What Is the Fate of Assisted Suicide?

When physician assisted suicide was legal in just four small states (Oregon, Washington, Montana, and Vermont), it made some sense to see it as an outlier in the culture wars—a laggard in society’s libertarian march on social issues like marijuana legalization and same-sex marriage. But now that assisted suicide has been legalized in California, roughly quadrupling the number of Americans who are legally permitted to kill themselves with medical help if they become terminally ill, it seems reasonable to wonder whether the practice will soon join the pantheon of “personal liberty” issues where a sea-change in public opinion quickly transforms public policy across the country.

There are clearly some good reasons for assisted suicide advocates (or, as they are euphemistically rebranding themselves, aid-in-dying advocates) to be optimistic. As David Leonhardt has noted, “the issues on which it’s easiest to predict the future of public opinion generally involve individual rights. Over time, rights—suffrage for women and blacks, job opportunities for Irish, Jews, Latinos and other ethnic minorities, marriage for interracial and same-sex couples—tend to expand in the United States.” The trend toward a more libertarian moral ethos has been central to American history, particularly since the cultural upheavals of the 1960s and 1970s. Walter Russell Mead has written that, like it or not, “the human movement toward less external constraint on individual freedom seems to be the essence of American life.” If the debate over assisted suicide—like the debate over same-sex marriage—comes to be seen as pitting the individual autonomy of a marginalized group of people against traditional notions of order and morality, then advocates of the practice are likely to score victory after victory.But there is no guarantee that the debate will be framed this way. There is more than one life-and-death social issue where the trend in recent years has been toward more state regulation, rather than toward more individual autonomy, narrowly defined. The most obvious example is abortion, where public opinion has been stalemated for decades, and where pro-life forces have actually made significant state-level gains in the last several years. As we have pointed out before, one reason for this is that when it comes to abortion, the autonomy argument cuts both ways—the fetus, as well as the mother, has a plausible claim to at least some basic rights.Interestingly, the left is also increasingly interested in curtailing individual autonomy on some social issues to protect the rights of the vulnerable. Witness the adoption of “Yes Means Yes” laws for regulating campus sex in liberal state legislatures across the country (including California’s). In our view, such laws are deeply misguided, but, like abortion restrictions, they reflect a sense that a libertarian free-for-all can sometimes increase the liberty of some people while infringing on the rights of others.The expansion of assisted suicide in the United States can probably only be arrested if its opponents successfully seize on the rights-based arguments that have proven so powerful in contemporary social debates. This would mean showing that while an assisted suicide regime superficially expands personal freedom, the net effect is insidiously to encroach on important liberties in ways that are more gradual and harder to detect. There is no shortage of evidence to make such arguments: Even with safeguards, assisted suicide regimes reshape the incentives for people who are sick and suffering, creating personal, emotional, and financial inducements for them to kill themselves. Moreover, unlike same-sex marriage, where opponents of that trend have been unsuccessful in pointing to slippery-slope consequences, there already exist right now European states that have expanded the practice of assisted suicide beyond adults with terminal illnesses. In Belgium, for example, dozens of people are euthanized each year for psychological conditions, and the country legalized the assisted killing of terminally ill children as well. So suicide opponents could argue that theirs is actually the side of individual rights, in that they are trying to prevent vulnerable people from being pressured or coerced into giving up the most important right of all.It’s too early, in other words, to tell how the assisted suicide debate will play out. California could be the last state to legalize the practice, or one of the first, as it was in the same-sex marriage revolution. But it seems more likely that the assisted suicide debate could follow the same trajectory that has defined the fights about abortion and “Yes Means Yes”, where both sides can claim the mantle of protecting individual rights—namely, ongoing debate and gridlock, with no clear winner anytime soon.