By Nikola Biller-Andorno, MD, PhD
Times and again, individuals have asked courts in the United Kingdom, Ireland and other countries for permission to have someone help them end their lives. Diane Pretty, Tony Nicklinson and, most recently, Marie Fleming are among those who suffered from a serious disease that prevented them from acting on their wish by themselves. Their requests, highly publicized and intensely debated, were all turned down.
There are concerns about the legalization of assisted suicide, such as the danger of abuse, that merit attention. One of the core arguments against physician involvement is that medicine is about saving lives, not about ending them. This argument, with its underlying notion of an unconditional reverence for life, is flawed.
At first sight, “reverence for life” seems appealing as a guiding principle of bioethics, even to those of us who might otherwise not be subscribing to religious doctrines about the sanctity of life. “I am life that wants to live, in the midst of life that wants to live”, a phrase attributed to the great humanitarian doctor Albert Schweitzer sounds peaceful, modest, noble. But if it is transferred into clinical contexts in a simplistic and dogmatic way, its benevolent character can quickly be turned upside down.
There is nothing great or noble about rescuing or maintaining a life if the individual living that life does not want it. A physician can be expected to accompany and support a seriously ill or dying person, to point out options and alternatives. But, as many medical ethicists have come to understand over the past decades of animated debate, there is no moral imperative to preserve “life” at all cost, no matter what. It is the patient that is the focus of medicine, not his or her life.
Such a misguided principle might feel good to those who embrace it but it can be catastrophic for those who are forced to continue an unwanted and unbearable existence.