Rational people should be able to end their own lives; suicide should remain decriminalized. But to say that is a far cry from saying that people have a right to have others, namely physicians and pharmacists, help them to end their lives. The ability to commit suicide is what Isaiah Berlin called a "negative liberty" -- a liberty to keep others from interfering with the individual. The right to euthanasia is a positive liberty -- a liberty to have others help to realize an individual's goal. The justifications for negative liberties are widely accepted, and the Bill of Rights is essentially a list of negative liberties; positive liberties are affirmed only when necessary to ensure robust participation in public affairs and to preserve essential opportunities. It is hard to see how granting a right to PAS and euthanasia is necessary to either of those goals.
In any case, the number of dying patients who have unremitting pain or who want to die and are physically incapable of killing themselves is very small -- a few thousand of the 2.3 million Americans who die each year.
There is a right to suicide, claims Dr. Emanuel - a right not to be interfered with. Of course, in practical terms, Dr. Emanuel is terribly mistaken, even in his conception of the right to suicide as a negative right: the state regularly and predictably interferes with individuals attempting to commit suicide. Pro-forced-life U. S. Supreme Court Justice Antonin Scalia has stated, in his concurring opinion in Cruzan v. Director, Missouri Department of Health, that
It has always been lawful not only for the State, but even for private citizens, to interfere with bodily integrity to prevent a felony. That general rule has of course been applied to suicide. At common law, even a private person's use of force to prevent suicide was privileged. It is not even reasonable, much less required by the Constitution, to maintain that, although the State has the right to prevent a person from slashing his wrists, it does not have the power to apply physical force to prevent him from doing so, nor the power, should he succeed, to apply, coercively if necessary, medical measures to stop the flow of blood. The state-run hospital, I am certain, is not liable under 42 U.S.C. 1983 for violation of constitutional rights, nor the private hospital liable under general tort law, if, in a State where suicide is unlawful, it pumps out the stomach of a person who has intentionally taken an overdose of barbiturates, despite that person's wishes to the contrary. [Citations omitted.]
Justice Scalia unfortunately states the policy of our country: it is decidedly one of interfering, using as drastic and invasive means as possible, with an individual's decision to commit suicide.
Even if we did live in the fairy land that Dr. Emanuel apparently hails from, in which there exists a "negative right" to suicide, there is still the problem of means. Dr. Emanuel says that there is no need for "assisted suicide," because one can perfectly well off oneself, and one has no right to have another person assist one in the act. However, again Dr. Emanuel ignores the sad reality that all would-be suicides face: the only means to commit suicide that are reliable and comfortable enough so as to not be objectionably cruel are in the exclusive hands of doctors. With barbiturates under the strict control of doctors, the "right to suicide" doesn't mean much.
As long as there is a drug prohibition, there will be a moral need for "assisted suicide." Remove the drug prohibition - at least, the prohibition on barbiturates - and there will no longer be a moral need for "assisted suicide," at least for able-bodied people.
Dr. Emanuel assures us that "the number of dying patients who have unremitting pain or who want to die and are physically incapable of killing themselves is very small." I wonder what he means by "physically incapable" of killing oneself. Unable (or unwilling) to shoot oneself in the head with a shotgun? To slash one's artery with a knife? To hang oneself? Is the "right" to do one of these things - and potentially be dragged back to life if one fails to die - really all the "right" that is morally called for?
Like many forced life advocates, Dr. Emanuel offers a comforting vision of an imaginary world, to distract us from having real compassion for suffering people in the real world.
Tragically, Dr. Emanuel is the Chair of the Department of Bioethics at the National Institutes of Health.
Edit: In summary, my problem is this: there is a general drug prohibition on sleeping pills that are lethal at high doses, and there are policy reasons for that, however misguided. In addition, there are good reasons why a person should not have the right to expect another person - here, a doctor - to assist him in committing suicide. But when you put these two sensible-sounding propositions together (drug prohibition and no right to assistance), they no longer make ethical sense. One of them has to give.