The Semantics of Decision-Making

Language shapes perception.  It becomes the reality by which we judge circumstances and draw conclusions.  Thus when people use the term “Physician Assisted Suicide”  (“PAS”), it suggests an almost nefarious collaboration between a doctor and a depressed patient.  It assimilates individuals in two antipodal situations:  the first, an able-bodied, physically healthy but mentally deranged or at least impaired individual with no physical obstacles to a continued life who is dealing with a temporary set-back; the second, a mentally competent but physically incapacitated, terminally ill person, increasingly decrepit and often suffering incurable excruciating pain whose days on earth are circumscribed to at best a few months.

Can one really call acts to end life in both situations identical or even so similar that they warrant the same descriptor.  One individual has every possibility of continuing to live perhaps for years or decades; the other is condemned by a terminal illness to a few months.  One’s act often strikes us as the height of irrationality; the other seems a rational response to the inevitable.

It is for this reason that the preferred term of art for the type of legislation we are seeking is Medical Aid in Dying or Death with Dignity or Physician Assisted Dying.  To use the word “suicide” to describe what competent patients facing a terminal illness choose as their exit plan is to trivialize the courage and strength of character involved.

We all can imagine talking a would-be suicide off the ledge:  “Don’t do it!  You have a family that loves you…this too will pass… you have your health… all is not lost!”  And those pleas are founded in reason, fact and logic.

But what do you say to a bedridden emaciated, dying person hooked up to feeding tubes or a respirator, lapsing in and out of consciousness form the daily regime of morphine to stifle temporarily the otherwise constant pain?  There would be a cruelty to lie to the patient that somehow the cancer will miraculously go away when every day it takes a larger toll; you know the person’s quality of life will only deteriorate and that the patient will never again be able to walk or run or enjoy life the way he once did.

Two vastly different situations warrant vastly different descriptions.

Let us examine then the statutory prohibitions in 40 states against Assisted Suicide, often deemed a felony which can result in lengthy prison time.  The first such law in the US was enacted in New York in December 1828.  This was a rather logical addition to the criminal code because at that time, suicide itself was a serious crime with grave repercussions for the heirs of the decedent.  The prohibition on suicide was largely a reflection of the common Judeo-Christian religious condemnation of self-murder as interfering with God’s plan.  Clearly if committing an act is illegal, abetting that act should logically also be illegal.  And so it was.  In every jurisdiction in the country, suicide was statutorily illegal and assisting someone in the commission of that crime was thus deemed a felony offense.

We have come a long way since theology alone dictated the whims of our legislators.  Now, suicide, albeit a tragedy and a national disgrace, is legal in every state and there are no legal repercussions for the heirs (with the exception that most life insurance policies are invalidated).  How then is it logical or even rational to state that although an individual may commit a certain act with impunity, anyone who aids that person in committing that legal act may go to jail for abetting the commission of, not a crime, but of a lawful action.  Should it be illegal to help someone do something lawful?

Even if we were to accept that what is right for the individual is impermissible for the abettor, clearly there are differences warranting legislative precision.

Again let us imagine two different situations.  Abel has just been dumped by his girlfriend.  In tears, he calls upon his estranged brother Cain for counsel.  Cain, knowing that he will inherit the totality of their parent’s patrimony if his brother Abel is out of the picture, takes advantage of Abel’s distraught and fragile state of mind and readily accedes to Abel’s jeremiad of self-pity.  When Abel mentions feeling suicidal, Cain suggests that would be the best solution and then hands him a loaded revolver with which Abel then shoots himself.

In another scenario, Jill lies in bed as she has for over a year, in a semi-comatose and constantly deteriorating situation:  incontinent, hooked up to intricate medical technology, in constant pain, unable to move her cancer-ravaged body without excruciation and exhaustion.  She was once a champion equestrian, fiercely autonomous and independent.  Now she languishes dehumanized, humiliate, dependent on nurses,  and loved one for all her daily needs.  Her doctor has been brutally honest that the cancer is incurable, inoperable and terminal.  She has at most 6 months to live.  She asks her loving sister Jane to facilitate her end by passing her an extra large dose of morphine.  She passes quietly surrounded by those who love her best.

In both cases, the state could prosecute Abel, the evil, sinister, malevolent brother and Jane, the loving, caring sister as equally guilty felons.  But query whether Jill is committing suicide when hastening her death by a few months given the inevitability of the outcome compared with Abel who has many years ahead of him if only he could get over his depression.

Words matter– it is irresponsible to deem Medical Aid in Dying as anything other than Good Samaritanism with the patient’s ultimate and rational wishes at heart.

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