Assisted Suicide Is an Abuse-Prone Legal Mess

Do you want the state to have a monopoly on violence or not?

Credit: Patrick Thomas

The U.S. has a knack for adopting failed policies from abroad five to fifteen years after their expiration date passes: France’s war in Vietnam; Britain’s price and wage controls; the Soviet Union’s exertions to modernize Afghanistan.

You’d think we’d learn, but apparently not. Some lawmakers are determined to add various social democracies’ adventures in assisted suicide to the list. Assisted suicide laws are before 19 state legislatures, including those in Pennsylvania, Virginia, and my own Maryland. The potential Maryland statute would allow patients to request a lethal dose of medication from doctors, which the patients could self-administer; the request must be made in writing with two witness signatures. It is not the first time the Old Line State has considered legalizing medically assisted suicide; the last push from the death lobby was in 2019, when the bill passed the House of Delegates but died in a 23–23 tied vote in the Maryland Senate. 

This may be the year. Per one poll, just shy of 70 percent of Marylanders think the terminally ill should be allowed to end their lives with medical assistance.

“I think this is a timely discussion, especially as we look at the abortion rights issue, because that’s one of self-autonomy, right?” commented Donna Smith, the campaign director for Compassion and Choices, to the news site Maryland Matters. “That pregnant women should have autonomy over their body. And I think that applies to death and dying as well. Because why would we not give dying people options at the end of life, when the options are so few?”

This sort of remark is, obviously, both revealing and unhelpful—the anti-abortion argument does not hinge on the woman at all, but whether the fetus is a human person worthy of legal protection. As the law stands in most of the country, the answer to that is “no”; the fetus is like a dog or a tree, homo sacer, outside the legal regime, to be killed at will without anything having occurred in the eyes of the law. For the anti-abortion side, this is wrong and bad (and, obviously, I do agree with them), but it is recognized as a current legal reality to be changed.  

On the other hand, nobody argues against the full personhood and citizenship of the terminally ill person. In the eyes of the law, the terminally ill person still must receive due process before being put to death, a penalty that is, per the most ancient principles of Western law, reserved for serious crimes and to be administered only by the state and its officials. (In the United States particularly, we believe in jury trials and ban bills of attainder. You have to break a law in the eyes of your fellow citizens for the state to bring force to bear on you.) Due process is not only about protecting the rights of citizens, but about defending the state’s monopoly on violence. Allowing suicide begins to chip away at the sovereignty of the state by opening a space for private control over life and death.

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To descend from the rarefied Temple of Justice and frame things in purely pragmatic terms, assisted suicide also opens a can absolutely pullulating with lively and upsetting worms. Canada legalized “medical assistance in dying” (MAID) in 2016, and has widened eligibility to those who are not dying but who can make a quality of life argument that their suffering is “unbearable” and they would be better off dead. The results are what you’d expect. In 2023, a staggering 4.1 percent of total deaths in the Land of the Maple Leaf—about 13,000 lives—are now attributable to assisted suicide. (For comparison, old-fashioned DIY self-slaughter has held steady in Canada at around 4,500 deaths annually for the past several years.) The program is to be expanded to those whose suffering is purely psychological, but the government is considering a three-year delay so health systems can prepare for the flood of requests. 

The potential abuses are obvious. For one thing, in Canada, doctors seem to have gotten the idea that MAID is a “solution” to poverty and patients requiring complex care; some doctors have adopted latitudinarian attitudes regarding the “safeguard” regulations on assisted suicide. Even the geniuses at Jacobin have figured out that “death with dignity” is the ultimate austerity program. This is pretty sinister stuff.

We already live in a period of elevated, indeed, record-breaking suicide and overdose deaths—the “deaths of despair.” Everyone knows this, including the officials of the state. Naturally, all the fact-finding for this column was accompanied by various sorts of warnings and messages from my computer informing me that I am not alone, that help is there, that I ought to call 988. Why should we give knobby old Leviathan the idea that it would be cheaper and cleaner just to finish me off? How is giving the American people a state-sanctioned tool for self-destruction in the national interest?


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