The ri ght  t o di e,  or t he ri ght  t o physi ci an assi st ed sui ci de ( PAS f or shor t )  i s an emot i onal  i ssue f or bot h l i beral s and conser vat i ves.   As i s t he case wi t h bot h homosexual i t y and abor t i on t he i ssues are of t en reduced t o pri vacy ri ght s versus soci et al  harm i n t he publ i c debat e.   Unl i ke ei t her of  t hose i ssues,  however,  t he soci et al  concern behi nd PAS may be l ess i deol ogi cal  and,  upon anal ysi s of  f act s,  f ar more obvi ous.   Despi t e t he ri ght  t o personal  pri vacy t hat  has devel oped t hrough a seri es of  supreme cour t  r ul i ngs,  t he negat i ve soci et al  ef f ect s of  physi ci an assi st ed sui ci de provi des val i d concerns f or bot h l i beral s and conser vat i ves t o be caut i ous of  l egal i zi ng PAS on a f ederal  l evel  and perhaps on a st at e l evel  as wel l .

In hi s f amous 1973 Roe v.  Wade opi ni on Judge Bl ackmun st at es,  “ The Const i t ut i on does not  expl i ci t l y ment i on any ri ght  of  pri vacy.   In a l i ne of  deci si ons,  however… t he Cour t  has recogni zed t hat  a ri ght  of  personal  pri vacy,  or a guarant ee of  cer t ai n areas or zones of  pri vacy,  does exi st  under t he Const i t ut i on.”  Herei n t he not i on of  a ri ght  t o pri vacy was brought  t o exi st ence.   Ameri cans general l y embrace t hi s ri ght .

Nevertheless, Blackmun admits that the right of personal privacy “is not unqualified and must be considered against important state interests in regulation.”  This echoes J.S. Mill’s notable “no harm principle,” in whichindividual freedom is valued and advocated but notunconditional.  Indeed, individual freedom is “properlylimited when individual acts are unduly harmful to self,others, or the whole, even if the harm is indirect.”  Onemust ask, what are the possible repercussions of PAS asimplemented in American society?

The l at e Chi ef  Just i ce of  t he Supreme Cour t ,Wi l l i am Rehnqui st ,  addressed t he i ssue of  st at e i nt erestconcerni ng t he prohi bi t i on of  PAS by t he st at e ofWashi ngt on i n t he 1997 case Was hi ngt on v.  Gl ucks berg.Foremost ,  Rehnqui st  scr upul ousl y not ed t hatWashi ngt on’s ban on PAS prot ect s t he i mpoveri shed,t he el derl y,  t he di sabl ed,  t he t ermi nal l y i l l  and “ot hervul nerabl e groups f rom i ndi f f erence,  prej udi ce,  andpsychol ogi cal  and f i nanci al  pressure t o end t hei rl i ves.”  Last l y,  Rehnqui st  makes t he so- cal l ed sl i pper ysl ope argument :  by adopt i ng an ant i – PAS pol i cy,  t hest at e avoi ds a dangerous sl i de t owards sanct i oned,cont roversi al  met hods of  deat h,  such as vol unt ar y ori nvol unt ar y eut hanasi a where a l et hal  dose of  dr ugs areadmi ni st ered t o t he pat i ent  di rect l y by a doct or,  so t hatt he doct or i s,  i n ever y respect ,  t he agent  of  deat h.   Int hi s way,  Rehnqui st  spoke f or t he maj ori t y,  uphol di ngWashi ngt on’s ban on PAS.

This ‘slipper y slope’ argument may be the biggestcause of concern for both liberals and conser vatives alike.Alan Shewmon of the University of California highlightshis concerns in an essay entitled “Active Voluntar yEuthanasia: Opening Pandora’s Box.”  Shewmon makesthe case that an analysis of the Dutch experience withlegalizing PAS has resulted in an ever expanding number of cases in which PAS has become legal.  “Dutch courts have steadily expanded the circumstances in which a doctor may avoid prosecution if he kills – with case law now permitting euthanasia for patients with such nonterminal afflictions as multiple sclerosis or simply the physical ravages of old age.”  Secondly, Shewmon and many other thinkers are concerned that, as time goes on PAS might become less a choice than an obligation.  Shewmon is concerned about circumstances in which the lives of comatose patients are being decided by a proxy that may or may not have any emotional attachment to the comatose patient.

Thi s concern f or t he pat i ent’s agency i s not  st ri ct l y l i mi t ed t o t hose who oppose a ri ght  t o di e.   Prof essor Mi chael  Green of  t he Uni versi t y of  Chi cago Phi l osophy and Human Ri ght s Depar t ment s bel i eves t hat  t here i s undeni abl y a ri ght  t o di e but  caut i ons agai nst  t he l egal i zat i on of  t hat  ri ght .   Accordi ng t o Green,  i f  PAS became more popul ar t he ai l i ng el derl y mi ght  f eel  pressured t o end t hei r own l i ves as t he cost  of  l i vi ng becomes hi gher and t hei r f ami l i es become more rel uct ant  t o vi si t .

These concerns are not  t ri vi al ,  par t i cul arl y because many of  t he reasons t hat  i ndi vi dual s ask f or PAS are not  l i mi t ed t o pai n i ssues but  are al so mot i vat ed by di gni t y i ssues.   It  seems t hat  i f  t he l oose t erm ‘ l oss of  di gni t y’  was consi dered a l egi t i mat e reason t o ask f or PAS,  t hen a def i ni t i on t hat  evol ved over t i me coul d event ual l y resul t  i n t he merel y el derl y aski ng f or PAS.   Thus t he horror st ori es of  t he sl i pper y sl ope argument  di scussed above woul d come t o f r ui t i on.   Thi s case i s wel l  document ed i n t he Net herl ands,  as ment i oned above.   Addi t i onal l y,  Dut ch advocat es of  eut hanasi a have warned agai nst  t he l egal i zat i on of  PAS i n t he US i n as l i beral  f orm as i t  exi st s i n t he Net herl ands.   They cl ai m t hat  t he resul t s coul d be ver y dest r uct i ve i n Ameri ca because of  t he l argel y pri vat e and st i ngy heal t hcare pl ans avai l abl e t o resi dent s of  t he Uni t ed St at es.

But ,  coul d Ameri cans avoi d t hi s sor t  of  Dut ch- st yl e mi sappl i cat i on of  PAS by st ri ct l y l i mi t i ng PAS t o t hose i n i mmense pai n t hat  can not  be cont rol l ed by any ot her means?  Thi s does seem l i ke a pl ausi bl e opt i on t hat  coul d be regul at ed so as not  t o expand i nt o ‘dangerous’  t erri t or y.   However,  i f  t here i s a const i t ut i onal  ri ght  t o di e,  t hen i t  woul d be di f f i cul t  t o draw such a di st i nct i on.

As Rehnqui st  ment i ons i n hi s Gl ucksberg opi ni on,  t he cour t  cannot  be i n t he busi ness of  awardi ng prot ect i on of  t he 14th Amendment  t o par t i al  ri ght s but  i nst ead onl y t o f undament al  ri ght s.  As Rehnqui st  says reser vi ng t he 14t h f or f undament al  ri ght s i s necessar y because,  “i t  avoi ds t he bal anci ng of  compl ex compet i ng i nt erest s i n ever y case.”  That  i s t o say t hat  t he 14th Amendment  can onl y be used f or l egi t i mat e,  cl ear,  and f undament al  ri ght s.    If  t here exi st s a f undament al  l i ber t y t o di e,  how coul d t he cour t  possi bl y l i mi t  t hat  ri ght  t o t he i ncurabl y i l l ,  l et  al one t he t ermi nal l y i l l ?  It  woul d onl y be a mat t er of  t i me bef ore an el derl y man or woman cl ai med t hat  she had a f undament al  ri ght  t o di e as expressed i n sai d r ul i ng.  As Rehnqui st  cl ai ms above,  t he cour t  can not  say t hat  onl y t ermi nal l y i l l  peopl e have a ri ght  t o di e or onl y t hose wi t h ext reme cases of  i l l ness have a ri ght  t o di e.

There are t wo assumpt i ons underl yi ng t he sl i pper y sl ope.   Fi rst  of  al l ,  t here i s an underl yi ng assumpt i on t hat  what ever a soci et y get s used t o wi l l  event ual l y get  l egi sl at ed.   If  we become accust omed t o permi t t i ng some peopl es’  deat hs,  we may al l ow t he deat h of  ot hers.   Thi s may seem l i ke a t enuous assumpt i on but  i t  i s not  i mpl ausi bl e.   Fur t hermore,  i t  has been obser ved i n t he Net herl ands.   The second assumpt i on regardi ng t he sl i pper y sl ope i s t hat  t here exi st s no t hreshol d at  whi ch t he sl ope wi l l  cease t o be sl i pper y.   Thi s i s t r ue f or t he f ederal  government  as expl ai ned above.   The f ederal  government  does not  have t he abi l i t y t o cut  up t he 14t h amendment  and procl ai m f undament al  ri ght s f or some peopl e and not  ot hers.   The quest i on t hen becomes a mat t er of  whet her t he st at es are capabl e of  di ssect i ng ri ght s i n t hat  manner.

The f act  t hat  t he Supreme Cour t  does not  have t he abi l i t y t o pass par t i al  ri ght s does not  mean t hat  t he st at es are si mi l arl y bound.   Oregon has passed l egi sl at i on al l owi ng PAS f or t he t ermi nal l y i l l  onl y.   Perhaps Oregon can be used as a t est i ng ground f or t he saf et y of  st at e regul at ed PAS.   However t he Sevent h Annual  Repor t  on Oregon’s  Deat h wi t h Di gni t y Act ,  conduct ed by Oregon’s Depar t ment  of  Human Ser vi ces st i l l  provi des onl y i ncompl et e i nf ormat i on.   Si nce t he enact ment  of  PAS,  doct ors have prescri bed l et hal  doses of  dr ugs t o 326 men and women i n order t o commi t  PAS,  of  whi ch 208 have act ual l y carri ed out  PAS ( 63. 8%) .  Bot h t he number of  peopl e prescri bed PAS and t he number of  peopl e who consummat e deat h vi a PAShave i ncreased si nce 1998,  f rom t went y- f our prescri pt i ons wri t t en i n 1998 produci ng si xt een PAS deat hs,  t o si xt y prescri pt i ons wri t t en i n 2004 i ncurri ng t hi r t y- seven PAS deat hs.   Fur t hermore,  t he medi an age of  t hose el ect i ng t o per f orm PAS has dropped f rom sevent y ( 1998- 2003)  t o si xt y- f our.   Di st urbi ngl y,  t he DHS repor t s t hat  t he percent age of  pat i ent s ref erred t o a psychol ogi cal  speci al i st  has decreased f rom t hi r t yone percent  i n 1998 t o a mere f i ve percent  i n 2004 and t hat  men and women who have ei t her never marri ed or di vorced are t wo t i mes as l i kel y t o ut i l i ze PAS as wi dowed or marri ed resi dent s of  Oregon.   Moreover,  t he concern most  f requent l y ci t ed by i ndi vi dual s who were prescri bed PAS was “a decreasi ng abi l i t y t o par t i ci pat e i n act i vi t i es t hat  make l i f e enj oyabl e” ( 92%) .

The f at e of  PAS has obvi ousl y not  yet  been deci ded.   However,  i t  i s cl ear t hat  despi t e t he nat ural  opposi t i on of  Ameri cans t owards l egi sl at i on t hat  l i mi t s t hei r ri ght s,  t he concerns of  l egal i zi ng PAS are wor t hy of  consi derat i on.     Thus whi l e i t  i s cer t ai nl y possi bl e t hat  st at es may ul t i mat el y be abl e t o regul at e PAS saf el y,  bot h si des of  t he debat e wi l l  need t o obser ve t he experi ment  i n Oregon wi t h const ant  vi gi l ance.