To help to die

National Review, Feb 10, 1997 by William F. Buckley, Jr.

NEW YORK, JANUARY 10

In the heavy discussions over doctor-assisted death last week, several arresting points were made, one of them in the formal hearing before the Supreme Court, the second in analysis done in news journals. What Justice Ruth Bader Ginsburg said echoed Pontius Pilate, asking why he should be called upon to send Jesus to Calvary. We all know that when Justices express their misgivings about a case that is being pleaded, it is by no means to be assumed that those misgivings are critical, let alone dispositive. Their purpose is to invite the petitioner to address a particular problem, in this case the problem Justice Ginsburg had in wondering why, at this particular moment in American history, the Supreme Court was being called in to decide what should be legal for a doctor to do.

Who decides these things? The Supreme Court has for so long acted as a moral tribunal, one tends to forget that self-governing societies are called upon to decide critical questions. Congress tells us when to go to war and how high our taxes need be. The states decide what qualifications a doctor has to have in order to be entitled to practice medicine. One of those qualifications is a reflection of the doctors' oath to do everything that can be done to preserve life and reduce pain.

The idea is to subordinate the doctor; to make him, in certain circumstances, a biological mechanic, at the beckoning of his patient. If the patient decides to end his life, it is maintained by the petitioners that the doctor should be obliged to assist in the process. Those doctors in sympathy with the movement are telling us that their skills are unique to effect what the patient desires --and that what the patient desires is the operative consideration. A new right.

The traditionalists argue that if there is political acquiescence in the proposition that such is the patient's right, let that be reflected in altered laws in those states that take that position. But then too there are those who argue that even if it were acknowledged as a right of the individual to terminate his life, the same doctor whose profession is to prolong life should not be expected also to accept the obligation of ending life. Unquestionably the Court will confront the philosophical question. Even if the patient has the right to die, individual states (and the medical fraternity) should continue to exercise the right to decline to serve as the agents of death.

The most interesting finding, from thorough research into the sentiments that govern those who would wish help in ending life, is that the greatest concern isn't pain. Fewer than 30 per cent of patients in extremis fear that their doctors will not protect them from physical agony. No, the primary concern is for death "with dignity." This surely is the most compelling argument for assisted deaths. The patient who contemplates a year or more with increasingly intrusive needles and pins and tubes and lotions, and helplessness. It is wrenchingly sad to contemplate the kind of end to which certain diseases point us.

Yet we fear also the evolution of a culture that puts a certain premium on death, sooner than it would come by natural means. The grandmother told she has a cancer that will ravage her body and exhaust the family nest egg will begin to wonder whether she should think it a duty to her children and grandchildren to remove this expensive cause of their concern -- how could it be otherwise? And, of course, there is the fear that the medical profession will gradually orient its strategy by the utilitarian imperative: All things considered, does it make sense to keep this particular patient technically alive? The fear is of that gradualism now widely associated with the Netherlands, where nothing much is said if at a manifestly convenient moment, the doctor's anaesthetic dose is mortal.

Professor Laurence Tribe of Harvard attempted to erase the distinction between the patient's withdrawing the life-preserving tube herself (she is at liberty to do this, under the law), and the doctor's withdrawing it at her request. But these are more merely than philosophical niceties. The individual is at liberty to jump off the George Washington Bridge. The doctor who helps her over the railing is transmogrified, the catalyst of death.

No wonder Mrs. Ginsburg acknowledges a reluctance, constitutional yes, but also psychological, to redefine the medical profession.