Death With Dignity: An Ethical Debate

Learn more about the comprehensive and engaging history of legal and political battles surrounding a terminally-ill individual’s "right to die with dignity."

| September 2012

Over the past 100 years, the average life expectancy in America has nearly doubled. While longevity is celebrated as an achievement, the longer people live, the more likely they are to succumb to chronic, terminal illness. At Liberty to Die (New York University Press, 2012) by Howard Ball dissects the battle for death with dignity in America and explores the pressing question: is it appropriate, legally and ethically, for a competent individual to have the liberty to decide how and when to die when faced with terminal illness? The following excerpt is taken from the book’s introduction. 

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Dudley Clendinen is a sixty-six-year-old author and columnist dying of amyotrophic lateral sclerosis (ALS, known as Lou Gehrig’s disease). In a recent essay, he discussed his existential situation. There is no meaningful treatment for ALS nor is there a cure. “Lingering would be a colossal waste of love and money. I’d rather die,” he wrote. Although leaving his daughter “is the one thing I hate. But all I can do is to give her a daddy who was vital to the end, and knew when to leave. . . . When I can’t tie my bow tie, tell a funny story, walk my dog, kiss someone special—I’ll know that life is over. It’s time to be gone.”

The central thesis of the book is that the liberty found in the U.S. Consti­tution’s Fifth and Fourteenth “Due Process” Amendments extends to Dudley Clendinen and other terminally ill competent persons’ right to choose to die with dignity—with the passive assistance of a physician—rather than live in great pain or live a quality-less life. While federal judges and most state legis­latures have not yet moved to accept this view, the book will show that there has already been some modest movement in that direction, one that presently allows terminally ill patients to die with the assistance of a physician in two states, Oregon and Washington. Recently, Montana’s Supreme Court ruled that the state constitution does not prohibit physician-assisted death (PAD) but, to date, there has been little legislative action to establish the necessary guidelines for medical practitioners to follow when ministering to their ter­minally ill patients who wish to die on their own terms.

However, there is an unusual consequence if there is no further movement toward either judicial expansion of the meaning of liberty or the passing of laws enabling terminally ill patients to die with the assistance of a doctor: terminally ill people crossing state lines to enter those states that allow such medical assistance. It is these persons—strong-willed, competent and dying adults who want to die with dignity when faced with a terminal illness—who are the eight-hundred-pound gorillas in this book.

This transient activity is not a hypothetical situation. It is presently occur­ring throughout the world and goes by a number of names: the “Switzerland syndrome,” “Death tourists,” “Suicide Tourists”: these are men and women who transplant themselves to obtain medical assistance in taking their lives because of terminal disease that either leaves them in great pain or robs them of a decent quality of life.