Assisted Suicide and the Evolution of Law and Technology

Assisted suicide is a relatively recent concern, both legally and in society as a whole. Although there are euthanasia laws dating back to 1903 (Urofsky 161), it did not surface as a clear and present national issue until 1990 when Michigan doctor Jack Kevorkian began practicing assisted suicide and "forced the American people to meet head-on the issue of physician-assisted suicide" (65-66, 86). The subjects of assisted suicide and euthanasia have risen due to technological and cultural advances. They also exemplify various aspects of the ever-expanding political and legal landscape in the United States. One facet of the American political structure especially relevant to the question of assisted suicide because of its recent emergence is the significance and ongoing evolution of the judicial branch. Melvin Urofsky's Lethal Judgments: Assisted Suicide & American Law shows how the topic of assisted suicide has come to be a major issue and how social, political, and legal practices, particularly actions within the medical industry and judicial hierarchy, play an integral role in shaping the debate surrounding this troubling societal issue.

The foundation for a legal right to take one's own life in a period of illness and pain, as well as the debate over that right in this country, more or less initially began with a series of essential court rulings in the 1960s and 70s, of which the most relevant to this issue is 1976's In re Quinlan, where the Supreme Court of the State of New Jersey ruled that individuals held the "right to die" (38-39). This ruling coincided with several other rulings during the time that reevaluated the issues of privacy and autonomy, such as Griswold v. Connecticut in 1965 and Roe v. Wade in 1973 (49).

These cases serve as a prime example of how our judicial system can function as a law making body, reacting to or spurring on social change. Lethal Judgments makes an obvious allusion to this principle when Urofsky records the dialogue between Chief Justice Richard J. Hughes and Paul Armstrong, attorney for the Quinlan family (46). In addition, Urofsky also states, "the law had not kept pace with the rapid technological advances" (39). It was thus up to the judiciary to decide if this "right to die" was valid.

It can also be deducted that one cause of the "right to die" and assisted suicide issues is found in the political and legal movements that took place throughout the 60's and 70's, such as the civil rights movement and the women's rights movement. As a result of these rising questions over ethics, privacy, and personal autonomy, various groups began to also polarize over the issue of patient's rights. Religious groups, among others, started opposition to the "right to die," whereas abortion advocates and people strongly interested in personal autonomy and freedom chose to defend it. Fragmented in pieces on both sides of the assisted suicide issue to this day stands the medical profession, the most intriguing sector involved in the debate.

Melvin Urofsky finds physicians so interesting and integral to the problem he devotes an entire chapter of Lethal Judgments to doctor's views on euthanasia (65). Part of the Oath of Hippocrates that all doctors swear to uphold is "I will give no deadly medicines to any one if asked, nor suggest any such counsel" (Qtd. on 75). It can be said that the ultimate goal of medical science is to fully understand the human body and to cure anything that may afflict it with pain or harm. Today, after a century of important biological and medical discoveries, patients are commonly being cured of once-deadly diseases and generally enjoying full recovery (23). However, one central cause of the assisted suicide issue is that society currently lies at a very puzzling stop on the road to "medical utopia." As far as modern medicine has come, there remain illnesses that are more or less incurable. Urofsky states this concept best: "Doctors cannot cure everyone, but in many cases they can keep that person "alive" far longer than might otherwise have been the case had they let nature take its course" (24).

Because medicine is presently in this gray area, and will be for the foreseeable future, the rights of patients who are in pain and cannot be adequately cured is an issue that must be faced. Therein resides the problem for medical ethicists and physicians opposed to the practice of assisted suicide. The training and tradition of medicine instructs medical workers "to save life and ease pain" (75). Therefore, anything involved with ending life is in moral conflict with their job description. One could say asking a doctor to end a person's life is like giving a fireman gasoline to spray on a burning building instead of water. Even within the segment of doctors who believe in such rights, there might be feelings of anxiety due to this contradiction. Timothy Quill, for example, felt "intense emotional stress" despite performing what he truly believed were ethically sound actions (73). Furthermore, partially as a result of this paradox, doctors are worried that patient-practitioner trust, a pillar of disease treatment, will erode (76).

But aside from the substantial ethical questions raised within the medical community, Urofsky shows physicians as having almost just as much concern from a legal perspective. During the original "right to withhold treatment" arguments, the threat of legal action was a primary concern for hospitals and medical workers (45). Later in Lethal Judgments, when discussing current assisted suicide issues for physicians, Urofsky makes it a point to mention that quite a few physicians are opposed to formal political and legal maneuvers to allow assisted suicide because they feel the business is over-regulated as it is (77).

These fears among the medical community have arisen because of the expansion of the American legal system. Administrative agencies such as OSHA and regulations connected to codes like the newly-enacted HIPPA now regulate nearly every aspect in the operation of a medical clinic or hospital. Fifty years ago, no one in the industry had to worry about the ramifications of how such codes would change if assisted suicide became legal because most of the regulations simply did not exist. In addition to legalization worries, the threat of malpractice has heightened because there is a consensus within the United States populace that contingency-fee lawyers have created a more litigious environment. Since malpractice is a significant monetary and reputation-altering force, any action that would increase the perceived greedy contingency-fee lawyer's possible avenues of action would be opposed.

But the concept of legal expansion playing a role in the assisted suicide debate is most certainly not isolated to physician's fears. In the last forty to fifty years, the Supreme Court has been more open to hear social disputes that are being addressed in the legislature. From Urofsky's Lethal Judgments, one can see how the increase in types of cases the High Court hears is a natural effect with time. The original Quinlan ruling in 1976 was based on common law and the precedent set in Griswold (37). The Cruzan case "brought together many of the strands of earlier decisions," and the Supreme Court majority cited the Fourteenth Amendment in making its final decision (59-60). The point is that the Quinlan case spurred several other political actions across the country and the Cruzan decision was brought up multiple times in the discussion and opinion regarding Quill v. Vacco and Washington v. Glucksberg (131-140).

With these and the other cases he writes on, Urofsky unintentionally shows that as precedents, laws, and codes become added to the legal repertoire, more disputes arise over how these laws and precedents can be interpreted and applied. Take the aforementioned Fourteenth Amendment. Quite a few social and legal issues have been brought to court solely because of the clauses in that amendment. It may be the exception to the rule, but the legal expansion cause by sheer number of precedents is still one factor that allowed "right to die" issues to come to the Supreme Court.

But perhaps the greatest insight into the American system that one can draw from Lethal Judgments is the importance of the judicial hierarchy in our legal system. In Washington v. Gluksberg the court of original jurisdiction, the federal district court in Seattle, Judge Rothstein ruled in favor of the plaintiffs (107). The Ninth Circuit then ruled in favor of the State of Washington on appeal (111). At an en banc review, the full Ninth Circuit overturned their original ruling 8-3 (114-115). Finally, at the Supreme Court, a full two and a half years after the case was first brought to court, the Ninth Circuit was overturned, ruling finally in favor of Washington (138). Through the long duration of this case and four separate courtroom sessions, it is virtually assured that every legal question surrounding this individual scenario has been raised and ultimately addressed. In this way, the appeal system allows for full judicial discourse, as well as much additional written literature, on the most controversial of issues, such as those discussed in Washington. In this context, the same widespread legal expansion that was mentioned earlier as affecting doctor's views on assisted suicide is an absolute necessity in assuring that all angles of an issue have been adequately spoken upon.

The Supreme Court's ruling in this specific case, as in Vacco v. Quill, continued the recent trend of the Rehnquist court in ruling in favor of State's Rights, while also showing the court's reluctance in "finding new rights (138)." The example of the Washington case also demonstrates the principle that citizens in the United States have multiple routes of access to the law and in changing the law. The supporters of physician-assisted suicide chose to maneuver around their state legislature in Washington by initially trying Initiative 119, a "death with dignity" movement (98-99). Initiative 119 was rejected 54 percent to 46 percent (100). Three years later, a group brought Washington to court (105). From the specific example of assisted suicide in one state, Melvin Urofsky shows three separate routes of access to the American government: action by elected legislature, civil initiative, and judicial action.

It is evident that from Melvin Urofsky's Lethal Judgments: Assisted Suicide & American Law, the reader gains a look at both political and judicial processes in a real-life context with a specific issue and a look at how a truly difficult moral and ethical question is answered within the American legal structure. The book does a skillful job of showing both the legal and extra-legal facets of the current "right to die" debate. This essay detailed two essential components of this discussion that Urofsky featured in the book: the societal issue of assisted suicide in the medical field and the legal issue of judicial processes and concepts used to answer questions on assisted suicide. However, there are many more groups and views in the "right to die" debate. The author summed this idea up best in the prologue: "But when we deal with questions of death, dying, and the law, and especially with assisted suicide, the social and ethical voices in the debate are many, and there in no unanimity" (3).

In closing, this issue, which arose out of technological advances, changes in thought, and the reassessment of individual rights through social movements and court cases, is an ongoing enigma for politicians, policy-makers, legal analysts and medical ethicists. Yet, although any permanent, peaceful decision is far away, the issue, as laid out in Lethal Judgments can give ample insights into the various political and legal processes that remain behind the issue.