Advocating for end-of-life rights
“If I cannot give consent to my own death, whose body is this? Who owns my life?” — Sue Rodriguez
Winter kill. That’s what they call it around here when, come spring, not everyone has emerged from their cocoons in the backcountry. “Hey, have you seen Travis?” Winter kill. Those two words tell you that Travis has taken his own life due to health or age. Folks here are tough and independent. They will not spend the last of their time on this planet in assisted living or a hospital—not when they have spent their lifetime in glorious nature, free and autonomous.
Winter kill. It’s no secret how it’s done. You mix a bottle of your favorite alcohol with a thermos of coffee and grab a seat under the stars in below 0 degrees temps. Both the coffee and the alcohol push your body heat out your pores. It doesn’t take long. And if you can’t wait for winter? There is always a Plan B. It’s just messier.
Before Christianity
Euthanasia, or mercy killing, was practiced in many ancient civilizations. Common in the times of the Greeks and Romans it was viewed as an act of mercy for those suffering from incurable diseases or severe physical distress. And then came the Christians and the sanctity of life. They condemned the practice of euthanasia, and it became taboo in many societies. Where Judeo-Christian beliefs are influential, the topic of euthanasia sparks intense moral and ethical controversy.
Worldwide, views on euthanasia vary, stemming from cultural, religious, and social backgrounds. The concept of Prayopavesa—fasting to death—is accepted in Hinduism under very specific conditions and is a decision made without any external pressure. It’s allowed only in cases where death is inevitable and when it’s a means of spiritual liberation.
Philosophical Perspectives on Euthanasia
Various philosophical traditions approach the question of euthanasia through their core ethical principles and theoretical frameworks.
Utilitarianism: Founded on the principle of maximizing happiness and minimizing suffering, Utilitarianism supports euthanasia in situations that bring about the greatest good or least harm for all involved. For utilitarians like Jeremy Bentham and John Stuart Mill, the key is the balance of pleasure over pain, justifying euthanasia if it alleviates suffering.
Liberal Humanism: Emphasizing individual autonomy and the right to self-determination, liberal humanism supports the right of individuals to choose euthanasia. This perspective values the capacity of individuals to make rational decisions about their own lives, including the decision to end one’s life under circumstances of unbearable suffering.
Existentialism: Although not a unified doctrine, existentialist thinkers like Jean-Paul Sartre who emphasize individual freedom, choice, and responsibility support the right of an individual to choose euthanasia. This support is rooted in the belief that individuals should have the autonomy to give meaning to their own life and death.
Secular Humanism: With its focus on human welfare, compassion, and empathy, secular humanism supports euthanasia as a means of relieving suffering. This perspective prioritizes the quality of life and the alleviation of pain and views euthanasia as a compassionate response to terminal illness and intractable suffering.
Pragmatism: Pragmatist philosophy evaluates the truth of beliefs in terms of their practical effects and benefits. They support euthanasia if it is seen as the most compassionate and practical solution for those suffering without hope of recovery. The emphasis is on the outcome of actions and their ability to solve practical problems.
In the other camp
Deontological Ethics: Based on the principles of philosophers like Immanuel Kant, this perspective argues that certain actions are inherently right or wrong, regardless of their outcomes. From a deontological viewpoint, euthanasia is seen as inherently wrong because it violates the principle of respecting the intrinsic value of human life.
Virtue Ethics: Drawing from the ideas of Aristotle, virtue ethics focuses on the character and virtues necessary for a good life. Opponents of euthanasia argue that courage and patience in the face of suffering are virtues, and that euthanasia undermines the development or expression of these virtues.
Social Contract Theory: Based on the ideas of philosophers like John Locke and Jean-Jacques Rousseau, some argue that euthanasia undermines the social contract, which is based on the protection and preservation of life. They contend that allowing euthanasia weakens societal commitments to care for the vulnerable and ill.
Religious traditions generally oppose euthanasia on the grounds of sanctity of life. There are discussions within some religious communities that explore conditions under which end-of-life decisions, including euthanasia, might be morally permissible. These discussions revolve around concepts of compassion, dignity, and the alleviation of suffering.
“It is the quality of life that matters, not the mere fact of living.” — Plato
They Shoot Horses, Don’t They?
I was still in school when I first saw the film. When I was young, death was seen as a failure in life. Suffering was hidden from view. We didn’t talk about friends and family who suddenly disappeared—left to die in a hospital somewhere. Hospice was not established until 1974 in the US. I looked at life, and death, differently after seeing this film.
A 1969 film directed by Sydney Pollack, They Shoot Horses, Don’t They? is set in the Great Depression era. It centers on a brutal dance marathon, highlighting the desperation of contestants Gloria and Robert, who endure physical and psychological hardships for a cash prize. The film examines human suffering, exploitation, and the extremes of the American Dream.The title reflects a key moment in the film, drawing a parallel between the euthanasia of suffering animals and the characters’ struggles—a commentary on the ethics of mercy and the human condition amidst hardship.
You Don’t Know Jack
Laws about euthanasia differ from one country to another, highlighting the deep ethical and moral differences within countries and between them. Belgium, the Netherlands, Canada, and Colombia have legalized euthanasia under strict conditions. These rules focus on patient consent, incurable illness, and unbearable suffering. The laws are designed with thorough oversight to prevent abuse and ensure that the decision is truly in the patient’s best interest. The bureaucracy can often impede the process.
Most countries strictly prohibit euthanasia, treating it as a form of homicide.Their laws are built on prioritizing life under all circumstances.
Dr. Kevorkian is a great example of someone vilified in the press and condemned by radical righteousness. To many, he was and still is a hero. You Don’t Know Jack, directed by Barry Levinson and released in 2010, stars Al Pacino as Dr. Jack Kevorkian, known for assisting terminally ill patients with suicide. The film centers on Kevorkian’s legal battles and the ethical debates around euthanasia and the right to die. It portrays his journey from a pathologist to a controversial figure in American medical ethics. Watching this film opened the door for me to explore the complex legal issues surrounding assisted suicide.
Whose Life Is It Anyway?
The euthanasia debate is extensive and encompasses a wide array of benefits and challenges. Proponents believe euthanasia can offer a dignified end for people with terminal illnesses. Finding relief from unbearable pain and the burden of dependency is of real concern to many. It is the ultimate act of autonomy and personal freedom.
Critics raise serious ethical concerns. What about the potential for misuse and the slippery slope to non-voluntary or involuntary euthanasia? They also argue that it undermines the value of life and could lead to decreased efforts in palliative care and support for the terminally ill.
Whose Life Is It Anyway? asks the hard questions. Directed by John Badham and released in 1981, it stars Richard Dreyfuss as a talented sculptor. Ken Harrison becomes paralyzed from the neck down after a car accident. Facing a future without the ability to create art or have any physical independence, Harrison becomes embroiled in a legal battle for the right to end his life.
What of our autonomy and our right to die? What scale do we use to judge the value of life? Badham explores these questions as Harrison fights against hospital administrators and the legal system, who seek to keep him alive against his wishes.
“People living deeply have no fear of death.” — Anaïs Nin
It’s My Party
For those of us who stood by our beloved friends during the AIDS epidemic, before the advent of AZT, the haunting images of their bodies destroyed by diseases like Kaposi’s Sarcoma will forever stay with us. Numerous opportunistic infections attacked every organ and tissue in the body, and no amount of morphine could dull the pain. But enough morphine could stop the pain. Permanently. It was an act of supreme compassion on the part of the doctors who assisted with this practice. With the stigma around queers and AIDS, everyone just looked the other way.
“The AIDS disease is caused by a virus, but the AIDS epidemic is not. The AIDS epidemic is fueled by stigma, by hate, by misinformation, by ignorance, by indifference.” — Elton John
Director Randal Kleiser tells the story of Nick Stark in the 1996 film It’s My Party. Stark is diagnosed with a terminal illness related to AIDS. With a rapidly declining health condition and the prospect of losing his mental faculties, Nick decides to take control of his fate. He plans a two-day farewell party to say goodbye to his friends and family on his own terms.
Kleiser addresses themes of love, loss, dignity, and the right to die in this film. It offers a heartfelt and thought-provoking look at end-of-life choices and the impact of AIDS—insights that will be useful with the looming possibility of more severe pandemics.
The Role of AI and Technology in Euthanasia
The role of Artificial Intelligence and decision-making in healthcare raises critical questions about euthanasia. Could AI someday assess patient suffering more accurately than humans, helping to decide when to call it time? If you are ever responsible for pulling someone off life support, AI could ease the stress of that final decision. Or can AI assist in making more objective decisions regarding euthanasia eligibility?
As we increasingly rely on artificial intelligence to make important choices, we grapple with the moral implications of entrusting consequential decisions to algorithms. We must examine and mitigate the risks of baked-in biases and skewed outputs that could lead to harmful outcomes.
Virtual reality technology is in development to offer palliative care patients the chance to escape their physical pain and suffering. This could potentially alter perceptions of pain and the need for euthanasia. Supporting VR’s impact on the quality of life for terminally ill patients can lead to innovative perspectives on managing suffering.
Before prioritizing euthanasia, we should develop and implement the benefits of AI technology. The 2017 film, Marjorie Prime is set in the near future, focusing on Marjorie, an elderly widow battling Alzheimer’s. Marjorie finds solace in a holographic replica of her late husband, Walter. This hologram, known as a Prime, is designed to mimic Walter’s younger self, providing companionship and a form of therapy by rekindling her fading memories.
Marjorie Prime explores artificial intelligence, selective memory, and human emotion. It raises questions about identity, the reconstruction of the past, and the human need for connection. Despair and loneliness often drive an end-life decision—could AI help alleviate that pain?
Eco-euthanasia: The Environmental Impact of End-of-Life Choices
Eco-euthanasia is another important consideration in the euthanasia debate. Focusing on the environmental costs of keeping someone alive with medical interventions and then disposal of their remains is imperative to discuss now.
As climate change leads to rising sea levels and more frequent flooding, we must confront the unsettling question of how and where we will lay our dead to rest in a world where traditional burial grounds may no longer remain viable. And many of us become climate refugees.
The environmental footprint of sustaining life through artificial means should be a factor in euthanasia decisions. This perspective ties into broader discussions about sustainability, the value of life, and ecological ethics.
“Euthanasia is a long, merciful end to unnecessary suffering.” — Taylor Caldwell, American novelist
Soylent Green
Film night with my friends and off we went to see Soylent Green, a dystopian science fiction film from 1973. It’s directed by Richard Fleischer and set in the year 2022. Usually after seeing a film we went for pizza to deconstruct the story. None of us felt like eating after this one.
In an overpopulated and polluted world where natural resources are depleted, and the greenhouse effect has led to a dangerously overheated climate, society struggles with widespread poverty, starvation, and despair. The majority of the world’s food supply comes from the Soylent Corporation, which produces a high-protein food product called Soylent Green.
The film follows New York City police detective Frank Thorn, played by Charlton Heston, as he investigates the murder of a wealthy businessman connected to the Soylent Corporation. Uncovering a horrifying secret behind Soylent Green, a shocking truth about its ingredients forces him to confront the ethical and moral decay of a society willing to go to extreme lengths to solve its overpopulation crisis.
Soylent Green is renowned for its critical take on environmental degradation, unsustainable living, and the moral implications of solving humanity’s problems at any cost.
These films center around conversations that have been ongoing for a long time. This is more than just table talk, these are real issues we face daily and we must be willing to frame our experiences in the larger context of real-world issues and euthanasia.
“No man has the right to dictate what other men should perceive, create or produce, but all should be encouraged to reveal themselves, their perceptions and emotions, and to build confidence in the creative spirit.” — Ansel Adams
Human vs Non-human Euthanasia
Road-injured animals are a common occurrence living in the mountains. Deer, elk, and wild sheep are among the animals left to die after being struck by large vehicles moving too fast. We call these drivers Flatlanders— folks not from the mountains and unfamiliar with winding, narrow roads running through wildlife migration paths.
There is not a resident around here who does not carry a gun in their car to end the suffering of these animals when we come upon them. We also shoot horses when it’s their time. There is no justification in the world to let an animal suffer. Why do we let humans suffer?
Many of us are no strangers to euthanasia for our pets suffering due to age or illness. These choices raise questions about the value we place on the ethical treatment of non-human life as opposed to human. Discussing the ethical models surrounding euthanasia in animals can help us with insights into human euthanasia. Perhaps it’s time to reconsider our definitions of personhood, autonomy, and ethical responsibility.
Megan Leavey a 2017 film directed by Gabriela Cowperthwaite tells the true story of a Marine Corporal Megan Leavey and her combat dog, Rex. The film touches on loyalty, service, and the strong bond between a handler and their military working dog, including the difficult topic of euthanasia. While deployed in Iraq, the two complete more than 100 missions and save countless lives, until an IED explosion puts their faithfulness to the test.
Neurodiversity and Euthanasia Rights
The euthanasia debate also raises questions about what it means to have the capacity to make one’s own decisions and what constitutes informed consent. How do we decide who can make autonomous decisions over their end of life? Euthanasia from the perspective of individuals with neurodivergent conditions, such as severe autism or intellectual disabilities, challenges prevailing notions of competence and consent.
We must keep in mind people’s right to autonomy on the one hand and the need to prevent harm on the other. This requires an immediate reevaluation and legislation of autonomy in the context of euthanasia. The United States has a lot of catching up to do in this regard.
The expansion of euthanasia and physician-assisted suicide (E/PAS) to include individuals with psychiatric and neurocognitive disorders in certain European and non-European countries is a matter of considerable ethical debate. Initially limited to severe physical illnesses, the extension to mental disorders has been seen as a move to avoid discrimination.
However, this decision brings forth ethical concerns, such as the individual’s capacity for self-determination, the influence of family, social, and economic factors, societal perceptions of dignity, pressures affecting personal value judgments, available therapeutic options, the roles of professionals overseeing the process, and the definitions of the disorders themselves.
Compounding these issues is the lack of legislation in some countries and inadequate evaluation and control mechanisms. The backdrop of global health challenges, aging populations, and socioeconomic disparities may further increase the demand for E/PAS.
The objective is to provide ethical guidance by outlining fundamental considerations for clinical practice in psychiatry, focusing on the irreversibility of conditions, assessment of suffering, and the integrity of decision-making processes.
Between 2012 and 2021, approximately 60,000 instances of euthanasia and physician-assisted suicide were documented in the Netherlands. Individuals with either learning disabilities or autism spectrum disorder accounted for 39 of these.
“It’s a good day to die” — Lakota Sioux leader Crazy Horse
Indigenous Perspectives on Euthanasia
Often left out of the debate are indigenous communities that have unique views on euthanasia. Cultural traditions, spirituality, and concepts of community and belonging all affect their beliefs on euthanasia. Understanding these perspectives is important for a culturally sensitive approach to euthanasia. The need for dialogue that respects diverse values and beliefs is essential to our humanity.
The legalization of voluntary assisted dying (VAD) has swept across Australia, with all six states enacting legislation and the territories actively considering similar measures. A closer look at the law reform processes in Victoria and Western Australia reveals the complex and varied engagement of Indigenous voices. This underscores the need to acknowledge and respect the wide range of perspectives within Indigenous communities when struggling with such significant ethical questions.
Euthanasia as a Reflection of Societal Health
Some argue that the demand for euthanasia is a symptom of broader societal failings, such as inadequate palliative care, social isolation, and the undervaluing of the elderly and disabled. I don’t buy this. By addressing these human-caused root problems we can alter the euthanasia discourse, framing it as part of a larger conversation about societal health and wellbeing.
“The art of life is the art of avoiding pain.” — Thomas Jefferson
Euthanasia and the Meaning of Suffering
There is a vast library of philosophical inquiries into the nature and value of suffering. These works offer any number of insights into the euthanasia debate. Some philosophies, such as Buddhism, view suffering as an integral part of the human condition, offering opportunities for growth and deeper understanding, releasing the Karmic burdens we carry.
This perspective challenges the notion that suffering should be avoided at all costs, suggesting instead that the focus should be on finding meaning within suffering. At a certain point, there is no meaning left to find when the pain and suffering is overwhelming. Although I have been a student of Buddhism for a long time I don’t believe in reincarnation. I see no value in letting someone die in agony if they don’t wish to.
What of our capacity for compassion? Can we look beyond righteous indignation and get to a place of trust within ourselves to make the right decision at the right time? Or have someone we trust to make that decision for us? Does Do No Harm not mean do not let inescapable suffering and unbearable pain prevail? Dr. Peter thought so during the AIDS crisis.
Death is inevitable, suffering is a choice.
Whose life is it anyway?
This is thy hour O Soul, thy free flight into the wordless, Away from books, away from art, the day erased, the lesson done, Thee fully forth emerging, silent, gazing, pondering the themes thou lovest best, Night, sleep, death and the stars. — Walt Whitman
Addendum:
In the United States, the legality of assisted suicide is determined on a state-by-state basis, under specific conditions that include terminal illness and mental competence.
California — Through the End of Life Option Act, California permits medically assisted suicide for terminally ill patients.
Colorado — The Colorado End-of-Life Options Act allows individuals with a terminal illness to request a medical aid in dying.
Hawaii — The Our Care, Our Choice Act in Hawaii permits assisted suicide under stringent criteria for terminally ill residents.
Maine — Maine’s Death with Dignity Act allows individuals who are terminally ill to end their lives through the voluntary self-administration of prescribed medications.
Montana — While not legislated through an act, a Montana Supreme Court ruling permits physician-assisted suicide under specific conditions.
New Jersey — The Aid in Dying for the Terminally Ill Act permits adults with a prognosis of six months or less to live to obtain medication to end their lives.
New Mexico — The Elizabeth Whitefield End-of-Life Options Act allows for medical aid in dying for terminally ill patients.
Oregon — As a pioneer in this realm, Oregon’s Death with Dignity Act was the first law in the United States to permit assisted suicide, establishing a precedent and framework for others.
Vermont — The Patient Choice and Control at End of Life Act allows for individuals with terminal illness to choose the time of their passing.
Washington — Through the Death with Dignity Act, Washington State allows terminally ill adults to request lethal medication from their physicians.
Washington, D.C. — also permits assisted suicide under the Death with Dignity Act, allowing individuals who meet certain criteria to request medication to end their lives.
The legislation in each state is typically surrounded by stringent safeguards, including multiple requests for life-ending medication, waiting periods, and confirmation of the diagnosis and prognosis by multiple healthcare providers.
Resources:
These books offer a range of perspectives and insights into the ongoing debate surrounding euthanasia. They can provide valuable context, arguments, and information for those seeking to deepen their understanding of this complex issue.
Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying by Derek Humphry — This controversial book provides a detailed guide to end-of-life options and has been influential in the right-to-die movement.
Euthanasia and Physician-Assisted Suicide by Gerald Dworkin, R.G. Frey, and Sissela Bok — This collection of essays offers a balanced and philosophical examination of the ethical, legal, and social implications of euthanasia and physician-assisted suicide.
The Good Death: The New American Search to Reshape the End of Life by Marilyn Webb — This book explores the history and cultural attitudes surrounding euthanasia and end-of-life care in the United States.
Dying Right: The Death with Dignity Movement by Daniel Hillyard and John Dombrink — This book provides an in-depth look at the death with dignity movement in the United States, examining the legal, political, and ethical dimensions of the debate.
The Future of Assisted Suicide and Euthanasia by Neil M. Gorsuch — Written by the current Associate Justice of the U.S. Supreme Court, this book offers a legal and moral analysis of the debate surrounding assisted suicide and euthanasia.
The Case Against Assisted Suicide: For the Right to End-of-Life Care edited by Kathleen Foley and Herbert Hendin — This collection of essays presents arguments against the legalization of assisted suicide and euthanasia, emphasizing the importance of palliative care and addressing concerns about abuse and social pressure.
Euthanasia, Ethics and Public Policy: An Argument Against Legalisation by John Keown — This book presents a comprehensive case against the legalization of euthanasia and physician-assisted suicide, drawing on ethical, legal, and empirical evidence.
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