philosophicaldistinctionbetweengivingpeopletheright
tostopexternalorartificialprocessesthatprolongtheir
livesandgivingthemtherighttostopthenatural,internal
processes that do so.
At root, the debate is about what mistakes we fear
most—themistakeofprolongingsufferingorthemistake
of shortening valued life. We stop the healthy from
committing suicide because we recognize that their
psychic suffering is often temporary. We believethat,
with help, theremembering self willlater see matters
differentlythantheexperiencingself—andindeedonlya
minorityofpeoplesavedfromsuicidemakearepeated
attempt;thevastmajorityeventuallyreportbeinggladto
bealive.Butfortheterminallyillwhofacesufferingthat
we know will increase, only the stonehearted can be
unsympathetic.
Allthesame,Ifearwhathappenswhenweexpandthe
terrain ofmedical practiceto includeactively assisting
peoplewithspeedingtheirdeath.Iamlessworriedabout
abuse ofthesepowersthanIamaboutdependenceon
them.Proponentshavecraftedtheauthoritytobetightly
circumscribedtoavoiderrorand misuse.Inplacesthat
allowphysicianstowritelethalprescriptions—countries
liketheNetherlands,Belgium,andSwitzerlandandstates
likeOregon,Washington,andVermont—theycandoso
only for terminally ill adults who face unbearable
suffering, who make repeated requests on separate
occasions, who are certified not to be acting out of
depressionorothermentalillness,andwhohaveasecond
physicianconfirmingtheymeetthecriteria.Nonetheless,
the larger culture invariably determines how such