The ‘right to die’? No thanks

’The thought of suicide is a great consolation: by means of it one gets successfully through many a bad night.’ Friedrich Nietzsche

What’s in a name? Last week, Lord Joffe’s Assisted Dying Bill was rejected, for the second time, in the UK House of Lords, which voted to put off consideration of the bill for six months. The bill attempts to redefine ‘assisted dying’ as a physician prescribing a deadly cocktail of drugs, following the Oregon model rather than the Dutch model, where physicians take a more active role. According to Dignity in Dying, the new-and-improved name for the Voluntary Euthanasia Society (VES), this is a crucial difference.

Names, it seems, are as contentious as any other part of the discussion. Many opposed to legalisation of assisted suicide evidently take the issue of names seriously enough to challenge the right to trademark Dignity in Dying. Groups including the Christian Medical Fellowship and the British Council of Disabled People have launched a challenge under the Trademarks Act to prevent attempts by the VES ‘to monopolise the phrase such that only pro-euthanasia campaigners would be able to use it’ (1).

The Assisted Dying Bill also demonstrates the obsession with words in this debate. In the past, it was referred to by both pro- and anti- groups as ‘assisted suicide’. The phrase assisted suicide – oxymoronic, as Thomas Szazs has pointed out before on spiked – has fallen from favour, perhaps because of the spate of suicide bombings in the news, evidently replaced by the gentler ‘assisted dying’ (see Killing to be kind?, by Thomas Szazs). Though it removes the taint of suicide, this descriptive phrase is, if anything, more vague and obfuscating. It could, of course, cover a litany of sins and certainly does not rule out the dreaded euthanasia. One might ask, is not capital punishment also ‘assisted dying’? What about murder?

The wide divergence between appearance and reality pervades this discussion at many levels. Looked at simply in practical terms, it is difficult to understand why this is not an obscure issue of medical ethics. If we accept the official reports from Oregon, few people would avail themselves if legalisation was made an option outside Oregon. Under Oregon’s Death with Dignity Act, which came into force in 1997, physician-assisted suicide has accounted for between 0.06 and 0.14 per cent of total deaths, or somewhere around 40 per year. The estimate for deaths in Britain should the proposed legislation become law is 650. This is fairly insignificant compared with the 4,629 persons that committed suicide in England and Wales in 2003, let alone the total in 2004 of 514,250 deaths.

Added to this, patients in the UK and in all 50 states in the US currently have the right to refuse all medical treatment. In approximately one-third of all deaths (170,000) every year in the UK, doctors withdrew treatment or drugs and thus hastened the death of the patient. According to one report, 3,000 more UK deaths per year were directly caused by the doctor in the last few hours of life.

Thus, if it were simply a matter of practical situations, we might reply to those who wish to legalise that a ‘good death’ is already available (and, ironically, jeopardised by the introduction of legislation to police the process) and that, even if the legislation were enacted, only a very small number of people – somewhere near a tenth of the total suicides every year – would avail themselves of the option. To those who fear what might happen if the legislation is passed, we might simply point to Oregon, where there is no evidence that malevolent doctors are sending patients to their deaths unwillingly or that many mistakes are being made. Let’s all go and get on with the business of living. If ever there was a bridge that we should cross when we come to it….

But there is far more at stake, and good reason to side firmly with those opposed to a change in the law. In the end, even the most ‘responsible’ right-to-die organisations, like Dignity in Dying, advocate suicide as a therapeutic answer to the problem of depression (2). As every report published to date on the subject confirms, fear and depression – not pain – always play the major role in assisted suicide requests (3). Far worse than that, it destroys the real, if abstract, values that connect us and make us human beings. Doctors would become executioners who made decisions about who had ‘quality of life’ and who did not. Disintegration would be being made whole again. Cowardice would become lionised as courage. The duty to make the most of what one has would become the duty to throw it away. The meaning of human life would be reduced to the physical, base animal instincts, trapped within the contours of the body. Human dignity would be reduced to bodily aestheticism.

Also, there would be no base to equality, as some lives would be deemed as worth living and others not. Freedom to die would be as meaningless and tautological as the freedom to sell oneself into slavery. All of these would not occur because of the passage of one law or another but because the premises of the right-to-die take hold take hold across society – and they must be vigorously challenged.

‘Clientisation’ and right-to-die societies

Just because campaigners for the right to die are wrong does not mean we should not investigate them. Something in the problems of the very last few hours of life seems to animate people for whom death is only a distant prospect. In Britain Dignity in Dying claims to have 100,000 members and supporters, over 150 to cheer on each of the estimated 650 assisted suicides per year, if the legislation is passed. Why so many so passionately advocating freedom for so few?

The reasons that there are only a few who do decide to check out early are clearly documented elsewhere (4). But there is a long history of discrepancy between the act and the contemplation of suicide. Books have been written about references to suicide in literature. In writing and film, of course, suicide gives meaning to the life of a particular character, renders their feelings and actions much more serious and heartfelt. It allows the writer to tell the whole story, to express poignancy, to illustrate the tragic ends to destructive events. The ancient Greeks, according to Alfred Alvarez, included many suicides in Greek tragedy that reflected acceptance of and even admiration for the act. Yet in ancient Greek society, the actual practice of suicide was ‘linked with the more profound Greek horror of killing one’s own kin. By inference, suicide was an extreme case of this, and the language barely distinguishes between self-murder and murder of kindred.’ (5)

Over 200 instances of suicide in 100 plays occurred on the English stage between 1580 and 1620, Shakespeare contributing no less than 52. However, the renewed interest in suicide during the Renaissance did not correspond to a rise in the actual suicides. As Georg Minois points out, those who talk most about suicide are often those least likely to commit the act, and the discussion or depiction of suicide may well have a therapeutic effect (6).

Might right-to-die societies express some cathartic need within their members and supporters? They would object, no doubt, that they deal with hard, political realities. They deal with real people and death, a real problem. However, the fact remains that the main conduit for their arguments is the tragic stories of those who are being denied a ‘right to die’, who occupy that hinterland between life and death, or who fear what will happen at the end. Some of the stories are from those left behind who have been arrested for aiding a suicide. They habitually begin, ‘What if you…?’, placing the reader in the shoes of those who long for death but cannot eventuate it themselves. But they admit that few will ever avail themselves of this option, if it comes. While some campaigners are so determined to die that they take themselves to Switzerland in order to do it, many of the many terminally-ill campaigners, such as Annie Lindsell and Diane Pretty, die natural deaths. This is, above all, about suicide in the imagination rather than as reality.

Certainly, the late Elizabeth Kubler-Ross, author of the celebrated On Death and Dying, noted that the advocates of assisted suicide were engaged in projection, of transferring their own anxieties and fears on to the dying person. Given the tiny numbers of people willing to take the final step in this campaign as opposed to the large numbers belonging to these organisations, some degree of projection must be involved. Projection of what, specifically, we might ask?

The history of ‘right-to-die’ movements

Continuity in organisation can cover very different motivations and attractions. From its inception in 1935 the Voluntary Euthanasia Society in the UK (the American equivalent, the Euthanasia Society, was formed in 1938) concentrated public sympathy towards the eugenic goals of euthanasia, in line with scientific theory of the time. Only in the late 1960s, when it became associated with the feminist-inspired concept of ‘bodily autonomy’, did the focus begin to shift towards the ‘right to die’.

In 1870, Samuel D Williams addressed the Birmingham Speculative Club, advocating the use of chloroform or other medications not just to relieve pain of dying but to end a patient’s life ‘at the express wish of the patient’. Williams’ address made a profound impact upon particularly American medical circles. In 1873, essayist Lionel A Tollemache asserted that euthanasia could serve the patient’s interests and benefit society in appropriate cases by removing an individual who was ‘unhealthy, unhappy, and useless’ (7). An 1884 editorial in the Boston Medical and Surgical Journal commented: ‘Perhaps logically it is difficult to justify a passive more than an active attempt at euthanasia; but certainly it is much less abhorrent to our feelings. To surrender to superior forces is not the same thing as to lead an attack of the enemy upon one’s own friends.’ (8)

The cause gathered some wealthy sponsors, and in 1906 ‘An Act Concerning Administration of Drugs etc. to Mortally Injured and Diseased Persons’ was introduced in Ohio. The British Medical Journal, responding with a robustness that is found wanting today, declared at the time that America was a land of ‘hysterical legislation’:

‘Every now and again [the legalisation of euthanasia] is put forward by literary dilettanti who discuss it as an academic subtlety or by neurotic “intellectuals” whose high-strung temperament cannot bear the thought of pain. The medical profession has always sternly set its face against a measure that would inevitably pave the way to the grossest abuse and would degrade them to the position of executioners.’ (9)

After 1906 interest in euthanasia declined, though sporadic individual cases revived interest from time to time. Eugene Debs, the American Socialist Party Presidential candidate who secured over six per cent of the vote in the 1912 election, declared in 1913 that patients should have the right to control the manner of their own death. Nevertheless, individualism was in full retreat and the new Liberal government in Britain and Progressivism in the United States encouraged the idea that government should promote the general welfare. At the same time, a new faith in the powers of science, as well as the authority of its practitioners, enabled the medical profession to consolidate control over medical education and practice (10).

The rise of euthanasia

The belief in science led to interest in the ability of scientific medical practices to improve the general human condition. Unlike in the previous period, medical professionals were at the forefront of this campaign. In the UK, Dr C Killick Millard, an early advocate of compulsory vaccination and birth control, suggested the legalisation of voluntary euthanasia in his Presidential Address to the Society of Medical Officers of Health in 1931. The Voluntary Euthanasia Society was formed in 1935 to push for legalisation and a bill was introduced to the House of Lords in 1936, only to be rejected.

The interest in voluntary euthanasia arose at this time because of a general interest in euthanasia as a social tool. In the US the term ‘voluntary’ was considered unnecessary when the Euthanasia Society of America (ESA) formed in 1938. According to Dr Alexis Carrel, winner of the Nobel Prize and supporter of the legalisation of euthanasia, elaborated when promoting his book, Man, the Unknown: ‘Sentimental prejudices should not stand in the way of civilisation. It is my opinion that not only incurables but imbeciles… habitual criminals, as well as the hopelessly insane, should be quietly and painlessly disposed of.’ (11) There was a Malthusian interest in promoting euthanasia, voluntary or otherwise, and it was connected to eugenic notions. This was a revolt against what birth control pioneer Margaret Sanger, a prominent member of the ESA, called ‘biological slavery’ (12).

The problem for euthanasia enthusiasts across the world mirrored that of eugenics. The exposure of Nazi atrocities in the name of eugenics, and recognition of the role that German physicians had played in genocide, produced widespread horror at the idea of state-sanctioned killing. To give doctors the power to kill seemed too dangerous.

Bodily autonomy

Voluntary Euthanasia societies in the US and the UK remained voices in the wilderness until 40 years ago. In fact, current fascination with this issue emanates from recent trends in thought that, in rejecting religious and wider social understandings of humanity, increasingly identify human life in physical terms, within the parameters of the body.

In this way, the movement to legalise assisted dying can claim descent from 1970s feminism. Its emphasis on bodily autonomy, so usefully demonstrated in the 1973 publication by the Boston Women’s Collective of the intriguingly-titled Our Bodies, Our Selves, led to the extension of demands for bodily autonomy. The exposition of previously private areas of life, like sexuality, also exposed death to wider scrutiny, especially after the publication of Elizabeth Kubler-Ross’s On Death and Dying in 1969.

As historian Ian Dowbiggin notes, in the 1970s ‘[e]uthanasia ceased being defined as active mercy killing, with its disturbing overtones of coercion and social usefulness, and increasingly became viewed as personal freedom from unwanted interference in one’s own life’. The personal became political, the formerly private became a public concern, and death entered the public pantheon. It has been this banner of bodily autonomy under which modern voluntary euthanasia emerged as a campaign. Hence the name change.

The meaning of right-to-die movements today

Often, right-to-die societies are accused of harbouring secret inclinations towards euthanasia. Both historian Ian Dowbiggin and psychiatrist Ezekial Emanuel imply that this is the real end of the campaign for the right to die. In the American publication National Review, Wesley J Smith claims that Oregon Health Management Organisations (HMOs) have jumped on board the assisted suicide bandwagon in order to save money (13). If only it were so, it would be easy to rouse a population against the evil HMOs and rationalisers in the National Health Service (NHS) in the UK in their plot to re-establish Hitlerian policies.

Of course, rather than evil, cigar-chomping capitalistic health administrators, the members of these organisations are normal human beings, most of whom would be horrified by the idea of sacrificing human lives for the sake of a few bucks. Whereas, as Dowbiggin has pointed out, these societies have always attracted a few people with Malthusian population concerns, they have never made up the bulk of the membership. Members tend to be more female than male, from relatively affluent backgrounds, and driven by compassion rather than self-interest, as the ratio of 150 to one between assisted suicide supporters and assisted suicide volunteers implies.

Whereas the end of all of these societies, despite their protests, is the legitimation of suicide, that bastard child of despair and self-pity, their subjective motives are different. But, in terms of motivation, what the members of the right-to-die societies seek is not so much the right to die as the right not to suffer. After all, this is the sentiment repeated so often in favour of legalised assisted dying when someone says: ‘We wouldn’t let a dog suffer like that; why should we condemn people to do so?’ The implication is that this is needless suffering or, even worse, suffering caused by human beings with their dogmatic religious intolerance.

Not that this seemingly altruistic motivation should not be interrogated, though. As historian Joseph Amato has noted, suffering has been redefined over the past few decades. ‘God, fate, and nature less and less suffice as valid explanations for the suffering of the world. One can no longer argue that human suffering is certain and preordained without being judged conscienceless, even inhuman.’ (14) In the past, suffering was seen as part of life, a trough that made the peaks appear higher. There no longer appears to be any reason for suffering, given the apparent meaninglessness of life; all suffering now appears unnecessary and thus is condemned.

Identifying and even sponsoring suffering groups has become one of the key ways of expressing one’s moral superiority over those who fail to respond to it. As Amato notes:

‘Identifying oneself with the “real suffering” of a chosen class, people, race, sex, or historical victim is the communion call of the twentieth-century secular individual. It is his sincerity, his holiness, his martyrdom. Objectivity, non-commitment, and indifference measure types of wrong corresponding to the Christian graduated judgment of the sin of not loving.’ (15)

Nor does the victim have to be real. Just like Nixon’s espousal of the ‘silent majority’ was more designed to give direction to the Republican Party than to alleviate any real suffering, so Dignity in Dying campaigns for a right that so few people will want in order to alleviate physical pain that, in no study to date, has been the primary reason for suicide. Suffering is no longer a personal experience but a cause and a moral identity.

This problem permeates the entire discussion. Many opposed to assisted suicides invent victims no less imaginary. Suddenly, the terminally-ill have become ‘vulnerable’. Once this is established, there seems no end to the people on both sides of the argument willing to stand up and speak out for these people who, apparently, cannot speak for themselves. Many pro-life Republicans adopted Terry Schiavo, the ultimate victim in that her feelings, opinions and needs could only be imagined by others. Schiavo’s nearly lifeless body became a battleground for competing claims over her victimhood.

The State of Alaska, arguing in opposition to legalised assisted suicide, stated that ‘the terminally ill are a class of persons who need protection from family, social, and economic pressures, and who are often particularly vulnerable to such pressures because of chronic pain, depression, and the effects of medication.’ (16)

Comfort in death

There is no doubt that those campaigning for the right-to-die push at an open door. They relate to a common feeling of trepidation over what the future holds. The stories that are told on the Dignity in Dying website often begin with a ‘what if…?’ scenario. As the Scottish Voluntary Euthanasia Society (which has not yet got around to changing its name) puts it, many people wish to retain a key marked ‘exit’.

What fears mean we take comfort in death? The first is meaninglessness. The nightmare captured so well in the last will of the eponymous anti-hero in Hardy’s The Mayor of Casterbridge haunts many. Michael Henchard asked that ‘no sexton be asked to toll the bell… that no murners walk behind me at my funeral… that no flours be planted on my grave… that no man remember me.’ (17) Meaningless existence culminates in a deep and total death itself, with all links to the land of the living cut off forever.

Death, in the contemporary imagination, is perhaps the only certainty in an increasingly uncertain life. Small wonder that many wish to control this final certitude. Funerals are the occasion for reflection upon the meaning of the deceased’s life for it is the first time when the entire life may be contemplated. As the Danish philosopher Kierkegaard commented, life must be lived forward but it can only be understood backwards. When control over the vagaries of life drifts further and further from our grasp, many are naturally inclined to assert control over the one certain chapter.

This would not be an unprecedented action. The Jewish Zealots at Massada committed suicide rather than be defeated and taken into slavery by the Romans. Their leader Eleazar Ben Ya’ir spoke before them, imploring his men to kill their own wives and children: ‘Let us die before we become slaves under our enemies, and let us go out of the world, together with our children and our wives, in a state of freedom. Let us therefore make haste and instead of affording them so much pleasure, as they hope for in getting us under their power, let us leave them an example which shall at once cause their astonishment at our death and their admiration of our hardiness therein.’

Eventuating one’s own death can be, as at Massada or, a raw if awful protest. But committing suicide in order to protest at the awfulness of continuing to live would be the very meaning of self-defeat, replete with heart-stopping irony. For who would be the victor but futility and emptiness itself? The Zealots wished to ‘preserve ourselves in freedom, as an excellent funeral monument for us’. What would be the funeral monument for an assisted suicide? ‘Too frightened to go on’ or ‘Can’t stand the prospect of pain’? Would that be ‘dignity in dying’? A suicide because one fears purposelessness can only underline that very purposelessness.

Disintegration

It is the hollowness of the terms used by right-to-die organisations that appalls. The old VES website contained a slickly designed home page with its logo and the words ‘choice. dignity.’ in blue against a white background. Choice? In fact, the choice to die demeans all human choice because it is the one aspect of life about which no one has a choice. Like the questionable freedom to be locked up in a six-foot box forever, this choice is no choice at all.

What about equality? Should not, as the Dignity in Dying website blithely asks us, the disabled have the right to suicide, just like the rest of us? If you accept this perspective of ‘equality’, then there can be no real distinction between a 21-year-old who jumps from a bridge after losing his girlfriend and a 78-year-old terminally-ill woman with weeks to live; it is the individual’s conception of the suffering and pain they feel that counts. But the equality of death is something we share with the lowest plants, with amoeba and even with stars themselves. What sort of equality is that?

One of the objections heard from religious leaders to the Joffe Bill is that it would demean human life. Dignity in Dying and other right-to-die societies dismiss this as religious cant. But an atheist humanist can recognise that life is lived between people as well as within them. One final terrible irony of the right to die is that the fear of bodily disintegration prompts some of us to opt for, well, the entire disintegration of the person. Even as the body disintegrates, much of what we truly are – our connections with those around us, our relationships with friends, relatives, children and grandchildren – can continue and even grow. Longstanding issues can be resolved, enemies can be reconciled, friendships rekindled by the shadow but not the early arrival of death. As Elizabeth Kubler Ross at least appreciated, the final stages of dying are necessary ones. Dying is disintegration; death is total and final disintegration.

This underlines a paternalistic side to the Assisted Dying Bill. It rules that only the wishes of those expected to be dead within six months count. Why? To the rest, it effectively denies the right to die. So the right to die joins the list of entirely hollow terms.

Dignity?

Here comes the final awful irony. Dignity in Dying is more destructive to human dignity than virtually any other contemporary historical force, though it is part of a revision of the conceptions of human dignity in the name of ‘extending’ them (18). We might first remind ourselves of what constitutes human dignity. The word dignitas was a Latin rhetorical and political term that indicated either the possession of high political or social rank or the moral qualities associated with it. The Roman Stoic philosopher Cicero applied the term ‘dignity’ to the human race, as that quality distinguished humans from animals:

‘But in every investigation into the nature of duty, it is vitally necessary for us to remember always how vastly superior is man’s nature to that of cattle and other animals: their only thought is for bodily satisfactions…. Man’s mind on the contrary, is developed by study and reflection…. From this we may learn that sensual pleasure is wholly unworthy of the dignity of the human race.’

Beasts and humans have physical sensations; only humanity is able to rise above the need for bodily satisfactions and it is precisely that which bonds us together with other humans. From a combination of Judeo-Christian and classical traditions, Renaissance humanists built upon this concept. Giovanni Pico della Mirandola, in his Oration composed in 1486, explained that what truly elevated human beings was the immense possibilities within their grasp:

‘Man is neither celestial nor earthly, neither mortal nor immortal. On the contrary, he may become all of these things through his own will. The Creator gave him the germs of every sort of life. Depending on what potentiality he develops, he may become a plant, an animal, a celestial being, an angel, or he may even be unified with God himself. Man therefore possesses all the possibilities within himself. It is his task to overcome the lower forms of life and to elevate himself towards God.’

Pico’s contemporary Pietro Pomponazzi compared humanity with vegetation in 1504. ‘An oak lasts for a thousand years but for that reason it still does not have the thousandth part of that perfection which belongs to man. It is rather more perfect to be a man for one year, than to be an oak for ten thousand years.’ (19) Compare this sentiment with that of high priest of irrationalism, Friedrich Nietzsche, who belittles humanity: ‘The pine tree seems to listen, the fir tree to wait: and both without impatience: they give no thought to the little people beneath them devoured by their impatience and their curiosity.’

While Enlightenment rationalists built upon Renaissance rationalism and optimism, raising human dignity to ever-greater heights, they also took a more tolerant attitude towards suicide. In fact, the word ‘suicide’ replaced ‘self-murder’ only in the eighteenth century. English Common Law held that suicide was a crime because it deprived the king of his ‘property’ in the form of one of his subjects. Judeo-Christian traditions held that suicide was an insult to God. Rejecting the constraints of both religion and monarchy, many of the new states decriminalised suicide in the wake of the American Revolution.

However, this was not the same as approving of suicide. As Immanuel Kant observed, ‘Suicide is not abominable because God prohibits it; God prohibits it because it is abominable.’

The Nietzsche-ization of the right to die

Nietzsche went beyond doubt, beyond fear into praise of death. His approval of suicide, as he knew (and as his modern-day followers will not or can not acknowledge), tore at the very fabric of humanity. His very doubts about human progress, about human life itself were expressed in his embrace of the grim reaper. Mirroring the pervasive self-doubt about the efficacy of human endeavour heard today, Nietzsche noted: ‘When one does away with oneself one does the most estimable thing possible: one thereby almost deserves to live.’

The concept of human dignity as that which connects us and raises us above animals, as the embrace of higher qualities, no longer existed for Nietzsche. No more were there higher and lower impulses. No more was reason to be prized over emotion. ‘You have your way. I have my way. As for the right way, the correct way, and the only way, it does not exist.’

However, Nietzsche was honest and intelligent enough to recognise the implications of his questioning. As Francis Fukuyama adroitly observed:

‘Nietzsche had the great insight to see that, on the one hand, once the clear red line around the whole of humanity could no longer be drawn, the way would be paved for a return to a much more hierarchical ordering of society. If there is a continuum of gradations between human and nonhuman, there is a continuum between the type human as well.’ (20)

Today’s rather pallid versions of Nietzsche rather randomly inveigh against racial discrimination at the same time as they, by ‘unsanctifying human life’, as Peter Singer rather awkwardly put it, construct a new edifice upon which discrimination may occur. As randomly as the rule that lives with less than six months are disposable, Singer and the assisted suicide movement have decided that relieving suffering is the primary aim of the ‘higher’ beings. Presumably, those that care, as opposed to those that are cared for, are the higher beings.

This devalues and cheapens life. Is dignity really to be restricted to the ability to go to the toilet unaided? Does that mean that I have human dignity because I manage to do this several times a day? Such sentiments cheapen all our lives Compare this to Paul Kristeller’s still-valid definition that exalts humanity: ‘We assert our dignity as human beings not simply by being what we happen to be but by choosing the best among our potentialities, by cultivating reason rather than blind feeling, and by identifying ourselves with tasks that are morally and intellectually worthwhile and that lead us beyond the narrow confines of our personal interests and ambitions.’ (21)

At least with that definition, we can recognise the small kindness of a Down’s syndrome child towards another child in a schoolyard and the heroics of a soldier sacrificing himself for his comrades as two acts of human dignity, the ends of meaningful choice.

Thus, there are deep, philosophical reasons for resisting the ‘right to die’ just as there are practical difficulties that have been dealt with elsewhere. Lord Joffe’s Bill should be seen not only as a counsel of despair, not just surrendering but, as the Boston Herald put it, leading the enemy charge against one’s own friends. It must be defeated.

If assisted suicide is legalised, it will not result in huge numbers of ill or disabled people being killed; but it will contain the conceptual but ultimately more important corpses of meaningful choice, freedom, equality and human dignity, life lived between us as well as within us, that which we have in common. These more abstract yet entirely essential legacies of the human condition must be protected.

(1) Christian Medical Fellowship press release

(2) In fact, Dignity in Dying admit as much on their web-site, including under their “people’s stories” section a woman who helped her 43 year old husband who suffered only from ME and chronic depression to kill himself. See Dignity in Dying website

(3) According to a report entitled, “8 Years under Oregon’s Assisted Suicide Law,” the major reasons for the 246 reported assisted suicides involved fear of what the future might bring. Only 54 of the suicides cited “inadequate pain control or concern about” as a reason for wishing to die.

(4) For a clinical discussion, see Georg Bosshard, Esther Ulrich, and Walter Bar, 748 cases of suicide assisted by a Swiss right-to-die organization, Swiss Medical Weekly 2003: 133: 310-317

(5) A. Alvarez, The Savage God: A Study of Suicide (NY: W.W. Norton and Co., 1990, © 1971), 56 58.

(6) Georges Minois, A History of Suicide: Voluntary Death in Western Culture tr. by Lydia G. Cochrane, (Baltimore, MD: The Johns Hopkins University Press, 1999), 300.

(7) Cited in New York Task Force on Life & the Law, When Death is Sought: Suicide and Euthanasia in the Medical Context (Albany, NY: New York State Department of Health, 1994), 8

(8) Ezekial J. Emanuel, “The History of Euthanasia,” Annals of Internal Medicine, Volume 121, Issue 10 (15 November 1994), P793-802.

(9) Cited in Emanuel, “The History of Euthanasia,” 797.

(10) Emanuel, “The History of Euthanasia,” 798.

(11) Radio speech broadcasted by Radio Station WLWL by Rev. Ignatius -W. Cox, S. J, Ph.D., November 15,1935. See transcript

(12) Ian Dowbiggin, A Merciful End: The Euthanasia Movement in Modern America (Oxford University Press, 2003), xv.

(13) Wesley J. Smith, Doctors of Death: Kaiser Solicits Its Doctors to Kill, NR Online August 19, 2002

(14) Joseph A. Amato, Victims and Values: A History and a Theory of Suffering (New York: Praeger, 1990)

(15) Amato, Victims and Values,

(16) Sampson et al. v State of Alaska, 09/21/2001. The Alaska Supreme Court’s Decision is available here

(17) Thomas Hardy, The Mayor of Casterbridge: A Story of a Man of Character (London, McMillan, 1974), 353.

(18) The clearest explication of this trend is contained in Peter Singer, Unsanctifying Human Life: Essays on Ethics, ed. By Helga Kuhse (Oxford: Blackwell, 2002). But see also Nick Bostrom, “In Defence of Posthuman Dignity,” Bioethics, Vol. 19, No. 3, pp. 202-214.

(19) Cited in Paul Oskar Kristeller, Renaissance Concepts of Man and other Essays (London: Harper Torchbooks, 1972), 19.

(20) Francis Fukuyama, Our Posthuman Future: Consequences of the Biotechnological Revolution (New York: Farra, Strauss and Giroux, 2002), 155.

(21) Kristeller, Renaissance Concepts of Man.