The "right to die" cause is building legal and popular momentum, with two federal courts recently allowing physician-assisted suicide and with polls showing 73 percent of Americans approve of the practice.
Despite public sympathy for what is a wrenching personal choice, the right-to-die movement has hit a snag. A legal, moral, and intellectual uprising against assisted suicide has emerged, partly in reaction to the clear shift toward its approval.
The fight may be bitter. The dramas of Michigan "suicide doctor" Jack Kevorkian, the stark testimony of patients and their families, and a new legal underpinning based on individual rights have led some experts to suggest that a US Supreme Court ruling to uphold a right to die may be in the offing. New York and Washington State have asked the high court to review the two federal court decisions. If the supreme bench agrees this fall to take the case, one of the most important decisions since Roe v. Wade could come by next spring.
Opponents are a broad and disparate group - physicians, legal scholars, religious thinkers, and ethicists. At bottom, opponents feel legal suicide is too profound an issue to rush into. They question whether a right to die is a constitutional right. Moreover, they share the view that doctor-assisted suicide, if not handled properly, could become dangerously routine, slowly cheapening the collective value of life in the US.
Last week a loose coalition of antisuicide attorneys, led in part by University of Michigan scholar Yale Kamisar, met in Washington for a strategy session, in the event the Supreme Court takes up the issue. "We are now in a second wave of questioning," says Daniel Callahan of the Hastings Center in Westchester County, N.Y. "When people begin thinking about it, this issue becomes less simple and more complex."
US law makes sharp distinctions between being allowed to die and actively seeking to end one's life. The Supreme Court recognizes the right to refuse medical treatment or be voluntarily removed from life-support equipment. Yet allowing mentally competent individuals to "determine the time and manner" of their own deaths, as Judge Stephen Reinhardt argued in March for the San Francisco-based Ninth Circuit Court, is criminal in 34 states and has never been upheld by the high court.
So far, the issue has been dominated by Mr. Kevorkian, a pathologist defrocked of his medical license, who earned the title "Dr. Death" in the 1950s when he tried to capture on film the moment when a person dies. Since 1990, Kevorkian has helped 33 clients end their lives. Last week he made headlines again when a Michigan medical examiner said Kevorkian's last client, Rebecca Badger, showed no signs of terminal illness in an autopsy, though in 1988 doctors diagnosed multiple sclerosis.
At the National Press Club on July 29, Kevorkian and his lawyer Geoffrey Fieger denied the charges and attacked the courts as corrupt and the media as "wimps." Mr. Fieger said, "This is not the right to commit suicide.... It is the right not to suffer."
Opponents say the focus on the personality of Kevorkian, and on tragic individual cases of patients, must be balanced by the larger practical effect of euthanasia. Some in the antisuicide uprising do not take an absolute position against it. What they want is a more conscious choice by Americans, not a rush to judgment. As Yale law professor Stephen Carter writes, "Because the arguments on both sides carry such strong moral plausibility ... the questions should be answered through popular debate and perhaps legislation, not through legal briefs and litigation."
Euthanasia advocates compare the right to die to the right to abortion. The Ninth Circuit opinion, in fact, cited Roe v. Wade, saying that under the Constitution's equal-protection clause people diagnosed as terminally ill, but mentally competent, have a right to choose.
OPPONENTS say society is not prepared for assisted suicide, in the way it was for abortion. Prior to the 1972 Roe decision, four states allowed abortion. A California law signed in 1968 by then-Gov. Ronald Reagan increased the number of abortions in that state from 5,000 in 1968 to 116,000 in 1971. The medical community supported abortion in a manner not currently shared in the case of euthanasia, they say.
"There is nothing now like the public consensus prior to Roe," says Robert Burt of Yale Law School, a medical ethics expert. "The idea that the court would jump ahead of society and make [suicide] legal is far more radical than the practical impact of Roe."
Polls show 65 to 80 percent of Americans favor physician-assisted suicide. Yet when voters actually faced the issue in recent California and Washington referendums, they voted it down. A 1994 legal suicide referendum in Oregon passed, 51 to 49 percent.
A central moral argument in the uprising is the "slippery slope." Opponents suggest that as euthanasia becomes more accepted, the attitudes of the healthy toward the sick will undergo a subtle shift, in which the weak and infirm may be asked to answer for their existence in ways they will feel helpless to counter. "The effect of maximizing freedom [to die] ... may be to make it more difficult for the sick - the dependent, those whose lives seem out of control - to refuse the question of death, harder to justify their existence," argues Allen Verhey, professor of religion, in the current issue of Christian Century magazine.
Others in the church community feel financial pressures could corrupt the church's basic commitment to fight death as an easy answer. "The church should carefully monitor its internal dialogue," says David McCurdy of Chicago's Park Ridge Center for the Study of Health, Faith, and Ethics, "lest a resource-conserving understanding of euthanasia infiltrate its own language and obscure the real moral challenge of euthanasia."
Shifts in health-care financing also present a dilemma. The move from fee-for-service to managed care has reversed the financial reward system of care. While more treatment formerly equaled more dollars, now profit is tied to reducing care. A financial incentive now exists for doctors to "speed along" the patient, critics say. "It's not that people become cruel. But they lose a sense of personal responsibility," says Mr. Burt. "There is financial pressure, and they can say, 'I'm just doing my job' - a standard unimaginable in terms of our current morality, to say nothing of the violence this does to the trust involved in a doctor-patient relationship."
Legally, if the equal-protection clause extends to a choice for suicide, what is to stop depressed people from choosing it? Rather than hospitalizing those who attempt suicide, "we should be asking them if they would like assistance," an evident absurdity, Mr. Carter says.