand, we have rational autonomy and the attempt to die with dignity. On the other, we have an obligation to respect God’s will.
There is space for some agreement. Several of the points discussed above should be a concern even for advocates of assisted suicide. Coercion is a danger. Misdiagnoses are a problem. Suffering people need palliative care. And the dying need spiritual support.
We will continue to disagree about assisted suicide. But each of us only has one life to live and one death to endure. Regardless of the outcome of the legal dispute, everyone ought to think about the morality of suicide.
This issue opens deep questions about life, the universe, and everything. Is life a right or an obligation? Is life always worth living? Are you entitled to make decisions about the time and manner of your own death?
Those are not easy questions. A meaningful life involves struggling with them. A good death comes only after we’ve made peace with the question of what makes life worth living and what counts as living and dying well.