Issues & Insights

21st Century Question: When Is Assisting Suicide Acceptable?

You may have missed it, what with all the media attention focused on the president’s important tweets. But Maine has just become the eighth state to legalize voluntary assisted suicide of the terminally ill. Nearly a dozen more are considering it.

Assisted suicide remains an emotional subject, of course, at least among healthy people who are not living with the constant pain and doomed future of a fatal illness.

Though we end the terminal suffering of beloved family pets when all is lost, many believe a dying patient’s wishes to stop the pain run against ethical and religious beliefs since science can now prolong life, often beyond the will to live it.

Even so, the idea of a doctor, who takes an oath to do no harm,  prescribing a lethal dose of medicine at a patient’s certified request is nowhere near as volatile as it was more than three decades ago when I first began writing about the subject.

Here’s this country’s secretive end-of-life reality: Arranged deaths have been quietly going on for decades, more intensively as medical technology advanced. Using chemical slurries pumped into stomachs and breathing machines programmed even to include sighs, among other tactics, doctors can keep a human body functioning long after the death of any hope of a return to sentient life.

But given those mixed miracles, when do we stop doing everything we can do? And help nature take its course? How do we protect a patient’s right to life – and a patient’s right to die in a humane manner of their own choosing? And avoid mourning family members suing compassionate doctors?

Who are we to dictate that a cancer-ridden woman and her family must endure more months of agonizing pain and drug-induced stupor until another end? Instead of prolonging a life, isn’t that really prolonging a dying? Whose life is it anyway?

No easy questions now to match all the complex answers.

Maine’s new law generally follows those in California, Colorado, Hawaii, Oregon, Vermont, New Jersey and Washington, which began the legalization movement in 1997.

They have carefully-prescribed medical and legal procedures to protect patients from greedy family members perhaps, their own passing depression or fears of financial ruin from costly treatments. Maine’s, for instance, requires one written and two witnessed verbal requests by patients and a second doctor’s examination and opinion that the illnesswill bring death likely within six months.

Americans are chronically uncomfortable with death talk. “Oh, gramps, you’re going to outlive us all.” The truth is, though, Americans have been quietly arranging their own demise for decades. In the 1980s the American Hospital Association estimated that four-of-five hospital deaths were somehow negotiated.

Remember during the AIDs epidemic the obituaries listing cause of death as pneumonia? Before modern medicines and antibiotics, pneumonia was known as the old man’s friend because it took elderly in more gentle fashion. The same for some AIDs patients.

Typically, doctors moderate such family negotiations, often over days or a week, facing the medical reality that Mom or Dad or brother is not going to recover ever. How aggressive should the treatments be or just palliative?

No one does anything actively to cause death, but they decide to stop treatments beyond keeping the patient comfortable. Which allows death to come.

I sat in on many such conversations, including one between a caring doctor and an elderly couple. The man had entered the hospital complaining of back pain. Turns out, he had widespread bone cancer that treatment might stall but never halt.

Bone cancer basically dissolves bones, quite painfully, raising calcium in the blood to levels toxic to the heart. That can be treated. Or not. Next day the couple decided. A week later, the man died at home surrounded by family. Official cause of death was heart failure.

Other hopelessly ill patients I came to know used a network of doctors who after study would help a patient peacefully pass away, often with friends gathered. There might have been a lethal dose bringing painless sleep, but no autopsies or official inquiries. “What would be the point?” one doctor told me. “Medically, she was going nowhere.”

A few cases became notorious legal struggles as Karen Ann Quinlan’s family fought to let her go. Politicians got involved in the Terri Schiavo case for their own purposes and professed beliefs.

Dr. Jack Kevorkian, who claimed to have helped scores of stricken patients die, went to prison for injecting one ALS victim.

Living wills and do not resuscitate orders eased such decisions over time as our society slowly came to grips with modern medical miracles that forced decisions about death beyond just accepting it.

They gave patients control and doctors and hospitals legal cover to abide by their wishes, sometimes over a family’s understandable initial inability to cope.

Now, we’ve entered the next stage, after detailed certification, of allowing or actually assisting suicides by the terminally ill, the most personal and certainly terminal decision of any individual’s private life.

That’s a decision I hope its vocal opponents never need confront themselves. Me too, actually.

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Andrew Malcolm

@AHMalcolm Veteran national & foreign correspondent, nonfiction author, blogger, National Politics Columnist for McClatchy at


  • Well, legal or not. I do not want my family to suffer financially or emotionally watching me prolong the inevitable.
    So sad I would need anyone’s permission to die , let alone some government agency.

    • The correct answer is “never.” If a person commits suicide, it is simply a permanent solution to a temporary problem. Should a person assist in a suicide? By doing do they are committing murder. We already have one decedent political party that believes, a baby already born, can be murdered. What is next? Raise the age to five, or put everyone over the age of 65 to death?

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