Patient Choice: Why It is Not Physician-Assisted Suicide to be Aided in Death

While there will continue to be much brouhaha hitting the airwaves in the aftermath of the Mueller Report and whether investigations to pave an avenue to impeach Trump should now rightfully proceed, there was one important event that occurred in the same time frame but being given little attention. It reflects the movement forward in our thinking about end-of-life decision-making.

On April 12, New Jersey became the ninth jurisdiction in the nation to enact a law or to recognize allowing competent adults with a terminal disease or deadly illness to be assisted in their demise on their own terms rather than the agony normally accompanying the last days of one’s life. In signing his state’s Medical Aid in Dying legislation, New Jersey governor Phil Murphy stated: 

“By signing this bill today, we are providing terminally-ill patients and their families with the humanity, dignity, and respect that they so richly deserve at the most difficult times any of us will face… Allowing residents with terminal illnesses to make end-of-life choices for themselves is the right thing to do.” 

As with all the other jurisdictions providing for this choice, its allowance will be dictated by strict adherence to statutory language, requiring a certification from a mental health expert that the patient has the mental capacity to make such a decision. In this case, two New Jersey licensed physicians must provide a diagnosis of terminal illness based upon a medical certainty of six months or less before death; and after which then the patient would receive a prescription for a series of self-administered pills to be taken at home alone or in the presence of loved ones. To clarify: this legislation does not allow for mercy killing, euthanasia, or assisted suicide. Nineteen other states are also considering aid-in-death legislation. 

There are opponents aplenty to this type of legislation, warning that disabled and vulnerable citizens may face pressure from family members to seek their demise based on nefarious motivations. Certainly, the Catholic Church is one of these critics, calling New Jersey’s legislation “…an affront to human life,” not to mention its dioceses in the state fearing that decisions will be based on false information and certainly that will affect the “handicapped, elderly, depressed, and vulnerable.” The Medical Society of New Jersey also opposed the bill, despite its adherence to patients having the right to make healthcare choices. The society asserted the new law “…requires a physician to participate in the termination of human life and puts physicians at odds with their professional ethical requirements.” However, data compiled ever since Oregon was the first state to enact such a law years ago – and that then survived multiple legal challenges – has shown the beliefs of these critics to be without foundation, are more fear mongering than anything else, and are not reflective of evolving thought on personal decisions affecting our health and bodies.

News outlets, in reporting the enactment of the New Jersey law, describe it as allowing for “physician-assisted suicide” and then concluding that the nineteen other states “are considering physician-assisted suicide bills.” This is even notwithstanding that the words “aid-in-dying” are in the title of the Garden State’s bill, and it specifically prohibiting assisted suicide.

How wrong, shameful, and irresponsible of media outlets that use the word “suicide” in their vocabulary to describe being aided in death.

My experience with such legislation and involvement in legal challenges to terminally-ill patients wishing to decide their demise dates back nearly 25 years. Before the United States Supreme Court, I was the first to advocate – alongside noted lawyers Ila S. Rothschild and Bruce C. Nelson – that the word “suicide” has no place in describing a terminally-ill patient’s choice to meet their maker. I originated two comparisons to drive home the point, keeping in mind that the ordinary dictionary definition of “suicide” is the intentional taking of one’s life.

First, consider a soldier in war that throws their body on an explosive device in order to save buddies, knowing it will cause certain death to themself. We never even think of that soldier committing suicide, preferring instead to call it an act of heroism and for the deceased to be awarded a medal of honor posthumously.

Or what about those individuals that jumped to their deaths from their offices in the World Trade Center on 9/11? Surely jumping from that many floors up would cause their immediate death. Yet the local coroner at the time ruled their deaths not as suicides, but deaths as a result of a terrorist attack.

What is so different about the soldier’s death, the office worker’s death, or a terminally-ill patient of sound mind that seeks options for escaping the toil an illness not of their own doing? 

There is no difference.

Despite those who oppose by claiming that a dying patient can seek palliative care to alleviate pain and suffering in the last days of life, that’s not the only choice. 

They also say the soldier falling on an explosive to save others was done with a heroic measure in mind, while the office workers jumping to their deaths had no alternative but death. Yet the soldier and office worker technically did intentionally take their own lives. Media, in using the words “physician-assisted suicide,” gives a lesser importance or value to the choice of the terminally-ill patient from that of the soldier or office worker. To be certain, none of them deserve the word “suicide” in describing what is to bring, or has brought, about their demise. Again, keep in mind that the patient does not wish to intentionally take their life, since that life has already been “taken” by the onset of a terminal disease or illness that long predates any desire to be aided in death – just like the office worker that was not responsible for 9/11 or a war in which soldiers proudly serve their country but can bring certain death.

If our existence has taught us anything, we evolve in our thinking to accept as a norm what we originally held or thought to be unlawful or conduct constituting a social taboo. Just think of being criminally charged for possessing marijuana after smoking it has become legal in many jurisdictions, abolishing slavery very long ago, or bootlegging booze before it became legal again, and – in very recent times – acceptance of same-sex couples and marriages. 

So, too, isn’t it high time that when a terminally-ill patient wishes to be aided in death by complying with state statutory requirements, the media must remove permanently the use of the words “suicide” and “physician-assisted suicide” from their lexicon? As an expression of free will and autonomy, scribing the proper description explicating individual choice – as it is throughout a patient’s life but now at its end – demands no less.