The freedom to choose when to die

By Chiang Sheng 江盛  / 

Sat, Sep 26, 2015 - Page 8

On Sept. 11, the California State Legislature passed a bill allowing physician-assisted suicide. It is not the first US state to do this — the practice is now legal in Oregon, Washington state, Vermont and Montana — but California is the US’ most populous state and it has joined the others on this final expression of the freedom of choice in an individual’s lifetime: The freedom to take their own life.

The immediate cause for speeding up the passage of the bill was last year’s case of a 29-year-old Californian woman named Brittany Maynard, who was suffering from late-stage brain cancer. Maynard’s symptoms included ferocious headaches, epileptic fits and memory loss. At the time, she said she wanted to end her life in a dignified manner and to no longer be tortured by her illness. Unfortunately for her, the assisted suicide legislation had not yet been passed in California, so she had to move to Oregon, California’s northern neighbor, which had passed the legislation more than a decade earlier.

Maynard posted a notification of her intention to take her own life on Facebook and on the day she took the lethal medication, she wrote: “Today is the day I have chosen to pass away with dignity in the face of my terminal illness, this terrible brain cancer that has taken so much from me … but would have taken so much more. The world is a beautiful place... My close friends and folks are the greatest givers... Goodbye world. Spread good energy. Pay it forward!”

Since Oregon passed the assisted suicide legislation through a referendum in 1997, a total of 1,100 people in the last stages of their lives have asked doctors to prescribe them with euthanasia drugs, and 750 of them have gone on to end their lives. According to one Oregon doctor who prescribed the drugs, helping people leave a body no longer fit to live in is a medical professional’s duty, and part of a doctor’s job, as the body is just a place to live, and when this place, due to disease, is no longer liveable, and the person can no longer cope physically, mentally or spiritually, the best thing to do is to allow them to leave.

Do people have the right to die? If respecting a sufferer’s right to autonomy is the pillar of medical ethics, why is it that people do not have the right to end their own lives at a time of their choosing? At present, the law does not look into suicide, but just gives people a half-baked right to die. Does that make sense?

Suicide has a long history with humanity and human beings have a very complicated relationship with it. Plato’s take on suicide was reserved yet accepting. For him, if an individual’s life changed to a point that the individual could no longer tolerate it, then suicide was a rational and legitimate behavior. Having a disease or living a restricted life were both reasons for people to opt for death. This philosophy established standards for the rationalization of suicide.

In Roman times, local officers were supplied with lethal medication that they could provide to people who wanted to end it all, so long as they were able to justify the reasons for doing so before the Roman Senate. For the people of the time, life was common to animals, slaves, and citizens, and as such was not accorded the dignity it now has. According to the Justinian code — the law at the time — ordinary citizens could take their own lives if they were sick, in pain, tired of life, insane or worried about their reputations, and no one would be punished.

In the West, suicide was initially tolerated. The act was first defined as a crime in later Christian teachings, when complicated theological concepts were introduced. At this point, suicide became a grave sin: The property of the person who committed suicide would be confiscated by the state, their reputation trashed, their social status and coat of arms annulled, and their groves and castles razed to the ground. In England, it was only in 1870 that laws requiring the confiscation of the property of those guilty of having committed suicide were changed, but still, all the way up until 1960, survivors of unsuccessful suicide attempts could still end up in jail for their sins.

The English poet Al Alvarez, in The Savage God, his study on suicide, provides the person who has spent their entire time on this planet striving for a high quality of life with a much welcome voice. Alvarez says that suicide represents a cry for help, an attempt to stop oneself from falling into a state of despondency. The only alternative comes in other forms: The help of the priest or the psychoanalyst or the few doctors who have the time and are willing to listen, or of groups specifically formed to deal with this kind of problems, who would try to empathize with all that the suicidal person has experienced. However, the person contemplating suicide might not necessarily need this kind of help.

California was a pioneer in this type of legislation, passing the Natural Death Act in 1976, allowing the terminally ill to establish advance directives giving permission for refusal of treatment. This is the most widely used blueprint for people supporting euthanasia.

So much has changed in legal practices over the past century: Women gained suffrage and the right to have an abortion, different ethnic groups now benefit from equality laws, and same-sex marriage has been legalized in the US and most of the UK. With all this, the legal right to die for people suffering from terminal or incurable illnesses has become the latest symbol of freedom and human rights.

Chiang Sheng is an attending physician in the Department of Obstetrics and Gynecology at Mackay Memorial Hospital.

Translated by Paul Cooper