I’ll See Myself Out, Thank You: Notes on the Right to Die

Two years ago, a book of thirty essays supporting the right to assisted death edited by Colin Brewer and Michael Irwin, was published by Skyscraper Publications, Ltd. Most of the essays make arguments familiar to Americans involved in the right-to-die movement, but often with a European (and British) take that makes them fresh. Others tell first-person stories that are as riveting as any heard in the US.

Europeans do not shy away from the term “suicide,” which seems to have fewer negative connotations in England and Europe than in this country, though this difference is belied somewhat by the clever title of the book–one of the best euphemisms for suicide I have encountered: I’ll See Myself Out, Thank You.

The essayists generally praise palliative care as an alternative to suicide, but they offer warnings, as well: “even being a doctor (or a doctor’s spouse) does not necessarily prevent the terminally ill from experiencing the painful, undignified failures and limitations of palliative care.” Some palliative care doctors now admit that palliative care cannot provide a “significant minority of the dying from unpleasant and undignified ends.” Yet all who have studied the Oregon experience with the right to die know that palliative care improved dramatically after its death with dignity (DWD) law was implemented, demonstrating that quality palliative care and DWD are completely compatible and, I would suggest, essential.

One concept referred to throughout the book by many authors is Medically-Assisted Rational Suicide (MARS), a concept we in the US need to use more. If legally we have mental capacity, to hasten our deaths when we are suffering from a terminal illness or because the quality of our lives has slipped permanently below what we consider tolerable is a rational decision that should be honored by all who believe in individual autonomy. After all, if we don’t have individual autonomy, then we have someone else making life-and-death decisions for us.

In the absence of such autonomy, the followers of St. Augustine’s Christian belief that suicide is worse than murder might want to make such decisions for me, a position I find less than charitable and certainly not in keeping with the compassion that Christ promoted in the most popular Christologies.

Opponents of MARS, and even some supporters, believe that the state–the government–has a vested interest in preserving life (except, of course, when it’s not convenient or expedient to do so). One writer responds to this notion with “Why should the law dictate the timing and circumstance of my death? What possible damage to the public good could that death do?” The answer is usually that the state wants to prevent killing, a questionable assumption considering the actions of that same state toward the poor and others who can’t get out of the way of our bombs. But when I am unable to do virtually anything for myself, and I have to endure one indignity after another, it is impossible for me to understand what interest the state has in keeping me alive against my wishes.

As one essayist concludes, “If there are no practical impediments, then it boils down to one group imposing their values on another.” And another essayist suggests that there is no adequate “philosophical argument as to why an individual should not be able to renounce his own right to life.”

A British essayist points out that we don’t deny people the right to go to Zurich at some great expense “to take advantage of something permitted there which is against the law in the UK,” noting an observation by the relative of such a “suicide tourist” who said, “We actually tolerate assisted suicide now. We just do it off-shore, for those who can afford it.” And the affording it is around $10,000 plus travel expenses.

Baroness Mary Warnock, a Cambridge educator, points out that no law [in either Europe or the US] requires a doctor to participate in a medically-assisted death, but another British writer hopes “that they know that their duty is as much to make death bearable as it is to fend it off . . . .” Surely, a doctor’s duty “to bring about a good death for a patient is simply to continue the duty of caring for that patient, of acting in the best interests of that patient” as that patient determines.

Baroness Warnock expressed her view clearly at a meeting of the Society for Old Age Rational Suicide (SOARS) in 2010, a view that resonates with many people:

“I simply do not want to be remembered as someone wholly dependent on others, especially for the most personally private aspects of my life, nor can I tolerate the thought of outstaying my welcome, an increasing burden on my family, so that no one can be truly sorry when I die and they are free. Our life, for us, is a narrative, with a beginning, a middle, and an end. We want it to have an end that is fitting, not an end that trails pitifully on into chaos and darkness.”

In response to the notion that one’s heirs, out of greed or exhaustion from the burden of caring for the dying relative, might pressure the relative to ask for death, Baroness Warnock suggests that even if such people exist “it is insulting to those who ask to be allowed to die to assume that they are incapable of making a genuinely independent choice, free from influence.” The idea that we can’t have assisted dying because it is possible that there will be untoward pressure from others to die is just another example of one person or group imposing its will on another person.

Such untoward pressure is also belied by the Swiss experience with assisted dying, which has been available for over seventy years. The Swiss live on average two and one-half years longer than the English, and they live longer with terminal illness. Their health care system treats 30,000 foreigners who seek Swiss help because of Switzerland’s high-quality health care system, yet only about 200 foreigners each year seek help there to end their lives.

For those who make a religious argument against taking one’s own life, as in the proposition “Only God can decide when it is time for a person to die,” a retired British theology professor suggests that if only God can decide when we die, medical interventions to prolong life would be wrong, as well. Few people are willing to decline all medical interventions in deference to God’s will, which seriously undermines religious arguments against MARS.

Other religious arguments against killing fail to acknowledge that the real biblical prohibition is against murder, not suicide. The sanctity-of-life religious argument is held to just as strongly by supporters of MARS, who “see themselves upholding the sanctity of life when they [support] allow[ing] people to die when their lives become a travesty of what a human life should be.”

A quotation from the late Ronald Dworkin, an American legal philosopher, succinctly makes the case for autonomy over our own lives: “Making someone die in a way that others approve, but he believes a horrifying contradiction of his life, is a devastating, odious form of tyranny.”

I’ll See Myself Out, Thank You also covers other topics concerning the right to die, including dementia, the “slippery slope” argument, morality, and more about palliative care. While not all of its essays are engaging, the collection touches on every major issue that I have encountered in right-to-die discussions. I recommend it to those new to the movement and those experienced in the fight for what Final Exit Network calls the “human and civil rights cause” of this century – the “ultimate human right” – death with dignity.