Suicide at the Ballot Box: Vote Yes on Question 2

“There is but one truly serious philosophical problem, and that is suicide.”

Albert Camus, The Myth of Sisyphus 

On Tuesday, Massachusetts voters will be asked to wrestle with that problem and vote up or down on Question 2.  I urge them to vote yes.

If Question 2 passes it will become the “Death With Dignity” law, allowing for physician assisted suicide; that is, it would allow doctors to prescribe lethal “medication” to patients with an incurable disease and less than six months to live.[1]   The law would not authorize euthanasia, in which a physician actually administers the lethal drugs or mercy killings.  Furthermore, the law would criminalize “coercing” people into requesting a prescription.  Physician assisted suicide is currently legal in Oregon, Washington state and Montana.  On the other hand the right to refuse life saving treatment is nearly absolute in the United States.

Unsurprisingly, and thankfully, the measure has provoked impassioned argument on both sides.  That argument caused me to reexamine my libertarian instinct to vote yes (hypothetically since I am a New Jersey resident) but failed to sway my conviction.  Among the arguments on the “Vote No” side is what many consider to be the insufficiency of the safeguards built into the law.  For example, many criticize the fact that the law does not require patients to be evaluated by a psychiatrist before requesting lethal medications.  The law would however require a psychiatrist to evaluate the patient if the physician believed the patient was suffering from a mental disorder affecting her judgment.  I, however, would not require psychiatric evaluations of patients with no other symptoms of mental-illness.  To do so, to me, implies that one is treating the desire to end one’s life itself as a sign of such illness.  While this question hinges on a philosophical debate on the nature of mental illness which I am not qualified to fully hash out; it strikes me as absurd, and demeaning, to treat a desire to die, especially in the circumstances in which this law would apply, as a sign of mental illness.

In a recent New York Times Op-Ed[2] bioethicist Ezekiel Emmanuel argues convincingly that the majority of physician-assisted suicides are not people in extraordinary physical pain but people overwhelmed with fear, depression, and hopelessness.  He writes, “[i]n this light, physical assisted suicide looks less like a good death in the face of unremitting pain and more like plain old suicide.”  While this is rhetorically powerful, it begs the question: what’s wrong with allowing doctors to help patients commit suicide in some well defined situations.[3]  I say nothing.  Ezekiel continues, “our response to suicidal feelings associated with depression and hopelessness is not to give people the means to end their lives but to offer them counseling and caring.”  Nobody is arguing that those seeking to end their lives should be denied counseling and caring; rather that in certain circumstances it is permissible to also allow them to commit suicide.

Similarly, Ira Byock, writing in the Atlantic,[4] opposes physician assisted suicide in large part because it does not fit into what he says should be the progressive agenda to improve end of life care.  While I agree with all of his proposals for doing just that, it does not follow that physician-assisted suicide should be left out.  Like Emmanuel, Byock seems to assume that suicide could only be the desperate surrender of a patient and that legalizing it could only be the desperate surrender of progressives in the face of a system that struggles to care for those close to death.  Rather, I firmly believe that suicide should be available for patients no matter how good or bad end of life care is, the right to sufficient end of life care and the right to suicide may matter at the same time, but they are complements not replacements.  Also, I, apparently unlike Byock have faith in progressives that they will not treat this as some sort of sufficient band-aid for end of life care and move on to other social ills to fix.

Furthermore, Byock concedes that “as Jean Paul Sartre reminded us, suicide is always an option.”  However, for Sartre Suicide was more than an option.  “Jean-Paul Sartre was likewise struck by the possibility of suicide as an assertion of authentic human will in the face of absurdity. Suicide is, according to Sartre, an opportunity to stake out our understanding of our essence as individuals in a godless world. For the existentialists, suicide was not a choice shaped mainly by moral considerations but by concerns about the individual as the sole source of meaning in a meaningless universe.”[5]  Doesn’t that sound like something progressives should fight for?  Suicide is thus the expression of an individual will, a will that neither Byock, nor the Commonwealth of Massachusetts, should attempt to coerce into a different expression of itself.  For that is what voting no on Question 2 would do.  Byock says that suicide is always an option.  However, for many of the people who would be eligible for physician-assisted suicide should Question 2 become law, that is only true in the most formalistic sense.  For many, suicide without the help of a doctor to make to make it more likely to succeed with as little pain as possible,[6] would be far too difficult to be a viable option.

Finally, Byock’s statement that “Progressives in Massachusetts who vote for Question 2 should remember that by the end of Orwell’s 1984 the protagonist, Winston Smith, loved Big Brother,” confuses me.  It may be that he is saying we who vote for it have fallen pray to the “Newspeak” of its advocates.[7]  It may be that he is saying that while it may be Big Brother-ish to prohibit suicide we will be thankful for it in the end. I simply disagree with the first possible meaning, because I have faith in voters to think through what they are doing.  As for the second, even if that is true, we cannot accept even a Big Brother that we do come to love.

The most compelling, fear of those fighting against the law is that this will open the door for abuse of a vulnerable population.  They imagine relatives (or, even more insidiously, insurance companies) pressuring the sick and elderly into “choosing” suicide in order to spare costs.  While this is certainly troubling and certainly a place in which regulation would be necessary, it seems to me that this would only rarely be the case.  Ezekiel’s article cites the lack of mass appeal of physician assisted suicide as a reason not to vote for Question 2.  The lack of occurrences of physician assisted suicide however, makes me far more comfortable with legalizing it.   The fact that Oregon and the Netherlands have had very few cases of physician assisted suicide seems to me to prove that incidents of suicide are unlikely to be the result of a whim or undue pressure from economically interested parties.   More basically, I do not think that the government’s stripping people of choice is the proper way to protect them from undue influence or the trauma of having to make a hard choice.   The question of suicide is personal, nuanced, difficult and fraught with emotions, philosophies, and faith.  It is not a question the government has any business answering for an individual.