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"I regard this as justice"

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June Hartley of Lodi, California, was charged with “assisting a suicide” and “causing injury leading to death” for helping her brother to commit suicide. She recently pleaded guilty to a lesser charge of “being an accessory to a crime.” (I thought suicide was not illegal?)

Her brother, blues musician Jimmy Hartley, had suffered a series of strokes which left him bound to a wheelchair and in constant neuropathic pain. Prior to his death, at age 45, he had begged others to help him end his life.

Both Hartley’s lawyer, Randy Thomas, and the prosecutor in the case, Sherri Adams, expressed approval of the plea agreement.

“I regard this as justice,” Thomas said. “It sent two messages: The district attorney had an acknowledgement [sic] that the law was broken but also that it was a unique situation involving mercy.”

The prosecutor, Deputy District Attorney Sherri Adams, said the plea agreement was just. Adams said the District Attorney’s Office must scrutinize cases of assisted suicide, which are illegal in California, to prevent malicious killings that are masked as merciful.

Hartley’s actions, Adams said, were a genuine act of mercy.

“This case did not involve any ill will,” Adams said. “The defendant violated the law out of love and support for her own brother.” [Emphasis mine.]

Both Hartley’s attorney and the prosecutor seem to agree that this is the correct outcome for a case of assisted suicide.[1] Adams and Thomas recognize two kinds of harm:

  1. The harm of living in misery and not being able to die (hence the recognition that the act of helping a person to die can be merciful or compassionate, and that such a person should not be punished);
  2. The harm of a “malicious killing” (presumably a murder, but perhaps something else is meant) going unpunished.

The statement that the outcome in Hartley’s case is “justice” indicates that the correct balance has been struck between the two kinds of harm.

In fact, in this case the first interest – the right to choose death over suffering – is almost completely sacrificed at the expense of the second – punishing “malicious” killers. James Hartley’s interests, and those of people like him, are ignored. Adams is concerned with “malicious” killers disguising their work as assisted suicide. But what about all the people suffering in misery, who have a longstanding wish to die, but cannot die because anyone assisting them will face prosecution? The idea that June Hartley’s actions were “merciful” concedes that her brother had an interest in dying. Prosecuting people who assist suicides does nothing to protect that interest.

Also, as I have previously argued, prosecuting assisted suicides is an extremely poor way (in practical terms) to prevent malicious killings from being disguised as suicides. In Oregon and Washington, for example, it would be extremely difficult to make a murder look like an assisted suicide, at least a murder of a person ill enough to qualify for suicide assistance from a doctor. Since a comfortable means of assisted suicide is legal, with many safeguards to ensure that it is the true wish of the decedent, an “assisted suicide” by any other means would be unlikely and extremely suspicious. I assert that assisted suicide in Oregon and Washington is much harder to fake than in California – and, of course, the right to die is protected better there, as well. Both interests recognized by Adams and Thomas are poorly protected by the solution they claim is “justice.”

Elsewhere on the web, TGGP rips apart Frontier Psychiatrist‘s definition of rationality, in the context of suicide (“Life is a disease, so cut the bullshit please.”). Rationality in this context means that a decision is “characterized by reason or ‘makes sense’ to others,” FP claims. I manage to comment in both places without rolling my eyes or sighing deeply.

And Bryan Caplan wonders why so few terminally ill people kill themselves.


1. The term “mercy killing” is often used in cases such as Hartley’s. I think this term is misleading: “killing” implies that one person caused another person’s death – such as by smothering or shooting the person – without his permission. In Hartley’s case, she merely helped her brother achieve his own aim of dying. Helping someone to commit suicide who has a longstanding wish to die is not properly considered a killing.

Written by Sister Y

June 4, 2009 at 1:49 am

The Free World

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Written by Sister Y

December 9, 2008 at 4:23 am

Worries about Oregon’s Law are Without Merit

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Katharine Whitehorn has an article in The Guardian about Oregon’s assisted suicide law (How to die ‘the Oregon way’). It’s a valuable article that’s worth reading in its entirety – she examines the strict safeguards of the law (a woman who had lived in Oregon all her life, but moved to Hawaii to retire two years before being diagnosed with terminal cancer, didn’t qualify), the effects of the law on the treatment of patients (better pain management and better hospice care), and Oregonians’ attitudes toward assisted suicide.

Here is an excerpt, dealing with the difficulties of accessing peaceful death under Oregon’s law:

So, is it all dead easy in Oregon? Not really. The very safeguards in the rules also serve to exclude some who might dearly love to have access to a planned and dignified death. It is the educated, the competent, those with a decent relationship with a doctor – which, in practice, usually means those with a decent relationship with health insurance – who are likely to seek it. The very poor have Medicaid, (which doesn’t pay too well so not all doctors welcome it), those in employment or pensioned retirement have good insurance, and the elderly have Medicare. But it is very difficult for those who are hard up, in erratic employment but not actually on the streets – those who make up the 17% of those who have no insurance at all – to raise the required cash to form a satisfactory relationship with the doctor, who has to certify the patient has less than six months to go. This often excludes those with Aids or MS or, of course, Alzheimer’s. Of the European countries that have assisted death, only Holland does not require death to be more or less imminent. Yet if you are bleakly in pain and not going to die pretty soon anyway, you might ache even more for an ending to it all.

Clearly, privilege and money play a role in assisted suicide – the privileged are more likely to have access to it, and to choose it. And those who are not on death’s door might often desire death even more than those who are about to die anyway.

(Please see this synopsis of Washington’s proposed law in Scientific American for the most hilariously contrived piece of stock photography I’ve probably ever seen.)

Written by Sister Y

October 13, 2008 at 1:27 am

What Distinguishes "Assisted" Suicide From Regular Suicide?

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“Assisted suicide,” in the popular use of the term, can probably be distinguished from garden-variety “suicide” in two ways:

  1. Assisted suicide requires the assistance of some third party to carry out the act.
  2. Usually, “assisted suicide” connotes suicide by a person who is terminally ill.

I wish to challenge the accuracy and importance of the first distinction, and to examine how it interacts with the second distinction.

Assisted suicide, by definition, requires the assistance of another person. It conjures images of doctors injecting a lethal drug into a patient at the patient’s request. But that is now how it often works in practice. Oregon’s law is considered an “assisted suicide” law, but the “assistance” consists only in a physician writing a prescription for a lethal dose of Nembutal – not in helping to administer the drug. But is this really assistance?

The purported “assistance” going on in this type of “assisted suicide” is merely an artifact of our particular system of drug prohibition. We consider suicide by gunshot to be a suicide, rather than an assisted suicide; but why not call it an “assisted suicide,” since the procedure for buying a gun requires the assistance of others? I think we would not call it an assisted suicide in the latter case. The distinction seems to be that, “assisted suicide” requires that the person providing assistance do so knowing the suicidal purpose of the person who is assisted. But the only reason the person wishing to commit suicide needs to let the doctor intrude on his personal life in this way is that he cannot obtain the drug in any other way. We too easily accept our drug prohibition as a given, when in fact it is a policy decision. There is not so much difference between “assisted suicide” and plain old suicide, except that in the former case, another person has been made privy to the suicidal person’s private decision, often because the state requires the intrusion.

“Assisted suicide” in the form of a prescription is necessary, in most cases, merely because proper drugs are not available through other means. It is not “assisted suicide” any more than divorce with the help of a judge is “assisted divorce.” But, in some cases, the physical inability to kill oneself is the circumstance that requires “assistance.” This circumstance is especially likely in cases of people who are terminally ill. Here again, the “assistance” required may be for legal or practical reasons. If proper drugs are not available for legal reasons, the person who wishes to die may have to send a relative in place of himself overseas to seek out the necessary drugs. Or, the person who wishes to die may actually need physical assistance in dying, such as an injection, or assistance holding the cup if the drugs are taken by mouth.

I suspect that many people who oppose “assisted suicide” are concerned about the act of assisting someone to die in this latter sense. They fear that, rather than willingly choosing to die to end their own suffering, people may be put to death because they are disabled or inconvenient or expensive to provide for. To its credit, the Oregon law specifically requires a personal request, as well as an assessment of legal “capability” and many other safeguards, to prevent murders from disguising themselves as assisted suicides. I think the fears mentioned above should be taken seriously, and in this limited circumstance, I approve of the restrictions.

But these restrictions are not necessary when it comes to people who are fully competent and need no physical assistance in taking their own lives. The only comfortable sort of suicide – a suicide by overdose of fast-acting barbiturates – is only “assisted suicide” in that competent adults are generally prohibited from accessing the necessary drugs. Lift or even relax the barbiturate prohibition, and forced life becomes chosen life. There is no compassionate reason for forcing capable, suicidal adults to choose between shooting themselves in the head, cutting their arteries, hanging themselves, or living a life of unbearable misery and indefinite duration.

Written by Sister Y

July 3, 2008 at 11:41 pm

Oregon’s Law

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Oregon’s Death With Dignity Act succeeds in many ways. The Act respects patient autonomy, from its definition of “capable” to mean that

in the opinion of a court or in the opinion of the patient’s attending physician or consulting physician, psychiatrist or psychologist, a patient has the ability to make and communicate health care decisions to health care providers, including communication through persons familiar with the patient’s manner of communicating if those persons are available.

to the way it allows patients to decide for themselves whether to notify family members and when – even if – to self-administer the lethal prescription, once requested. (Some people who request suicide assistance don’t use it until months or years after it has been provided.)

Oregon’s law is wrong, however, in limiting access to death to those with terminal illnesses. Although this flawed version is certainly the only version of the law that would have had a chance of being enacted, the fact remains that it is wrong.

First, restricting access to comfortable means of death to those with a terminal illness is actually demeaning to people with terminal illnesses. The idea that human dignity somehow requires that one be able to walk and talk and control one’s bodily functions is demeaning and wrong, as Felicia Ackerman (see Readings) and disability advocates point out. A terminally ill person must decide for him or herself whether to request suicide assistance; it is not the right decision for everyone. But what possible justification could there be for limiting this right to terminally ill people, except that their lives are somehow less valuable than those lives that will (probably) continue on for many years? The designation “Death With Dignity Act,” of course, hints at the demeaning implication of the limit: some deaths are dignified, other are not. The state will decide for you whether you are undignified enough to be allowed to die peacefully. (The Oregon law does not allow assisted suicide to be provided to non-terminally-ill disabled or merely old people, but the implications of the restriction to terminally ill people are clear enough.)

Second, the Oregon law’s restriction against suicide assistance to non-terminally-ill people is wrong because suicide is an important right for everyone, not merely the terminally ill. In fact, if anything, the right is more important for those who are not terminally ill, because their time of suffering will most likely be much longer than those who will die soon naturally. And, as pointed out by Velleman, terminally ill people are much more likely to be harmed by having the option to die than healthy people are, because they are more likely to be dependent on the care of others and therefore to feel themselves to be a burden. A more sensible restriction might be to allow suicide assistance only to non-terminally-ill people! I am not, of course, in favor of this restriction, but it makes more philosophical sense than Oregon’s law, which makes political sense, if anything.

Meanwhile, Switzerland recently extended suicide rights to those with incurable mental illnesses. Jacob Appel, writing in the Hasting Center Report, explains the basic ethical issues:

Another set of objections are from those who support a basic right to assisted suicide in certain situations, such as those of terminal disease, but do not wish to extend it to cases of severe and incurable mental illness. This resistance may be inevitable, considering the increased emphasis that contemporary psychiatry places on suicide prevention, but the principles favoring legal assisted suicide lead logically to the extension of these rights to some mentally ill patients.

At the core of the argument supporting assisted suicide are the twin goals of maximizing individual autonomy and minimizing human suffering. Patients, advocates believe, should be able to control the decision of when to end their own lives, and they should be able to avoid unwanted distress, both physical and psychological. While these two principles might explain why a victim of amyotrophic lateral sclerosis or cancer would choose assisted suicide, they apply equally well in many cases of purely psychological disease: a victim of repeated bouts of severe depression, particularly in cases where treatment has consistently proven ineffective, rationally might prefer dignified death over future suffering. [Hastings Cent Rep. 2007;37(3):21-23. Via Medscape. Emphasis mine.]

Written by Sister Y

June 24, 2008 at 3:40 am