Ryan T. Anderson is the William E. Simon Fellow at the Heritage Foundation and the Founder and Editor of Public Discourse. He’s just released an important new report this week titled “Always Care, Never Kill: How Physician-Assisted Suicide Endangers the Weak, Corrupts Medicine, Compromises the Family, and Violates Human Dignity and Equality.” Below is an interview that I conducted with Ryan about his paper.
ATW: You’ve just written a really important report on the problems of supporting Physician Assisted Suicide as a policy in the United States and globally. What’s happening that required a response from you?
RTA: This year alone, 18 states plus DC are considering whether to allow doctors to assist in the killing of patients. Physician-assisted suicide directly conflicts with the Hippocratic Oath, which proclaims: “I will keep [the sick] from harm and injustice. I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.” This is an essential precept for a flourishing civil society. No one, especially a doctor, should be permitted to kill intentionally, or assist in killing intentionally, an innocent neighbor.
Human life need not be extended by every medical means possible, but a person should never be intentionally killed. Doctors may help their patients to die a dignified death from natural causes, but they should not kill their patients or help them to kill themselves. This is the reality that such euphemisms as “death with dignity” and “aid in dying” seek to conceal.
ATW: The most important question that should be asked is rather obvious: Why is Physician Assisted Suicide wrong—morally and as a policy proposal?
RTA: Physician-assisted suicide (PAS) would be a grave mistake for four reasons. It would:
- Endanger the weak and vulnerable;
- Corrupt the practice of medicine and the doctor–patient relationship;
- Compromise the family and intergenerational commitments; and
- Betray human dignity and equality before the law.
First, PAS endangers the weak and marginalized in society. Where it has been allowed, safeguards purporting to minimize this risk have proved to be inadequate and have often been watered down or eliminated over time. People who deserve society’s assistance are instead offered accelerated death.
Second, PAS changes the culture in which medicine is practiced. It corrupts the profession of medicine by permitting the tools of healing to be used as techniques for killing. By the same token, PAS threatens to fundamentally distort the doctor–patient relationship because it reduces patients’ trust of doctors and doctors’ undivided commitment to the life and health of their patients. Moreover, the option of PAS would provide perverse incentives for insurance providers and the public and private financing of health care. Physician-assisted suicide offers a cheap, quick fix in a world of increasingly scarce health care resources.
Third, PAS would harm our entire culture, especially our family and intergenerational obligations. The temptation to view elderly or disabled family members as burdens will increase, as will the temptation for those family members to internalize this attitude and view themselves as burdens. Physician-assisted suicide undermines social solidarity and true compassion.
Fourth, PAS’s most profound injustice is that it violates human dignity and denies equality before the law. Every human being has intrinsic dignity and immeasurable worth. For our legal system to be coherent and just, the law must respect this dignity in everyone. It does so by taking all reasonable steps to prevent the innocent, of any age or condition, from being devalued and killed. Classifying a subgroup of people as legally eligible to be killed violates our nation’s commitment to equality before the law—showing profound disrespect for and callousness to those who will be judged to have lives no longer “worth living,” not least the frail elderly, the demented, and the disabled. No natural right to PAS exists, and arguments for such a right are incoherent: A legal system that allows assisted suicide abandons the natural right to life of all its citizens.
ATW: Why should Physician Assisted Suicide concern Christians and churches and what can they do to combat the trend toward Physician Assisted Suicide?
RTA: All Americans, and especially churches, should resist the temptation to view some lives as unworthy of life. Physician-assisted suicide sends the message that some people are better off dead. That’s a lie. Our culture must resist it. And our laws must respect the equal dignity of every member of the human family.
The D.C. assisted suicide bill, like most, attempts to define which lives are unworthy of legal protection and thus eligible for physician assistance in killing. That definition is unavoidably a statement of who is unworthy of legal protection. There is no way around it. The attempt to define which lives are eligible for suicide is a grave injustice: It violates human dignity and equality before the law. It declares that some lives matter less than others.
ATW: A lot of observers might look on at this and say, “Physician Assisted Suicide doesn’t harm me. Why should I care?”
RTA: Our law and our public policy shape our culture, and our culture will either view the elderly and the disabled as burdens to be disposed of, or as people to be loved and cared for.
Law shapes culture. My Ph.D. is in political philosophy, and much of my work at Heritage has focused on the importance of marriage as an institution and religious liberty—and how the law will either support or undermine these institutions. We tend to think about law and policy only in terms of individuals—individual rights and individual harms. But that’s a woefully insufficient way to think about politics. My work has really focused on the importance of institutions, and how the law shapes institutions. As I point out in the report, physician-assisted suicide will change the practice of medicine and the nature of inter-generational family obligations. We need a philosophy of institutions as well as of individuals to understand this.
ATW: Advocates for Physician Assisted Suicide argue that terminally ill persons should have the right to choose a humane death rather than suffer. Are you saying that you’d rather have people suffer than die peacefully?
RTA: Of course not! Though I only became aware of her story after my report went to editing, Kara Tippetts provides a wonderful example of what a natural death with dignity looks like.
Physicians are always to care, never to kill. They are to eliminate illness and disease but never eliminate their patients. Not every medical means must be used. Patients can refuse or doctors can withhold particular treatments that are useless or causing more harm than good. But in deciding that a treatment is useless, we must not decide that a patient is worthless. Doctors should not kill. But doctors should help their patients die a natural death with dignity.
Instead of embracing PAS, we should respond to suffering with true compassion and solidarity. People seeking PAS typically suffer from depression or other mental illnesses, as well as simply from loneliness. Instead of helping them to kill themselves, we should offer them appropriate medical care and human presence. For those in physical pain, pain management and other palliative medicine can manage their symptoms effectively. For those for whom death is imminent, hospice care and fellowship can accompany them in their last days. Anything less falls short of what human dignity requires. The real challenge facing society is to make quality end-of-life care available to all.
Doctors should help their patients to die a dignified death of natural causes, not assist in killing. Physicians are always to care, never to kill. They properly seek to alleviate suffering, and it is reasonable to withhold or withdraw medical interventions that are not worthwhile. However, to judge that a patient’s life is not worthwhile and deliberately hasten his or her end is another thing altogether.