Whose Right to Die?

Articles from 1974 to the present consider the question

In recent years the case of Terri Schiavo, a Florida woman who has been kept alive for the past fifteen years by a feeding tube, has brought the right-to-die question to the forefront of national consciousness. Schiavo's husband, asserting that she never wished to be kept alive artificially, points to the fact that she has long been in what doctors refer to as "a persistent vegetative state" and argues that she should be allowed to die. Schiavo's parents, on the other hand, believe that she is responsive and might one day recover, and want permission to keep her alive indefinitely. Schiavo's family, the Florida judicial system, and now the President and conservative members of Congress have all become entangled in legal wrangling over the case.

Over the years, several Atlantic contributors have addressed the right-to-die question, considering various aspects of the ethical dilemmas involved. In "Death, Legal and Illegal" (February 1974), Daniel C. Maguire, a Catholic theologian, faulted the American legal system for failing to acknowledge that killing does not in every instance represent an act of malice.

When the law imputes malice to mercy killings it is indulging in the Anglo-Saxon penchant for confusing reality with legality.... That is why wise judges are needed to temper the shortcomings of the written law....

To say that mercy killing is first-degree murder because it is premeditated and malicious, and that it is malicious because it is against the law, is a non sequitur.

Maguire pointed to a number of cases in which people in unrelenting pain or despair had been put out of their misery as an act of kindness. He emphasized that such an act, however, is only occasionally appropriate, and should never be undertaken lightly.

Life is the good thing and the precondition of all good things. Any decision to end it in any context, for self or for another, must be slow, deliberate, and reverential. But the life that is good also bears the mark of the tragic. There are times when the ending of life is the best that life offers. Moral man will see this, and then, more than ever, he will know the full price of freedom.

More than two decades later, in "Whose Right to Die?" (March 1997), Ezekiel Emmanuel, an oncologist, urged caution on those who would seek to loosen laws against euthanasia and physician-assisted suicide. Legally allowing mercy killing under certain circumstances, he warned, could spiral out of control to the point where even those who cannot be proven to have offered consent—"the unconscious, the demented, the mentally ill, and children"—might end up euthanized.

In the Netherlands, he pointed out, where euthanasia is sanctioned, studies have shown that approximately 1,000 deaths a year represent "nonvoluntary euthanasia." "There is a very strong tendency among people who are healthy," he warned, " to extrapolate from the suffering of others in ways that those who are in fact suffering would not countenance." And in some cases, he suggested, the motive for mercy killing may be less than altruistic:

Providing the terminally ill with compassionate care and dignity is very hard work. It frequently requires monitoring and adjusting pain medications, the onerous and thankless task of cleaning people who cannot control their bladders and bowels, and feeding and dressing people when their every movement is painful or difficult.... Ending a patient's life by injection, with the added solace that it will be quick and painless, is much easier than this constant physical and emotional care. If there is a way to avoid all this hard work, it becomes difficult not to use it.

Finally, in "Will the Circle Be Unbroken?" (October 2001), the oral historian Studs Terkel presented a collection of interviews with Americans from various walks of life on the subject of death and dying. One of his interview subjects, Matta Kelly, a worker at a community outreach program in Illinois, recounted her efforts to help one of her clients—a transvestite with AIDS—die in the manner she desired.

When Kelly learned that Norma, the client, was in the hospital and had slipped into a coma, she had to make a decision. Norma had given Kelly power of attorney and indicated in a living will that she didn't want to be kept on life-support. Kelly consulted with Norma's doctors.

"She had three different doctors: the head doctor, the doctor in the middle, and then the lowest one on the totem pole. All of them were telling me different things. One of them said, 'If we unplug her, she will die.' The other one said, 'If we unplug her, she might live and she might continue to breathe.' And the third one was telling me, 'If we unplug her, it's going to be a really ugly death and she's going to be gasping and she's going to suffer.' So I had to think some more about this. This was such a difficult decision. This was a decision to take a human life. And I am not a trained person. The only thing I can go by are my instincts and my compassion, and what she wanted."

Norma was transferred to a coma center where the doctors and nurses wanted to try to keep her alive artificially. After a battle with the center's staff and a meeting with its ethics committee, it was finally agreed that Norma would be removed from life support in accordance with the wishes expressed in her living will. As it happened, that turned out to be unnecessary.

"They were supposed to unplug her the following day....

So I went into Norma's room. I stuck my finger in her hand like this ... and I told her, I said, 'Norma, I have promised you for ten years that I would make sure that you died with dignity. I would make sure that you wouldn't have to be in pain. And I'm here to take care of your wishes. If you understand me, squeeze my finger.' And she squeezed my finger. And then I told her, I said, 'Norma, your cats are okay. Your rent is paid. Wayne is fine. Everything is taken care of. Your house is clean. Phone bill is paid. Everything is okay. You can just let go. I know you're in pain. I know you want to stop this. If you still want me to do what I promised you, squeeze my finger.' And she squeezed my finger. The next morning she died from a heart attack. And that was the story of Norma."

Sage Stossel