In Case You Missed It: Prof. Ackerman (PHIL) on Physician-Assisted Suicide

by Matthew Lee '15

A map showing which US states have legalized/prohibited physician-assisted suicide. [image via]

Imagine Emma Sue Schroeder, an 83-year-old terminal cancer patient who wants her doctor to prescribe lethal pills for her. Should that be legal?

It is legal in some states, and many mainstream bioethicists advocate such legalization.

Now imagine Emma Sue’s daughter, Rachel. Forty-five and healthy, Rachel has lost her executive job, her house, her looks, and her husband. Having endured five years of living alone in a one-room apartment and getting subsistence wages for drudge-work she detests and considers beneath her dignity, Rachel wants her doctor to prescribe lethal pills for her. Should that be legal?

It is not legal in any state; nor do mainstream bioethicists advocate such legalization.

On April 2, Prof. Felicia Ackerman (PHIL) discussed the above scenario in a Science Café hosted by The Triple Helix called “The Double Standard in Physician-Assisted Suicide.”  Ackerman is well-known as the writer of well over a hundred letters to the editor in The New York Times and as the writer of a column in The Providence Journal.  Ackerman teaches PHIL0030 “Skepticism and Knowledge” and PHIL0880 “Ethical Themes in the Contemporary American Short Story.”

Ackerman argued that, out of respect for Rachel’s autonomy, it should be legal for lethal pills to be prescribed to Rachel and contended that government should not deal in morality. 

Ackerman hit upon five main ideas:

1. Physical agony: Many believe that lethal pills should only be used to alleviate physical agony, and that those who suffer the most physical agony are people with terminal illnesses.  Even though people with terminal illnesses are often depicted in pain, not all of them, all the time, are in pain.  In fact, many nonterminal illnesses such as rheumatoid arthritis can cause greater pain and discomfort.  Shouldn’t those with very painful nonterminal illnesses have the option to alleviate that physical agony?
   
2. Loss of dignity: Our society believes that dignity depends on physical function, that illness undermines human dignity.  For example, Dr. Quill describes the case of a patient who wanted to “maintain dignity and control on her own terms until her death” (1).  What if someone with a stutter thinks the stutter undermines their dignity?  What if someone thinks dependence on machines or their family undermines their dignity?  Ackerman was skeptical of the mainstream view of dignity and of dignity itself, which she described as a social construct that emerges when some people are viewed as lesser.
   
3. A brighter future: An argument against the legality of lethal pills for Rachel is that she still has a chance for a brighter future, but Emma Sue does not.  Although it may be true that the terminally ill have less of a chance for a brighter future simply because they have less time, people with less time also include death row inmates, who also have  very little chance for a brighter future.  Since those on death row also have less time, should they also be allowed lethal pills?
   
4. Desire to not be a burden: The option to commit suicide could create a social climate in which patients have to justify their continued existence.  This could create familial and societal pressure to kick the bucket.  If such pressure became so ingrained, the option could also create a “duty” to die when you are too old or too sick.  Ackerman considered the “paradox of the selfless invalid” (2): 

In its most extreme form, the paradox goes as follows. Either the patient’s loved ones want him to die quickly in order to save money or otherwise make their lives easier, or they do not. If they do not, the patient does not respect them by dying for their sake. If they do, then why is the patient sacrificing what would otherwise be left of his life for people who love him so little that they value his life less than money and/or freedom from encumbrance? Wouldn’t a truly loving family find such a sacrifice appalling? … Decent and loving families, as part of their decency and lovingness, will recognize the latter desire as ignoble and, on balance, will not want patients to pander to it. 

5. Suicide is possible without pills: Some people against the legality of lethal pill prescriptions argue that people who want to commit suicide already have the means to do so. But the fact remains: pills are much easier, gentler, and less gruesome than other methods of suicide. People should have the freedom to commit suicide in an easier, gentler, and less gruesome way.

Ackerman's cat Palomides. [image via]

Ackerman then fielded questions from those in attendance.  The questions covered a variety of important extensions and ideas, including:

• Should a physician’s opinion matter?  If so, should a pharmacist’s opinion on birth control prevent them from dispensing birth control?  Our society does not allow a pharmacist to not dispense birth control because they disagree morally, and the law should be consistent, so physicians with deep moral quarrels should at least refer the patient to someone willing to supply lethal pills.  Ackerman disputes that what kind of life doctors consider is worth living should not influence a patient’s decision.
  
• But people with depression are at a higher risk of committing suicide.  Today people with depression may be given a bunch of different pills. Even if a doctor forces a patient to take a bunch of pills and the patient thanks the doctor later, the possibility that the patient is grateful for their intervention is not justification for forcing someone to take pills.  Do the ends justify the means?  Ackerman called upon 1984 by George Orwell: Winston is forced to conform to society’s view of what is an acceptable emotional response to Big Brother (“He loved Big Brother”) by harrowing torture.  That doesn’t make forcing people into a particular emotional state acceptable.
  
• Government should not value some lives over others.  Ackerman was very adamant against any sort of measure allowing a government to compare the values of human beings.  By prohibiting Rachel from getting pills, the law suggests that Rachel’s life is more valuable than Emma Sue’s.
  
• Should a family’s opinion matter? Ackerman was very skeptical that a patient’s family’s opinion matters more than the patient’s regarding issues of life and death.  
  

Ackerman’s position, that doctors should be allowed to prescribe lethal pills to people like Rachel, is not mainstream.  It runs counter to the generally accepted idea that death is the absolute worst thing that can happen to someone ever.  The fascinating subject and its associated moral questions, combined with Ackerman’s wit and straight talk, made this discussion incredibly engaging, stimulating, and thought-provoking.

1. Quill, TE. Sounding Board: Death and Dignity: A Case of Individualized Decision Making. The New England Journal of Medicine. 1991 Mar; 324(10):691-694. Available from http://web.missouri.edu/~bondesonw/Quill.HTM 
   
2. Ackerman, FN. “For Now Have I My Death”: The “Duty to Die” versus the Duty to Help the Ill Stay Alive. Midwest Studies in Philosophy. 2000; 24. Available from http://www.brown.edu/Departments/Philosophy/onlinepapers/ackerman/DutyToDie.pdf