鈥淭HERE is more to life than breathing.鈥� This was how Ted Kulongoski, governor of Oregon, explained his support recently for his state鈥檚 Death With Dignity Act, which allows terminally ill patients to have someone help them end their life. Many people would doubtless agree, but not all of them would support the implication: that when someone with a terminal illness loses the will to live, it is OK to help them kill themselves.
Since the Oregon law came into effect in 1997, 鈥渕ercy killing鈥� has become a hotly debated issue in many countries (see 鈥淟ast rights鈥�). This month a UK parliamentary committee gave tentative support to a proposed right-to-die law that would allow assisted suicide and voluntary euthanasia, and last week the French senate approved legislation allowing terminally ill patients to refuse treatment that would keep them alive. Switzerland already permits assisted suicide, and Belgium euthanasia. The Netherlands allows both.
Opponents say that such laws risk making premature death increasingly acceptable. The old and disabled, worried about being a burden, might feel increasingly obliged to 鈥済o quietly鈥�. Ending the lives of comatose patients, or even those with advanced Alzheimer鈥檚, would become the norm, they say. While there is no evidence that places where mercy killing is legal are edging down this slippery slope, firm figures remain scant.
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Advocates of right-to-die laws say there is little danger of a slippery slope so long as the patient is an adult and is required to give consent. Much of the debate in the Terri Schiavo case centred on her husband鈥檚 claim that she told him she didn鈥檛 want to stay alive in a vegetative state. Yet living wills can be ambiguous, and families of those who make them are often split over how to interpret them. And while the quality of life for vegetative patients may look dire, how can we be certain? With no responsibility for decision making and no memory, might life be oddly sweet?
Science鈥檚 ability to resolve these dilemmas is limited. Improved diagnostic techniques can help determine the extent of brain damage in vegetative patients and their chances of recovery. But they cannot determine their quality of life or whether they think it worth living. Likewise, while better palliative care can make life more bearable for the terminally ill, pain is not the only reason why people seek to end their life. For some, knowing that their illness is terminal is an unbearable burden.
The danger is that people will be tempted to reduce these difficult issues, which go to the heart of what it means to live and die, to the comfort of technological fixes. The fundamental dilemmas remain, not least the fact that technologies rightly celebrated for their capacity to prolong life can sometimes make a dignified death more difficult.
