Assisted Suicide: Canadian Perspectives

AMBIGUITY AND SYNERGISM IN "ASSISTED SUICIDE

C. G. Prado AMBIGUITY AND SYNERGISM IN "ASSISTED SUICIDE" Present debate about "managed death"1 is vitiated by ambiguity . Various forms of managed death—not delaying or hastening death in terminal illness—are being lumped together as "assisted suicide." But the bulk of managed death is not help in se/f-destruction; rather it is compassionate causing of terminal patients' deaths by physicians complying with those patients' desire to end their suffering. Ambiguity poses a worrisome issue because we are beginning to acknowledge what has long gone on in our hospitals, to more openly accept socalled "assisted suicide" and inclining to legalizeits provision. We need to frame sound policies to govern the practice if it is legalized. We cannot afford to let debate, legislation and regulative policy be jeopardized by unreflective acceptance and equivocal description of different kinds of managed death as all cases of self-destruction. Still, misconception and misrepresentation of managed death as assisted suicide are neither accidental nor simply mistaken. What prompts both is a combination of circumstantial , moral and legal pressures that provide some warrant for thinking of managed death primarily in terms of patients' self-determination. Terminal patients who choose to die, rather than endure pointless pain and degradation, cannot readily enact their decisions by themselves and need the help of others , usually physicians, to achieve their ends—in both senses 43 ASSISTED SUICIDE: CANADIAN PERSPECTIVES of the phrase. Because terminal patients' circumstances both prompt desires to not delay or hasten death and dictate that others help enact their decisions, the historically new term "assisted suicide" emphasizes the role of patients' decisions and de-emphasizes the role of others' actions to construe and describe managed death as essentially suicide, even if in fact caused by others. Additionally, as is pointed out in the Canadian Senate's report on assisted suicide and euthanasia, useof pivotal terms in the managed-death debate is "seldom based on...literal meaning." Instead, terms are used in ways that reflect and promote "a specific moral or ethical perspective."2 A crucial aspect of this usage and the thinking it reflects is limitation of responsibility. Emphasizingpatients' own decisions, in order to construe managed death as assisted suicide, attributes primary responsibility for managed death to patients. If physicians managing patients' deaths are assisting suicide, their moral and legal responsibilities are more narrowly defined and may be more leniently assessed than if they are performing euthanasia. If patients' decisions are given definitive priority over physicians' death-causing actions, the latter are cast as those ofagents carrying out patients' decisions and not those of individuals acting in their own stead. Webster's Unabridged* dictionary defines suicide as "the intentional taking of one's own life." Suicide is se/f-killing. Causing another's death for compassionate reasons is euthanasia. In managed death, physicians typicallycause patients' deaths directly or indirectly, so it would seem that managed death is not assisted suicide. Unfortunately, matters cannot be settled by recourse to the dictionary. Jan Narveson rightly points out that "it is not possible to separate neatly questions of definition from questions of moral substance."4 The substantial question about managed death is whether it is morally permissible for terminally ill individuals to take their own lives and for others to help them do so or to take those individuals' lives at their behest. The basic issue is whether "life is the possession of the person who lives it" or is 44 AMBIGUITY AND SYNERGISM IN "ASSISTED SUICIDE" "a gift, of which we are custodians with certain duties."5 Proponents of managed death, who hold the former view, think disposition of one's own life is coveredby personal autonomy, so they think managed death is morally permissible in the right circumstances. Theyalso think that assistance should be provided where those wishing to end their lives for good reason are unable to do so unaided. Because proponents of managed death emphasize personal autonomy, they are comfortable with describing it as assisted suicide, since that description puts the emphasis where they think it belongs: on patients' own choices to forfeit time left to them in order to avoid suffering and debasement. Opponents of managed death think life is an unrenounceable gift and see managed death as impermissible killing, regardless of who bears primary responsibility for causing death, how insistent the demands of those wishing to die or how compassionate the motives of those assisting self-destruction or causing death...