The right to a self-determined death
The universal right to a self-determined death affirms the view that people are capable of autonomous choices concerning the desire for a rational suicide, and that this right is beyond the claims and restrictions of any law or institution.
The Swiss Criminal Code of 1937 comes closest to enshrining this right in law. It allows assisted suicide, also known as assisted dying or medical aid in dying, which is a suicide that’s done with the aid of another person.
Assisted dying usually refers to physician-assisted suicide, which is a death that is assisted by a doctor or other healthcare provider. However, there is no requirement in Swiss law that doctors need to play a role in assisted suicide.
Further, unlike the long list of requirements and ‘safeguards’ that apply to assisted suicide laws in other jurisdictions, Switzerland has just two requirements/safeguards: (i) mental capacity (ii) and that the action(s) of ending one’s life are performed by oneself, and no one else.
Swiss law specifically outlaws “incitement or assistance to suicide from selfish motives” (Art. 115). Any active role in voluntary euthanasia (“manslaughter on request”) is also outlawed, even if committed from “respectable motives” such as mercy killings (Art. 114).
So, lethal drugs can be prescribed so long as the recipient takes an active role in a drug’s administration, but active euthanasia (such as administering a lethal injection) is not legal.
Swiss law allows providing the means to commit suicide but the reasons for doing so mustn’t be based on self-interest (such as monetary gain). Based on this legal situation, non-profit organisations administering life-ending medicine were first established in Switzerland in the 1980s.
Under Swiss law, the basis for an assisted suicide need not be a terminal diagnosis. Assistance that is driven by altruistic motivations is lawful.
Physician-assisted suicide, also known as voluntary assisted dying (VAD), is legal in some countries, under certain circumstances, including Canada, Belgium, the Netherlands, Luxembourg, Spain, Switzerland, Germany, parts of the United States (California, Colorado, Hawaii, Maine, Montana, New Jersey, Oregon, Vermont, Washington and Washington, D.C.) and Australia (Tasmania, Victoria and Western Australia).
To qualify for legal assistance in most of these jurisdictions, individuals who want a physician-assisted suicide need to meet certain criteria, including: having a terminal illness, proving they’re of sound mind, voluntarily and repeatedly expressing their wish to die, and taking the specified, lethal dose by their own hand.
In the three Australian states where physician-assisted suicide is legal, there are more than 60 conditions and ’safeguards’ that must be met in order for people to qualify for a legally sanctioned exit. It is only available to those suffering from an incurable, advanced and progressive disease, illness or medical condition, and who are experiencing intolerable suffering. The condition must be assessed by two medical practitioners to be expected to cause death within six months.
These conditions and safeguards are so narrow, however, that many people who might want access to physician-assisted suicide are denied it. For example, those aged less than 18 years cannot access this law. Having a disability alone, such as quadriplegia, blindness or MS, is not a sufficient reason to access this law. Similarly, mental illnesses alone, such as depression or bipolar disorder is not a sufficient ground to access voluntary assisted dying.
Each of these caveats and restrictions on people’s right to end their life ignore the fundamental human right to self-determination and autonomous decision-making concerning the desire for rational suicide.
Philip Nitschke argues that people’s reasons for wanting choice at the end of life is about more than wanting to avert dying from a terminal disease and being spared the (all too common) indignities of poorly administered palliative care.
“Choice at the end of life is much more fundamental,” he says. “It is about taking back control of one’s existential existence from the world we all live in. This is not a choice that can or should be delegated to a bunch of doctors.” [i]
People have a host of reasons for wanting to die before death claims them. For example, some old people lose the will to live because their spouses and friends have died, they are physically diminished, living with pain, and have lost much of their autonomy, especially if they are living in an aged care facility.
Even without these restrictions and vicissitudes, some older people feel they have a lived a full life and have no desire to live another ten or 20 years of inexorable decline. Many people living with chronic depression feel that suicide is a desirable and rational choice because their lives are intolerable and there is little prospect of any improvement.
For people living with chronic or life limiting or terminal conditions their leading motives for wanting a quick, assisted (or unassisted) exit include loss of autonomy, a dwindling ability to engage in activities that make life enjoyable, loss of dignity, intolerable pain from their disease or medication, loss of sense of self, and a fear of burdening others.
Other common reasons include long-standing beliefs in favour of hastened death, a desire for control, and people’s fears about their future quality of life and dying.
Further, anyone with knowledge or experience of palliative care will probably want to avoid being palliated at the end of their life, if they can avoid it. Dozens of reports confirm that palliative care in Australia, at least, is inadequately funded, understaffed, poorly planned, administered and monitored. [ii]
For these and a host of other reasons, many people are seeking ways to secure a quick and painless death outside of the restrictions and prohibitions imposed by law.
Exit International is an international non-profit organisation that informs and assists people who want control over how and when they die. It is engaged in several activities, including advocating the legalisation of voluntary euthanasia and assisted suicide, publishing material providing information on assisted suicide and voluntary euthanasia, and research and development of non-medical ways of achieving a quick and painless death.
For example, the Sarco machine is a euthanasia device resembling a small spaceship. It was invented in 2017 by euthanasia campaigner Philip Nitschke. It comprises a 3D-printed detachable capsule mounted on a stand that contains a canister of liquid nitrogen to commit suicide through inert gas asphyxiation. The device can be made from biodegradable material and the detachable capsule can be used as a coffin.
The main reasons that some people are opposed to assisted dying and suicide coalesce around issues of vulnerability, access and concerns about eroding the value of human life.
Once we let doctors kill patients, or enable ways for people procure fast, pain free ways of suiciding, there will be pressure, some argue, to extend the range of circumstances where euthanasia is permissible.
This is sometimes called a ‘slippery slope argument’ because it’s argued that it’s easier to amend or liberalise existing laws that permit euthanasia than getting it approved in the first place.
Once active euthanasia is legalised, opponents say that frail, chronically ill or terminal people will be vulnerable to an ever-expanding set of circumstances where doctors could kill patients, or where they could help people kill themselves.
Therefore, patients who don’t really want to end their lives might feel pressure to end their lives when this isn’t what they really want.
Another rationale used by some opposed to euthanasia is that pain isn’t a sufficiently good reason for anyone to want to die. Pain is simply part of dying and can be adequately managed, they say.
Another view is that passive euthanasia is a better alternative — such as withholding life-saving treatment like chemotherapy or turning off life-support systems.
Embedded in this argument is a view that the difference between active and passive euthanasia is morally significant. That letting nature takes its course (passive euthanasia) is morally defensible, while taking a life (active euthanasia) — even with patient consent under legally defined circumstances — is not.
Judeo-Christian religions oppose euthanasia and assisted suicide on moral grounds. The Catholic Church considers active euthanasia to be a ‘crime against life’ and a ‘crime against God’. [iii]
Catholicism says euthanasia is a sin because life is ‘holy’ and ‘sacred’, and human actions that cause death, or that intend to, are effectively ‘playing God’. Implicit in this view is the idea that God created life and that human actions to end it go against God’s dominion and what Catholics regard as the inviolability or ‘sanctity of life’. The Jewish, Islamic and Hindu faiths also look gravely on active euthanasia.
Euthanasia is divisive. And like other issues that divide us, like immigration policy or same-sex marriage, I’m guessing that people with little to no experience of euthanasia have more strident and negative views than those with personal and professional experience of it. [iv]
I say this because there’s good evidence, for example, that people with racially and ethnically diverse social networks are less likely to support racist views than people with monocultural networks.
It turns out that education and life experience breed tolerance and compassion.
Tolerance says, I am willing to accept difference. I still have my opinions but as a mark of respect, I am willing to say live and let live. Each to her own. I can agree to disagree and leave it at that.
Compassion goes deeper than tolerance because it walks in the shoes of another without judgment or opinion. Compassion is a matter of heart, not head, and bridges the divide between us.
Compassion says, I feel what you feel. And even if I thought you were making a ‘mistake’ by choosing to die as a way to end your fear and suffering, who am I to judge?
We all face death. Can we be so certain, so confident in our views that we feel ordained to tell others how to face theirs? What gives any of us the right to tell another that they don’t have the right to die?
If we lay aside our arguments and religions and moral precepts, maybe we can let others face these end-of-life choices in their own way.
Dan Gaffney is a teacher and author. He leads workshops and educational events and hosts a men’s group in the Blue Mountains. His book and podcast series, Journey Home — Essays on Living and Dying was published in 2019.
[i] Philip Nitschke, e-deliverence, Exit International newsletter, p3, December 2020
[ii] NSW Auditor-General’s Report to Parliament: Planning and evaluating palliative care services in NSW, NSW Audit Office, August 2017
[iii] Sacred Congregation for the Doctrine of the Faith (May 5, 1980). Declaration on Euthanasia
[iv] Maria Sacchetti, M and Guskin, E (2017). In rural America, fewer immigrants and less tolerance, The Washington Post, June 17
