December 2012

Last month, a Massachusetts ballot initiative that would have legalized physician-assisted suicide in that state narrowly failed. It was only the latest in a decades-long set of legal and electoral battles over what we might call the last choice: when and how we may end our own lives, and with what forms of assistance.

Powerful ethical and legal questions surround this choice. While a libertarian might be tempted to affirm that physician-assisted suicide is an exercise in personal autonomy, the matter is by no means so simple. The legal and constitutional traditions of our country have only occasionally affirmed such a right, and the potential for abuse in various assisted-suicide regimes may be unacceptably high. Add to this the concerns raised by those who argue for the essential dignity, not of a painless death, but of a natural one, and we confront a vast terrain of ethical issues.

Our lead essay this month is by Howard Ball, a Professor Emeritus of political science at the University of Vermont and author of At Liberty to Die: The Battle for Death with Dignity in America . Joining him will be Patrick Lee, the John N. and Jamie D. McAleer Chair in Bioethics at Franciscan University of Steubenville; and Philip Nitschke, the Founder and Director of Exit International, a leading group advocating for end-of-life rights.


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Lead Essay

  • Howard Ball reviews the recent history of physician-assisted death (PAD) in America. He argues that it is a fairly direct outgrowth of other trends in our society, including the medicalization of death, the movement toward palliative end-of-life care, and the longstanding concern for individual autonomy that has characterized American legal and political thinking. Social values evolve, and he argues that allowing physicians to assist patients in dying will eventually come to be an accepted value as well, as a matter of compassion for those who are suffering.

Response Essays

  • Philip Nitschke looks back at the Baby Boom generation. All through their lives, they have broken the mold, in women’s rights, contraception, divorce, and many other areas. Now, as they approach retirement and the end of life, they are again breaking the mold. Death isn’t what it used to be, and a long, drawn-out, medicalized death may not be to everyone’s liking. Yet the law has often lagged behind, and one might even question, with Nitschke: Why do we need law, or physicians, in deliberately ending our own lives?

  • Patrick Lee urges us to observe the difference between committing suicide and foregoing burdensome treatment. Committing or assisting a suicide both disrespect the intrinsic good of human life and are objectively morally wrong. We rightly abhor pain and suffering, but this sentiment should not lead us to attack the person who is experiencing the pain and suffering. If we do, the lives of the elderly and disabled throughout our society will be devalued, with grave consequences for all.

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