The Right To Die

The Right to Die

1. Introduction

Why has the right to die initiated such a vigorous debate among philosophers, lawyers and doctors? The Fourteenth Amendment of the Constitution states "No State shell deprive...any person of life, liberty or property, without due process of law." [1] However, how does one define life? Even more so, how do we define a life worth living? Does the right to privacy give the individual freedom to choose even on issues concerning the termination of his own life? Or does the state have the right to interfere with person's choice to terminate his life if it is in the best interest of the society? This paper will try to address the issues stated above by taking into consideration arguments of both sides, pro and against the right to euthanasia.

2.1 Nancy Cruzan's Case shapes History

The case of Nancy Cruzan is now part of the history of the US Constitution for it arose the most extensive debate so far in terms of the right to die. After her car accident at the age of twenty four, she was left in coma and in what doctors describe as permanent vegetable state. [2] Having no hope for their daughter's improvement in future, her parents petitioned the court asking to grant the hospital authorization to terminate artificial nutrition. Although the State court granted the permission, the Supreme court of the US reversed the decision on the grounds of insufficient evidence that Nancy would refuse a life as a vegetable, as well as on the argument that the state must do everything in its power to preserve life. [2]

2.2 Right of Privacy at Stake

Prior to the accident Nancy has told her friend that in case she was left in a state where there was no hope for her improvement, she would rather not live at all. However, the Supreme Court found this not to be a convincing evidence of Nancy's wish not to be subjected to a medical treatment. It further stated that a "clear and convincing evidence" would take the form of a Living Will, which would state the opinion of the individual regarding medical treatment in case they were left incompetent. However, as one judge noted, "even someone with a resolute determination to avoid life support under circumstances as Nancy's would still need to know that such things as living wills exist and how to execute one." [3] Furthermore, it is very relative if people who live what might be considered a quality life would abide to the writing of such document, since the thought itself of one day becoming an incompetent person in a vegetable state might be horrible for many.

By presenting this argument the court recognizes the right of competent people to accept or refuse medical treatment. However, we must ask ourselves if incompetent people still have that right as if they were competent, and if not, can someone else, including the state, decide for them? We must ask ourselves if the Due Process Clause of the Fourteenth Amendment permitted Cruzan's parents to refuse life-sustaining treatment on their vegetated daughter's behalf? [4=oyez]

In the case of Nancy Cruzan, there was evidence that Nancy would have rather wanted to die than be kept alive as a vegetable. However, the court found this evidence insufficient to definitely prove her wish to refuse medical treatment. On the other hand, the court never asked for a proof that Nancy would rather be kept alive. Even if it did, there was no such evidence. On the contrary, the opposite side was much stronger. Furthermore, the court violated Cruzan's privacy right to determine her own fate by refusing to accept her own words while still competent as liable to express her wishes and determine her destiny. Even though the court held that competent individuals enjoyed the right to refuse medical treatment, it clearly denied Nancy Cruzan that right since she made that choice prior to the accident that left her a comatose. Her right to privacy, in terms of making a choice, has obviously been lost somewhere in the vigorous debate over other issues, such as the state's best interest in "preserving life."

2.3 Right to Die for some, but not for others?

On one hand, when competent people refuse medical treatment necessary for the preservation of their life, doctors face a dilemma. "They have an ethical and legal obligation both to act in the patient's best interest and to respect his autonomy, his right to decide for himself what will be done with or to his body."[3]

Most would agree that "competent adults are generally at liberty to refuse medical treatment even at the risk of death." [5] Consequently, doctors may not treat a competent patients against their will. Furthermore, it could be argued that "where there is the slightest doubt about the wishes of a patient, that patient should be treated, because [deciding for some one else] when it is best to die is effectively denying [the patient's autonomy]." [6]

In the case of Nancy Cruzan, the court introduced another consideration for this dilemma, a consideration of the state's interest in preserving life. According to the court, if a Jehovah's witness refuses blood transfusion which is vital to keeping him alive on the grounds of religious beliefs, the state's interest of keeping him alive and by that preserving life complies with his own best interest. However, when a patient is in great pain, the state's interest in keeping him alive is in conflict with his own best interest. [3] This poses important questions, such as whether the state has the right to preserve a patient's life even against his wish and best interest, and even more so, whether the state has the right to keep a patient alive to insure obedience to its own policy, in this case "preservation of life?"

In the Cruzan case, the court offered two main arguments as to why Missouri had the right to require a convincing evidence of Nancy's wish to rather die if in a vegetable state. One was that it is in the best interest of incompetent people since it benefits them from guardians who abuse their trust, whereas the other was that the state had its own legitimate reasons for preserving life. [3]

These are highly questionable and debatable. First, as Dworkin argues in [3], many people that are now in a vegetable state acted in a way that suggests that they would have signed a living will had they predicted their accidents. The decision of the court in that case denies them the right of choice, had that choice taken place.