The Ethicist is column published in the Times Magazine every Sunday. Each week the author responds to a question that revolves around a moral quandary.
This year, on January 20th, a 50-year-old woman asked the Ethicist if she should help her sister end her life. She says her sister has a range of serious medical problems including “uncontrolled epilepsy, a stroke that left her physically and mentally impaired, paranoid schizophrenia, to name a few.”
The Ethicist responded that no one has the right to help end another person’s life, sister or not, even if it’s clear it’s not a life worth living. Only her sister has the right to commit suicide, on her own, without the aid of anyone else.
If she was in the Netherlands or Belgium, her plight would be much different. In discussing the life-long struggles of a woman in Belgium, Rachel Aviv (New Yorker, 6/22/15) describes the work of Wim Distelmans, an oncologist and professor at the Free University of Brussels. Distelmans is one of the leading proponents of a “law in Belgium that permits euthanasia for patients who have an incurable illness that causes them unbearable physical or mental suffering.”
It was the phrase “mental suffering” that caught my attention. I had never heard of a nation or state that permits euthanasia for that reason. It isn’t a reason I haven’t thought of before or found as compelling as incurable disease. But I had never imagined a law permitting it.
According to Aviv, Distelmans has euthanized more than a hundred patients who claimed they were simply tired of living or unable to find a reason to continue.
Her article dwells on the controversy over the law, the case of one woman and her son, in particular, and the situation in other countries, as well as the United States.
The Belgian Council of Ministers appointed Distelmans to serve as the chairman of the Federal Control and Evaluation Commission which reviews euthanasia deaths to insure that doctors have complied with the law.
In terminal cases, two doctors need to confirm that the patient’s suffering stems from an incurable illness. For non-terminal cases, three doctors must agree. But doctors have adopted increasingly loose interpretations of disease.
Last year, thirteen per cent of the Belgians who were euthanized did not have a terminal condition, and roughly three per cent suffered from psychiatric disorders.
Belgium was the second country in the world, after the Netherlands, to decriminalize euthanasia; it was followed by Luxembourg, Switzerland and Columbia this year.
The United States Supreme Court has recognized that citizens have legitimate concerns about prolonged deaths in institutional settings, but in 1997 it ruled that death is not a constitutionally protected right, leaving questions about assisted suicide to be resolved by each state.
Within months of the ruling, Oregon passed a law that allows doctors to prescribe lethal drugs for patients who have less than six months to live. In 2008, Washington adopted a similar law; Montana decriminalized assisted suicide the year after; and Vermont legalized it in 2013.
In Oregon and Switzerland, studies have shown that people who request death are less motivated by physical pain than by the desire to remain autonomous. This pattern of reasoning was exemplified by Brittany Maynard, a twenty-nine-year-old newlywed who moved to Oregon last year so that she could die on her own terms rather than allowing her brain cancer to take its course.
While several states in this country currently permit doctor-assisted suicide for terminal illnesses, none do so for mental suffering. To my knowledge, no one has ever proposed such a law and I cannot imagine one will ever be enacted in the near future. That does not mean the issue is not worth considering. Perhaps it is time to begin a public dialogue on the matter in this country.