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Jun 6, 2004 11:01 am

More on Assisted Suicide

Here is my response to the private reaction I got to my position on the Ayn Rand Institute’s statement on physician-assisted suicide:

Thomas Szasz's point about principals and assistants is crucial because clear language is both an inducement to and a consequence of clear thought. The physician is not merely an assistant if he has the power to veto the patient's desire to kill himself, which he does. Under the Oregon law, the attending physician and a consulting physician must agree, among other things, that the patient's judgment is not impaired and that he suffers no mental illness when he expresses the wish to kill himself and asks for the drugs with which to carry out his wish. The patient is not in the driver's seat. Do you think that if the two doctors veto the request, the patient can simply doctor-shop until he accomplishes his goal? The patient, having been certified as impaired and, by virtue of his request, obviously dangerous to himself, could be committed to a mental hospital against his will. We cannot separate the legal issue of suicide today from the entire psychiatric/mental illness edifice—a massive violation of individual rights that any Objectivist should categorically condemn.

Contrast that situation with a free market. A drug seller could choose not to sell lethal drugs to a terminal patient (or anyone else). But the situation would be very different from what exists in Oregon. If one retailer refused to sell the drug, the patient would be free to find another without fearing commitment to a mental hospital. The seller would not be under a legal mandate to certify that the patient was acting with"unimpaired judgment." He would have no legal liability if the patient committed suicide. (The family of the deceased could not sue him, for example.)

By the way, when a free-market pharmacy sells someone a lethal drug with which to kill himself, would we call that"pharmacist-assisted suicide"? Of course not. That's why Szasz labels"physician-assisted suicide" an oxymoron.

Re the claim that the Oregon law does not expand the power of doctors because they can already write prescriptions: the law expands the"therapeutic state" by widening the definition of"medical treatment." In Szasz's words,"neither the person who kills himself nor the physician or anyone else who gives him a lethal drug is performing a medical act." This is critically important: killing oneself is not treatment. Neither is helping someone to do so."Not everything physicians do is a treatment," Szasz writes. Suicide is a moral/legal matter in which doctors have no special expertise. Yet the Oregon law obscures that fact—worse: it declares assisted suicide to be medical treatment. To put it mildly, there is no progress in having the status of suicide changed from symptom of mental illness to medical treatment.

Because the law expands the therapeutic state by expanding the notion of"treatment," I cannot accept the argument that physician-assisted suicide is a proper reform pending laissez faire in drugs. On the contrary, such laws (including medical marijuana laws) put off the day we will achieve laissez faire. Who needs laissez faire (most people will ask) if doctors can prescribe drugs under"proper" conditions and safeguards? But what about the rights of someone who is not a terminal patient but who nevertheless wants to take his own life? Is he not a self-owner?

We should use the right of suicide as part of our agitation for a free market and full property rights. As to what someone wishing to commit suicide should do in the meanwhile, I would prefer to see him break the law (as many do) rather than see more power go to the already-threatening therapeutic state.

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