Assisted Suicide: Ethical Issues

Aid in Dying Autumn 1996

Do people have the right to terminate their lives in the face of painful and humiliating ill­ness? Does a victim of cancer, multiple sclero­sis, or creeping paralysis have the right to end intolerable suffering? Do they have the right to receive medical assistance to ensure that suicide is successful and relatively painless?

These issues are now absorbing the atten­tion of the Western world. Dr. Jack Kevorkian has boldly defied Michigan authorities to stop him from assisting those who ask him for help. Some people admire his intentions and his tactics. Some despise both. Some approve of assisted suicide but are wary of his tactics.

Very recently the Northern Territories in Australia authorized medically assisted sui­cide — the first political entity to do so. (Hol­land forbids it by law but allows it by refusal to enforce the law.) The first “customer” in Australia has already been served. Public opinion in most Western countries supports this development.

But is it ethical? Does Humanistic Juda­ism justify such behavior?

Suicide — any kind of suicide — is for­bidden by rabbinic Judaism. Life belongs to God. Only he can authorize killing. He has authorized the killing of enemies, infidels, and apostates; but he has not authorized kill­ing oneself.

In authoritarian systems, no reason need be provided. But priests, prophets, rabbis and theologians often feel uncomfortable with such a naked and dismissive form of author­ity. They search for reasons to justify what appears to be arbitrary. In the case of suicide they appeal to the virtue of suffering. In a sin­ful world, suffering is the perfect repentance. Since sin is unavoidable, suffering is also unavoidable. Given the almost infinite possi­bilities for sinning, there can never be too much suffering. Killing oneself does not ulti­mately end pain or anguish anyway. Beyond the grave is eternal suffering for the wicked. You might as well suffer now as suffer later.

Of course, there are circumstances under which it is mandatory to allow others to kill you — a form of passive suicide. If you are being compelled under threat of death to wor­ship gods other than Yahveh, or to commit incest, then death is preferable. But the ac­tual killing is done by your enemies, not your­self. Killing yourself to avoid pain or humiliation is not a “kosher” alternative, nor is hav­ing someone else kill you for such a reason. The martyrs of Masada, who killed themselves rather than fall into the hands of the Romans, might be construed as being avoiders of forced idolatry; and the martyrs of the Christian Middle Ages were clearly defenders of the faith. They chose to die for one of the two available legitimate reasons. Refusing to sur­render to the sinful demands of enemies was not really suicide; terminating your life as an act of kindness to yourself was.

There is no legitimate — or devious — way of extracting approval for assisted sui­cide from rabbinic Judaism. It is as futile as seeking a vague endorsement of homosexual­ity. But in an aging population beset by de­bilitating illnesses, the right to end irrevers­ible suffering is an unavoidable ethical issue. The halakhic rabbis may say no; but Human­istic Jews do not have to accept their moral judgment, especially if we have come to be­lieve that their judgment is not moral.

Humanistic Judaism does not derive its ethics from rabbinic Judaism. It derives its eth­ics from human needs bumping into the real world. Food, shelter, and sex are bodily needs. Long-run survival, happiness, and dignity are equally important. When life can offer neither dignity nor happiness, survival loses all ethi­cal meaning. To survive merely in order to sur­vive makes no humanistic sense unless there is some modicum of pleasure and dignity. Even if there is a God and he wants us to suffer for the sake of suffering, his demand is illegitimate. Humanistic Judaism does not find relentless pain either therapeutic or romantic.

Ever since the Enlightenment, the right to happiness and the value of personal au­tonomy have been celebrated in much of the Jewish world. They reflect the importance most contemporary Jews place on the ability to choose the course of one’s life. When that control vanishes, the value of life is called into question. It is simply not rational for people to endure the humiliation of helplessness when that humiliation is avoidable and when there are compassionate experts available to offer relief.

Most public opinion in North America supports assisted suicide, with appropriate safeguards, in the case of terminal illness. The appropriate safeguards are three: (1) The dy­ing person should choose assisted suicide in the presence of reputable witnesses; (2) his or her physician should verify that the patient is suffering from a terminal illness; and (3) a psychiatrist or psychologist should verify that the dying person is sane and not momentarily depressed. (Of course, being depressed when you are dying is rational!) This right, with these safeguards, should be incorporated into legislation. The rule of law should replace the rule of Kevorkian.

What about intolerable chronic illness? What about paraplegics and handicapped people, emphysemics and organ defectives, who find life not worth living? Should they have the right to assisted suicide? I think the humanistic principles of dignity and happi­ness give them that right; but it is not wise to press for it now, since public opinion does not yet widely support it. The rights of the terminally ill will be lost if we ask for too much too soon.

What about depressed people who find no meaning in existence? The humanistic answer to them is no. Although they have no happiness, as long as they are mobile and without physical restraint they retain the pos­sibility of dignity.

There is no “slippery slope” if safeguards are provided. What exists now is useless pain. It is time for reason and compassion to replace reverence for suffering. Where human dignity is at stake, old laws must yield, and new laws must be created to defend it.