First, let me thank Senator Sears and members of the Judiciary Committee for allowing us to be here this morning to provide our views on S.103. We appreciate your concern, and know that this is a very difficult and emotional issue for many people in our state. At the same time, we also are very grateful for the support that Vermont legislators have shown for increased access to our excellent palliative and hospice care throughout the state.
My remarks this morning focus on three points:
S.103, if passed, makes us all complicit in the act of suicide.
S.103 would medicalize suicide, undermining the assertion that assisted suicide would honor personal autonomy.
S.103 fails the transparency test.
First, the proponents of physician assisted suicide suggest that S.103 will further ensure their right to govern their own living and dying, and guarantee a personal and intimate choice at the end of life. The assumption here is that the individual is solely in charge of her living and dying. I would challenge this assumption. By legislating the act of suicide, S.103 takes what is commonly thought of as an individual act and places it squarely in the public realm. At least indirectly, the public, through our duly elected officials, would now be complicit in sanctioning suicide. We generally think of suicide as personal, private, and solitary, and contrary to social norms. This act places the person on the outside. However, proponents of S.103 are now looking for our permission and an endorsement of the act of suicide. In order to make this autonomous, private choice at the end of life, individuals are now seeking our authorization. Thus suicide is no longer an act of individual autonomy, but one that involves the public from the start. Suicide becomes part of our “socially stipulated code of conduct.”
Second, defenders of physician assisted suicide tell us that S.103 will help de-medicalize death; that is, it will add another protection to an individual’s right to refuse medical treatment. The point being, that taking this final decision out of the hands of medicine it would grant real control over one’s dying. However, because a doctor is required to certify that the patient is of sound mind, and then a doctor has to prescribe the lethal medication, the decision to commit suicide is no longer an individual expression of self-determination—it becomes a mutual decision. But ultimately the doctor still is in charge, and the choice to end one’s life is right back in the medical arena. In fact, the doctor can decide that a person is not of sound mind. Who but the individual himself should decide that?
When a patient and doctor discuss how to relieve pain and suffering, and mutually decide that lethal medication is an option, the decision to commit suicide becomes yet another clinical problem needing treatment. But in this case, the treatment is a prescription for death. To be sure, the individual determines when and where the act will occur, but it is no longer a “pure” choice, because it can’t be acted on without a doctor’s help. As one author has stated: “The ‘private,’ ‘intimate,’ ‘self-determining’ decision to commit suicide is translated into a clinical event.” And this is exactly what doctors should not be doing. When assisted suicide becomes a medical treatment, it normalizes suicide because the patient needs observation, examination, and careful questioning to determine that this is indeed a rational choice. Instead of limiting paternalism, S.103 would permit doctors to decide what is in the best interests of individual patients.
Finally, while there are a number of particular problems with S.103, I will point to one very troubling question. Section 5298 reads: “Action taken in accordance with this chapter shall not be considered tortious under law and shall not be construed for any purpose to constitute suicide, assisted suicide, mercy killing, or homicide under the law.” This is clearly untrue. When an individual self-administers a lethal dose of medication, intentionally and deliberately causing her death, we commonly understand this to be suicide. When a physician aids and abets this act, he assists.
Thank you again for the opportunity to be here today.
Edward Mahoney is the director of the Graduate Theology and Pastoral Ministry program at Saint Michael’s College, as well as a professor in the Religious Studies department. He is an expert in the Human Genome Project, ethics and genetics, fundamental moral theology, and ethics of long-term care. He is the president of the Vermont Alliance for Ethical Healthcare—an organization of healthcare professionals and friends who joined together in an effort to support the expansion and improvement in end-of-life care and to oppose the legalization of physician-assisted suicide in Vermont.
This article has been reprinted with permission and can be found at http://secure.campaigner.com/Campaigner/Public/t.show?RvFD--DBhp-uXz7M8.