In parts of Europe, such as in Germany, Luxembourg, Belgium, and Switzerland, the active assistance of a person other than a physician is acceptable. Notably, in Germany, while lay people are permitted to assist, physicians are forbidden from participation of any kind. The public has apparently neither forgiven nor regained trust in the profession for its shameless complicity in mass killings in the 1930s in which death panels decided whether or not a life was deemed unworthy of living—i.e., those with severe birth defects, mental illness, and others were assigned to be euthanatized. (The book Death and Deliverance by Michael Burleigh [Cambridge University Press, 1995] is an important work that offers eye-opening revelations on this subject. The author asks why so many ordinary Germans abandoned concern for the weak in favor of a vulgar ideology of social Darwinism that dragged the whole society down to the laws of the jungle; and, importantly, the medical profession was at the heart of the program and did most of the killing.)
Explore This Issue
May 2018
Since a rendezvous with death is common to all of humankind, shouldn’t medical caregivers—the overseers of dying—be an important part of those discussions that standardize, regulate, and establish the ethics and the legal language applied to the process? —Roy B. Sessions, MD
Legal Application
Given this classification, let’s look at applicability. The U.S. has a shifting social landscape that is undergoing gradual secularization, and without very specific legal, moral, and ethical standards relative to the subjects of this essay, the boundaries of correctness will certainly be tested. As a means of demonstrating this eventuality, consider the rules governing this issue in Switzerland, in which there is now a “not-for-profit” business that will provide active euthanasia for money. Many Europeans and citizens of the U.K. who don’t have easy access to death travel there for life’s closure. This company is Dignitas (which means “dignity” in Latin), and if you write them a check, they will end your life.
Until I began research for a book that included this subject, I naïvely failed to appreciate the complexity of the subject. The tendency is to focus on the morality of the issues, and that’s not necessarily unwise, but that’s personal, and no doubt, personal standards can be complex. The complexity to which I am referring, however, is the law. In my opinion, the gold standard for study of the law was developed by Supreme Court Justice Neil M. Gorsuch, who has written extensively on the subject. (For a review of the case law as well as a discussion of concepts, read Gorsuch’s thorough and well-written book, The Future of Assisted Suicide and Euthanasia [Princeton University Press, 2006].) The U.S. Supreme Court’s 1997 decisions in Washington v. Gluksberg and Vacco v. Quill held that there is no constitutional right to physician-assisted suicide, whether by passive participation or by direct infliction of death. In not ruling either for or against in these cases, the Court sidestepped the moral issues and left the path of resolution to the individual states.