A right to die? - Elizabeth Bouvia

National Review, May 4, 1984 by Ernest van den Haag

ELIZABETH BOUVIA, a quadriplegic in Riverside, California, wants to starve herself to death. The hospital in which she spent seven months said, in effect, Not here. It obtained the backing of a local court for feeding Mrs. Bouvia by force. This decision--which has now forced Mrs. Bouvia to check herself out of the hospital--seems an abuse of the court's and of the hospital's power.

Not that I am in favor of suicide. But suicide is legal in all states of the U.S. that I am familiar with. For good reason: It is impossible to punish a successful suicide in this world, for he has left it. Wherefore the threat of punishment is unlikely to discourage would-be suicides. On the other hand, an unsuccessful suicide is not going to be cheered up by punishment and discouraged from trying again. Hence, there is no point in making suicide unlawful.

Morally, opinions differ: Some think suicide is licit, other do not. Most think, intuitively, that a suicidal person is deranged. Usually this intuition is correct. But not always. There can be rational reasons for suicide, although 90 per cent of people who commit suicde are permanently or temporarily deranged. Not infrequently they are despondent about a temporary situation and temporarily unable to grasp the temporarines of that situation. Thus, the present practice has much to be said for it: The cops usually take people who attempt suicide to a psychiatric hospital where they are observed to find out whether or not they are incompetent, in need of custodial or other care. If they are competent they are released. The two weeks of "observation," together with the failure of the suicide attempt, often are cathartic enough to prevent further attempts. Ideally more care is needed. Surely a person desperate enough, or deranged enough, to dry suicide ought to be helped to overcome his problems if at all possible. Psychotherapy and social work could help. Yet hospitals seldom can give more than custodial care. Still, even the present, less than ideal, practice is better than nothing. It temporarily protects the suicidal person against an impulse that may be temporary, although, if he remaims suicidal, not much help is provided.

whereas 90 per cent of suicides are deranged, the remaining 10 per cent may realistically find their situation to be hopeless and rationally prefer death to life. Religious persons think it presumptuous to make decisions about their own death themselves. Religion requires us to leave this decision to God. But not everybody is religious. And the government in the U.S. is not meant to enforce religious doctrines. Rational suicide--such as the recent suicide of Arthur Koestler--is possible. It cannot be prevented by law, and I do not believe it should be, it is could be, although most of us intuitively, or doctrinally, oppose it.

However, aiding and abetting a suicide is regarded as a crime and can be effectively punished. There appear to be sound reasons for outlawing such aid. If we allow Smith to help Jones commit suicide, the help may be indistinguishable from persuasion and the persuasion indistinguishable from homicide. To be sure, there are cases in which such help is well intentioned and well motivated. But such cases are which such help is well intentioned and well motivated. But such cases are not easy to define in law. Thus a person who wishes to commit suicide must do so by his own efforts. If he is unwilling to rely on his own efforts it may well be a sign that he does not relaly want to commit suicide. Society certainly should not permit anyone to persuade, help, or push him.

SO FAr so good. But we must now consider the case of a person, Mrs. Bouvia, who wants to commit suicide, but is physically unable to do so by her own efforts. According to current law, even in such a case nobody is entitled to help her end her life by any positive act. But that is not the issue. She only wants to be left alone. She does not want to be helped. She only wants not to be forced, against her wishes, to take nourishment. Should she be forcibly prevented from starving herself to death? Should the hospital in which she was staying have been authorized to feed her parenterally against her will? Or through a tube in the nose? The hospital insisted that if it did not force-feed her it might be liable for abetting a suicide, and a California court authorized the hospital to force her to accept nourishment as long as she remained there. This interpretation of the law strikes me as perverse.

A few years ago a number of Irish terrorists straved themeselves to death in British prisons to protest British policies. The British government certainly had the right to force-feed them, for they were convicts, not entitled to the liberties nonconvicts are entitled to. But the British government--wisely--allowed them to do as they wished, without fear of being held liable by the families of these men. The British government felt that even a convict should be allowed to refuse food if he so wished. A hospital--or a prison--may be liable for failing to artificially feed patients who cannot eat by normal means, or are incompetent. But not a patient who will not eat. He has a perfect right to decline food, or medicine, or an operation, if he so wishes and is competent to understand the consequences.