Right to die

The right to die is a moral principle based on the belief that a human being is entitled to commit suicide or to undergo voluntary euthanasia. Possession of this right is often understood to mean that a person with a terminal illness should be allowed to commit suicide or assisted suicide or to decline life-prolonging treatment, where a disease would otherwise prolong their suffering to an identical result. The question of who, if anyone, should be empowered to make these decisions is often central to debate.

Proponents typically associate the right to die with the idea that one's body and one's life are one's own, to dispose of as one sees fit. However, a legitimate state interest in preventing irrational suicides is sometimes argued. Pilpel and Amsel write, "Contemporary proponents of 'rational suicide' or the 'right to die' usually demand by 'rationality' that the decision to kill oneself be both the autonomous choice of the agent (i.e., not due to the physician or the family pressuring them to 'do the right thing' and commit suicide) and a 'best option under the circumstances' choice desired by the stoics or utilitarians, as well as other natural conditions such as the choice being stable, not an impulsive decision, not due to mental illness, achieved after due deliberation, etc."^[1]

Hinduism accepts the right to die for those who are tormented by terminal diseases or those who have no desire, ambition or no responsibilities remaining; and allows death through the non-violent practice of fasting to the point of starvation (Prayopavesa).^[2] Jainism has a similar practice named Santhara. Other religious views on suicide vary in their tolerance, and include denial of the right as well as condemnation of the act. In the Catholic faith, suicide is considered a grave sin.^[3]

Ethics

A debate exists within bioethics over whether the right to die is universal, only applies under certain circumstances—such as terminal illness, or if it exists at all. A court in the American state of Montana, for example, has found that the right to die applies to those with life-threatening medical conditions. Suicide advocate Ludwig Minelli, euthanasia expert Sean W. Asher and bioethics professor Jacob J. Appel, in contrast, argue that, all competent people have a right to end their own lives. Appel has suggested that the right to die is a test for the overall freedom of a given society.^[4]

The 1991 Patient Self-Determination Act passed by The Congress of the USA at the request of the financial arm of Medicare does permit elderly Medicare/Medicaid patients (and by implication, all "terminal" patients) to prepare an advance directive in which they elect or choose to refuse life-extending and/or life-saving treatments as a means of shortening their lives to shorten their suffering unto certain death. The treatment refused in an advance directive under US law, because of the 1991 PSDA, does not have to be proved to be "medically futile" under some existing due-process procedure developed under state laws, such as TADA in Texas.

By country

See Voluntary euthanasia

As of 2009, some forms of voluntary euthanasia are legal in Belgium,^[5] Luxembourg,^[6] the Netherlands,^[5] and Switzerland.^[5]

Netherlands

The Netherlands legalized voluntary euthanasia in 2001 and is one of the few countries in the world to have done so. Under current Dutch law, euthanasia by doctors is only legal in cases of "hopeless and unbearable" suffering. In practice this means that it is limited to those suffering from serious medical conditions (including mental illness) and in considerable suffering like pain, hypoxia or exhaustion. Helping somebody to commit suicide without meeting the qualifications of the current Dutch euthanasia law is illegal.^[7] These criteria concern the patient's request, the patient's suffering (unbearable and hopeless), the information provided to the patient, the presence of reasonable alternatives, consultation of another physician and the applied method of ending life.^[7]

In February 2010 a citizens' initiative called Uit Vrije Wil (Out of Free Will) further demanded that all Dutch people over 70 who feel tired of life should have the right to professional help in ending it. The organization, initiated by Milly van Stiphout and Yvonne van Baarle, started collecting signatures in support of this proposed change in Dutch legislation. A number of prominent Dutch citizens supported the initiative, including former ministers and artists, legal scholars and physicians. Among them were former politicians Frits Bolkestein, Hedy d'Ancona and Jan Terlouw, as well as television personality Mies Bouwman.^[8][9][10] This initiative has never been legalised.

Canada

As of August 2011 a B.C. Supreme Court judge had been requested to speed up a right-to die lawsuit so that Gloria Taylor could have a doctor assist her in committing suicide. She suffered from Lou Gehrig's disease.^[11] She died of an infection in 2012.

A B.C. Civil Liberties lawsuit is representing six plaintiffs and challenges the laws that make it a criminal offence to assist seriously and incurably ill individuals to die with dignity.

On February 6, 2015 the Supreme Court of Canada ruled that denying the right to assisted suicide is unconstitutional. The court’s ruling limits physician-assisted suicides to “a competent adult person who clearly consents to the termination of life and has a grievous and irremediable medical condition, including an illness, disease or disability, that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.” The ruling was suspended for 12 months to allow the Canadian parliament to draft a new, constitutional law to replace the existing one.^[12]

The court decision includes a requirement that there must be stringent limits that are “scrupulously monitored.” This will require the death certificate to be completed by an independent medical examiner, not the treating physician, to ensure the accuracy of reporting the cause of death.^[13]

The Canadian Medical Association (CMA) reported that not all doctors were willing to help a patient die. However, the belief in late 2015 was that no physician would be forced to do so but the CMA was offering educational sessions to members as to the process that would be used.^[14]

New Zealand

Euthanasia is illegal in New Zealand. In 2015, lawyer and cancer sufferer Lecretia Seales brought a case to the High Court to challenge New Zealand law for her right to die with the assistance of her GP, asking for a declaration that her GP would not risk conviction.^[15][16]

United States

The term 'right to die' has been interpreted in a number of ways, including issues of suicide, passive euthanasia, active euthanasia, assisted suicide, and physician-assisted suicide.^[17] As health of citizens is considered a police power left for individual states to regulate, it was not until 1997 that the US Supreme Court made a ruling on the issue of assisted suicide and one's right to die. In 1997 the Supreme Court heard two appeals arguing that New York and Washington statutes that made physician assisted suicide a felony violated the equal protection clause of the Fourteenth Amendment.^[18] In a unanimous vote, the Court held that there was no constitutional right to physician assisted suicide and upheld state bans on assisted suicide. While in New York this has maintained statutes banning physician assisted suicide, the Court's decision also left it open for other states to decide whether they would allow physician assisted suicide or not.

Since 1997, three states in the US have passed assisted suicide laws. Oregon, Washington, and Vermont, in 1997, 2009, and 2013, respectively, have laws that provide a protocol for the practice of physician assisted suicide.^[19] The law in these three states allows terminally ill adult patients to seek lethal medication from their physicians. In 2009, the Montana Supreme Court ruled that nothing in state law prohibits physician-assisted suicide and provides legal protection for physicians in the case that they write a prescription for lethal medication upon patient request. In California, the governor signed a controversial physician assisted-suicide bill in October 2015 that had been passed during an special legislative session intended to address Medi-Cal funding,^[20] after it had been defeated during the regular legislative session.^[21] Because the bill was passed during a special session, it will not take effect until three months after that session ends, which could be as late as fall 2016.^[22]

In early 2014, a New Mexico Second District Judge Nan Nash ruled that terminally ill patients have the right to aid in dying under the state constitution, i.e. making it legal for a doctor to prescribe a lethal dose of medication to a terminally ill patient.^[23] The ultimate decision will be made with the outcome of New Mexico's Attorney General's appeal to the ruling.

See also

• Washington v. Glucksberg

Initiatives Advance Directives Act (Texas) Initiative 1000 (Washington) Oregon Death with Dignity Act Groups Compassion & Choices of Oregon Dignitas Exit International World Federation of Right to Die Societies Films How to Die in Oregon documentary film Right to Die? documentary film Books Final Exit

Individuals Elizabeth Bouvia Eluana Englaro Edward Brongersma Betty and George Coumbias Nancy Cruzan Tirhas Habtegiris Derek Humphry Richard Huxtable Jack Kevorkian Brittany Maynard Philip Nitschke Haleigh Poutre Diane Pretty Karen Ann Quinlan Sue Rodriguez Terri Schiavo Ramón Sampedro

Other related Assisted suicide Bioethics / Medical ethics Do not resuscitate Euthanasia Force feeding Right to life Letting die Living will Patient refusal of nutrition and hydration

References

1. A Pilpel, L Amsel. "What is Wrong with Rational Suicide" (PDF)
2. "Hinduism — Euthanasia and Suicide". BBC. 2009-08-25.
3. "Catholic Digest - The Magazine for Catholic Living - Do people who commit suicide go to hell?". Retrieved 14 December 2014.
4. "Next: Assisted Suicide for Healthy People". The Huffington Post. 16 July 2009. Retrieved 14 December 2014.
5. Smartt, Ursula (23 December 2002). "Euthanasia and the law". BBC News.
6. "Luxembourg says 'yes' to euthanasia". Daily Mail (London). 20 February 2008.
7. Buiting H, van Delden J, Onwuteaka-Philpsen B, et al. (2009). "Reporting of euthanasia and physician-assisted suicide in the Netherlands: descriptive study". BMC Med Ethics 10: 18. doi:10.1186/1472-6939-10-18. PMC 2781018. PMID 19860873.
8. "Citizens group argues 'right to die'". Retrieved 14 December 2014.
9. "'Right to die' for elderly back at centre of Dutch debate". Retrieved 14 December 2014.
10. Frans Bosman en Corrie Verkerk (2007-02-10). "70-plus eist zachte dood" (in Dutch). Het Parool.
11. "B.C. court asked to fast-track right-to-die lawsuit". CBC News. 2 August 2011. Retrieved 14 December 2014.
12. Supreme Court rules Canadians have right to doctor-assisted suicide Sean Fine, Globe and Mail 6 Feb. 2015
13. Guichon, Alakija, Doig, Mitchell and Thibeault (December 28, 2015). "Assisted dying: Four problems, one simple solution". Glove and Mail (Toronto, Canada). Retrieved January 2, 2016.
14. The Canadian Press (December 27, 2015). "Canadian doctors express mixed opinions on assisted dying". CTV News. Bell Media. Retrieved January 2, 2016.
15. "Lecretia Seales: Lawyer with cancer embarks on challenge to New Zealand's euthanasia laws". Australian Broadcasting Corporation. Retrieved 5 June 2015.
16. "Judge thanks woman for right-to-die case". Radio New Zealand. Retrieved 5 June 2015.
17. http://law.justia.com/constitution/us/amendment-14/35-right-to-die.html
18. https://scholar.google.com/scholar_case?case=10644975876581235704&q=vacco+v.+quill&hl=en&as_sdt=40000006
19. Barone, Emily (3 November 2014). "See Which States Allow Assisted Suicide". Time.
20. https://www.gov.ca.gov/docs/6.16.15_Health_Care_Special_Session.pdf
21. http://www.sacbee.com/news/politics-government/capitol-alert/article33269166.html
22. http://www.sacbee.com/news/politics-government/capitol-alert/article37818555.html
23. Hamedy, Saba (19 January 2014). "New Mexico judge affirms right to 'aid in dying'". Los Angeles Times.

Further reading

• The body as unwarranted life support: a new perspective on euthanasia.
• Appel JM (May–June 2007). "A suicide right for the mentally ill? A Swiss case opens a new debate". Hastings Center Report 37 (3): 21–3. doi:10.1353/hcr.2007.0035. PMID 17649899.
• (Dutch) "Uit Vrije Wil — Burgerinitiatief voltooid leven"