More than three decades ago, the three-term governor of Colorado, Richard Lamm, told a group of healthcare lawyers that the terminally ill elderly have "a duty to die and get out of the way" instead of trying to prolong their lives. Lamm compared the fulfillment of this "duty" to "leaves falling off a tree and forming humus for the other plants to grow up."
Lamm was denounced by organizations representing the elderly. One lobbyist likened the then-governor’s statements to those of Hitler.
Fast forward to the present, when six states and Washington DC have legalized physician-assisted suicide, permitting physicians to order a lethal dose of medication that a terminally ill individual can take to end his or her life. Another thirty states are considering such legislation. Furthermore, a recent Gallup poll found that almost three-quarters of Americans deemed physician assisted suicide to be morally acceptable.
Legalizing physician-assisted suicide has a lot to do with autonomy, a stance that would make a claim like “it’s my life, and I want control over how to end it.” Or even maintain: “I should have a right to die.” The 14th amendment of the Constitution provides us with a right to life. However, we do not have a constitutional right to die.
The philosopher John Hardwig writes that it “would be foolish to think that the ‘right to die’ won't, much less can't, one day become the ‘duty to die,’ especially in an ageing society where health care costs as a percentage of the GDP are projected to double over the next 25 years.”
He adds: “The only way to prevent the ‘right to die’ from becoming a ‘duty to die’ is to reject the ‘right to die’ from the start. Anything else places the most vulnerable, the elderly and especially the disabled, on an already well-greased slippery slope.”
Are there unintended consequences from a constitutional right to die when usefulness has ended and the country’s financial resources are strained? Do we lose control over our deaths in what was meant to be an assurance of autonomy with an amendment guaranteeing a right to die?
With every right comes a corresponding obligation. If we demand a right to die, does that then become a duty to die? A right to life obligates society to protect one’s life. Would a right to die obligate society to help end one’s life? This behind the scenes debate is unfolding as legislation to legalize physician-assisted suicide sweeps across this county.
As we age and place financial and emotional demands on our loved ones, we may feel a duty to die to avoid compromising the lives of those we love. For most, it would be gut wrenching to watch our families struggle as they cared for us.
Charles Camosy, an associate professor of Christian ethics at Fordham University, speculates: “Suppose that Hardwig’s view was adopted by a patient nearing the end of her life - could we sat that her ‘choice’ to die would be truly autonomous and free? Or would her choice in fact be coerced by a number of underlying social factors, including a perceived duty to die and get one out of the way of her family and the broader society?”
Could that then extend to society’s expectation for a vulnerable population?
Western culture values autonomy and productivity. The danger is that this culture could not only marginalize the vulnerable, but it also could require dying in order to make space for the young, vigorous and productive.
Hardwig and Camosy agree when they caution, “that trend, as long as autonomy and consumerism dominate in the West, can do nothing other than continue.” “In light of this social situation, it is understandable why so many bioethicists believe that a “right to die implies a duty to die."
Physician-assisted suicide legislation takes us from a discussion of personal rights to the potential for a corresponding societal duty. Do we really want to go there?