Why the ‘Right to Die’ Will Always Be Controversial

What is the right to die? To put it simply, it’s a moral argument that a person should be able to die on their own terms — that is, to commit suicide. The conditions necessary to exercise this right (if it exists at all) vary drastically from country to country.

Countries that have a legal right to die often have a few stipulations in common — that the individual must suffer unbearable pain, that their illness be incurable and that the decision is made within the individual’s full consciousness. Cases in which these stipulations are not met are likely to be treated as homicides rather than suicides.

The right of a terminally ill patient to choose when their life will end would seem, at least at first, to be a not-too-terribly controversial topic, but recent US history belies this. Thanks to a number of high-profile cases, right to die and death with dignity are more contentious than ever before — thanks in part to America’s status as one of the world’s premier conservative nations.

The current state of the debate—as well as where the controversy goes from here—is very much uncertain. Let’s get things rolling with a look at one of the fundamental problems with right to die laws: The subjectivity of pain.

The Physiological Basis of Pain Is Not Well Understood

No discussion of suffering is complete without an understanding of the way pain affects us, and really, what pain itself actually is.

Some pain has a physiological basis, like when you burn your finger on a hot stove. The tissue-damaging heat activates nerve endings within your finger. These nerve endings produce an electric signal that is transmitted via the nervous system to the spinal cord, where the electric message is converted into a chemical message, which activates pain-transmission neurons.

These neurons send their message to the brain stem and thalamus, which then project to different parts of the brain, which results in the sensory experience of pain. The process, as you can see, is incredibly complex. No one knows how heat or other stimuli like a pinch, smash or chemical burn activate the nerve endings — it’s hard to find these nerve endings at all, let alone research them in a laboratory.

Chronic and psychological pain are even more complex. Even enduring the unpleasant feeling of pain can trigger changes in mood, leading to anxiety and depression. Stress and anxiety can lead to muscle contractions and trigger the sympathetic nervous system, which worsens any current pain or creates new pain in itself. Pain is a vicious cycle.

The feeling of pain is always subjective. Physicians may use a pain scale to assess the amount of pain perceived by a patient, but everyone has a different pain tolerance. What is tolerable to one person may be completely unbearable to another.

Pain can leave its sufferers disabled and socially isolated. Symptoms absolutely require treatment. Treatment usually involves opioid drugs, which are the most effective drugs available for pain treatment. Opioids are synthetically manufactured drugs designed to inhibit pain. They originate from naturally occurring chemicals found in the opium poppy, which also produces drugs like heroin and morphine.

So what is someone suffering from pain to do?

For rape victims, particularly child victims of sexual abuse, litigation may help to obtain some compensation for the emotional distress endured, cover the costs of hospital visits and prevent this type of trauma from happening to others.

There are non-medication based therapies available, too, but their results are mixed and mechanisms not fully understood. In the way of treatment with highly addictive drugs, conducting a risk-benefit assessment for the use of opioid drugs is a difficult task for physicians and policymakers, let alone a patient without formal training in medicine. Pain management is still subject to intense debate and will continue to be a pressing issue in our time.

But will we ever recognize suicide as a “pain management tool” on a societal level? Lots of people are hoping we do — and soon.

The “Right to Die” and the Moral High-Ground

The fact that there is no scientific way to prove someone’s pain — which can be mental as much as physical — means the issue of the right to die is fraught with ethical and moral debates. From some rationalist perspectives, the right to die is obvious. The astrophysicist Stephen Hawking has said, “To keep someone alive against their wishes is the ultimate indignity.” If you were in excruciating pain and knew you would die soon, would you rather end it all or continue to suffer?

One young woman answered this question with a heartfelt yes last year when she moved from California to Oregon to take advantage of the latter state’s enlightened “right to die” laws. Brittany Maynard, who had been diagnosed with a stage 4 brain tumor, decided that she’d greatly prefer ending her life on her own terms, rather than waiting around for the tumor to finish her off, which would’ve cost her a great deal of time, dignity, and physical pain.

But there’s a reason why our United States are a hodgepodge of contradictory death with dignity laws: We live in a country where both the fear of death, and religious conservatism, hold sway in the courts of public opinion. From the perspective of two of the world’s largest religions, Christianity and Islam, killing yourself is a sin against God. Religion is one of many factors that makes the right to die, morally and legally, extremely complicated.

Even from a humanist perspective, the right to die is fraught with ethical implications. If, for example, a perfectly healthy and financially secure adult male wanted to legally pay someone to kill him simply because he was tired of living, should such a “radical choice” be permitted? That man could argue that his mental pain — the fatigue of his existence — was just as real as a cancer patient’s.

With this example, there is no clear “right” or “wrong” answer when it comes to the right to die — just a variety of perspectives and a multitude of legal experiences. The potential spectrum ranges from outright legalization to a total ban of the practice.

A decent starting point in the euthanasia debate is distinguishing between “active” and “passive” euthanasia. Historically, “passive” euthanasia was favored by doctors as the more ethical solution.

An example of this would be a terminally ill 92-year-old woman suffering enormous pain after a critical injury. Knowing that the patient had no chance of recovery, doctors would simply let the patient die in a hospital bed without actually treating her, aside from some pain medication. Medically speaking, there are a number of ways to let someone die: Calling off another major surgery for example, or scaling back non-pain medication.

“Active” euthanasia, however, is different. An example of active euthanasia would be the case of another terminally ill patient, like Brittany Maynard and her brain tumor. A patient like this suffers excruciating pain on a daily basis due to her disease.

Letting her die “naturally” (if such a label applies here) of this affliction would be an enormously cruel sentence. She would die eventually, this much is true, but she would suffer enormously all the way through. Even doses of the strongest pain medication would not stop this woman from suffering. Therefore, “active” euthanasia would call for directly ending the patient’s life — killing her — upon her request. Lethal injection can knock someone unconscious and kill them within an hour. Some patients in this circumstance would prefer an injection to days of agony with no cure in sight.

In a famous 1975 essay, American philosopher James Rachels argued that active and passive euthanasia are indistinguishable. After all, both forms rely upon a decision made by a doctor leading directly to the death of the patient.

The ‘Right to Die’ Is Not Straightforward Legally and Varies Drastically Between Countries

Legally speaking, the distinction between active and passive euthanasia continues to exist. In India, for example, passive euthanasia was legalized in 2011. However, the active form is still considered murder. Interestingly, Japan allows both forms of euthanasia under strict terms. For example, for a doctor to administer active euthanasia, the patient must be proven to be suffering enormously and provide consent. No direct consent is needed from the patient in a case of passive euthanasia — if the patient is bedridden and barely sentient.

The Netherlands is similar. In 2002, it passed a law allowing direct euthanasia as long as strict conditions, overseen by physicians and the patient’s family, were passed. That hasn’t come without pushback or controversies, though.

Just this month, it was revealed that a Dutch woman in her 20s legally ended her life because she could not bear the mental pain of her PTSD resulting from childhood sexual abuse. The case greatly angered anti-euthanasia activists across the world, who cited the woman’s death as the inevitable consequence of legalizing euthanasia — an argument often called the “slippery slope.” The woman’s case yet again highlighted the importance of knowing what pain really is.

In the United States, active euthanasia is illegal in every state. However, physician-assisted suicide is legal in five: Washington, Oregon, California, Montana, and Vermont, and all of these laws are meant to cover people suffering enormous pain or living in vegetative states. Assisted suicide means that a physician provides the tools for patients to kill themselves — the physician never administers any form of euthanasia directly.

The right to die remains enormously controversial in the US, particularly due to its status as one of the developed world’s most religious countries. Most famous was the case of Terri Schiavo, who became a figurehead of the debate when her family decided to remove her feeding tube (passive euthanasia) after she was in a coma for years. Religious and politically conservative organizations mobilized in reaction, arguing that despite Schiavo’s non-sentient status, she was still alive and anything which was not designed to keep her that way was essentially murder.

Although Schiavo’s family was ultimately successful in cutting off her feeding tube, resulting in her death, the debate has hardly been settled. This is most evident by the growing number of states passing right-to-die laws, often termed “dying with dignity” laws by their advocates. In 2009, for example, Montana’s Supreme Court deemed that a doctor aiding a terminally ill patient to die was not illegal.

The Right to Die Is Ultimately a Personal Choice

While we wait and see what kind of legacy the Brittany Maynard and Terri Schiavo cases will have, it’s already clear that this debate is raging on across the developed world, and may soon become a mainstream, household political issue.

But because pain and suffering cannot be quantitatively determined, and political tensions surrounding this issue are contentious, the argument for the right to die becomes a morass of moral, legal, and personal issues. People decide on major, personal life decisions all of the time, regardless of political norms, like the decision to get an abortion or gender reassignment surgery.

Moreover, the religion-based argument holds less and less water with each passing day. While religious folks believe with all their hearts that their soul is destined for eternal life, they cling to earthly life with something approaching fanaticism. Indeed, formal and informal research suggests that Christians awaiting death in hospice fear death more than their unbelieving counterparts do.

One thing remains clear: For believers and unbelievers alike, these are deeply personal issues and their interpretation varies depending on culture, religion, and personal beliefs. Like many personal choices, the right to die may continue to be controversial for decades to come.

What has become necessary is this: Both sides need to recognize that mobilizing the Federal Government to enshrine personal beliefs — whatever form they may take — in the language of the law is not the proper function of bureaucracy in this country or any other. Government exists to allow us the means to reach a consensus on difficult topics — or, at the very least, to approach a common understanding of phrases like “victimless” and “a cessation of suffering.” Your morals might chafe at the thought of state-sanctioned suicide, but a dignified ending to another mammal’s suffering ought to be universally recognized as a morally acceptable outcome.