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'The Freest Nation in the World'?

by Peter Singer


The following article is from Free Inquiry magazine, Volume 20, Number 3.


The real thing that we're going to be debating is about life, and as the freest nation in the world, are we going to abandon the principle that life has value?

Representative Tom Coburn (R- Okla.), a supporter of a measure passed by the House of Representatives to Congress to overturn Oregon's law allowing physician-assisted suicide, said these words on Jim Lehrer's News Hour, last October 27. Is it possible that Representative Coburn really cannot see the flagrant contradiction between wishing the United States to be "the freest nation in the world" and insisting on ramming the belief that life has value down the throats of terminally ill people who have made careful, considered, and well-grounded decisions that they do not want to continue to live?

In his celebrated essay On Liberty, John Stuart Mill wrote:

. . . the only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others. . . .Over himself, over his own body and mind, the individual is sovereign.

No nation can claim to be "the freest nation in the world" if it overrides this principle on such an important matter as the right to decide when and how one dies. On that basis, the Netherlands and Switzerland are freer nations than the United States, because the citizens of those nations are able to receive assistance from physicians in ending their lives. 

If Mill's principle were generally accepted in the United States, it would provide a clear basis, not only for accepting the law for which the citizens of Oregon have twice voted, but for getting rid of all laws prohibiting physician-assisted suicide and voluntary euthanasia. For what could be a plainer case of denying the sovereignty of individuals over their own mind and body than a law that tells competent adults that they must continue to live beyond the point at which they see any value in doing so?

It is sometimes claimed that patients who are terminally ill cannot rationally or autonomously choose euthanasia, because they are liable to be depressed, or their minds may be clouded by medication. It is curious, however, that people who make this claim do not argue against the right of terminally ill patients to refuse life-sustaining treatment or to receive pain relief that is liable to shorten life. Indeed, the bill that the House of Representatives passed that seeks to prohibit the use of federally approved substances for the purposes of physician-assisted suicide specifically allows for the use of pain relief that is foreseen to shorten life. But the patients who refuse treatment or request life-shortening pain relief are also terminally ill and are making choices that will, or may, end their lives earlier than they would have ended if the patients had chosen differently. To support the right of patients to make these decisions, but deny they should be allowed to choose physician-assisted suicide or voluntary euthanasia, is to assume that a patient can rationally decide to refuse treatment or receive life-shortening doses of pain relief (and that doctors ought, other things being equal, to cooperate with this decision) but that the patient cannot rationally choose voluntary euthanasia. There is no logic in this view. The question is whether a patient can rationally choose an earlier death over a later one (and whether doctors ought to cooperate with these kinds of end-of-life decisions), and that choice is made in either case. If patients can rationally opt for an earlier death by refusing life-supporting treatment or by accepting life-shortening palliative care, they must also be rational enough to opt for an earlier death by physician-assisted suicide or voluntary euthanasia. 


Peter Singer is DeCamp Professor of Bioethics at the University Center for Human Values at Princeton University. He is the author of Animal Liberation, Practical Ethics, How Are We to Live?, and Rethinking Life and Death.


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