Fall of 2024 witnessed a variety of news accounts on the topic of assisted suicide. On Nov. 11, The New Atlantis broke an exclusive story about Canada’s increasingly messy Medical Assistance in Dying (MAID) practice. Using leaked documents, Alexander Raikin reported that “Ontario’s euthanasia regulators have tracked 428 cases of possible criminal violations—and not referred a single case to law enforcement.” Less than a decade into legalized assisted suicide, with annual body counts mushrooming and embarrassing stories of impoverished Canadian elderly and handicapped being counseled to consider suicide, it begins to look like Ottawa has come to consider the only good Canadian a dead Canadian.

Meanwhile, in Switzerland, the home of international assisted suicide tourism, a legal uproar broke out last September over the death of a 64-year-old American woman. She was the inaugural user of the Sarco suicide capsule, a coffinlike structure engineered to administer nitrogen gas once the suicide seeker presses a button. Perhaps surprisingly, four people involved in the suicide (including Florian Willet, head of the assisted suicide advocacy group The Last Resort) were arrested by the Swiss police on a “strong suspicion of the commission of an intentional homicide.” Swiss authorities initially apprehended them because a video of the death seemed to show bruising on the woman’s neck suggestive of strangulation, although they apparently had second thoughts about this and released them from custody in November.

Then at the end of November came word of the English House of Commons’ vote in favor of a British version of assisted suicide. Although the bill still faces months of debate and possible amendment, punctuated by further votes, news reports called ultimate enactment there highly likely.

Back in the United States, increasing numbers of us live in states that either have legalized assisted suicide already or see yearly legislative attempts to do so, with the “pro” count generally creeping up like an insidious tide. Still, I and likely many of the Review’s readers have perhaps been tempted to treat assisted suicide like the tail of the pro-life dog, given its lower body counts, more complicated motivations, and less appealing victims.

Over the past century or so, many of our age’s dystopian novels have insinuated into their futuristic social fabric various forms of expedited “assisted suicide” or euthanasia. Brave New World is a classic example: In Huxley’s fictional society, while the pre-elderly pursue their pleasures and float along on the pharmaceutical high of soma, the aged are painlessly ushered out of life. Published in 1932, Brave New World is itself advancing in age, but it was hardly the first dystopia to introduce euthanasia: Robert Hugh Benson’s 1908 Lord of the World, for instance, depicted an apocalyptic dystopia ruled by the Antichrist. A memorable scene in Benson’s novel describes the involuntary euthanasia administered to an elderly character, and voluntary euthanasia is on offer for any reason in spa-like death clinics after an eight day waiting period.

More recently, detective fiction author P. D. James’s 1992 foray into dystopian writing, The Children of Men, memorably portrayed a 2021 world in which women are inexplicably infertile, and society is haunted by the absence of children. As part of the social and psychological fallout from this seeming loss of humanity’s future, the predictably totalitarian government has instituted (for all but a privileged few) euthanasia by mass drowning upon turning 60.

Although such fictional representations (along with other sci-fi examples we can recall) depict euthanasia as one aspect of a (usually) totalitarian society, in real life, reactions to legalization are more mixed. Twenty-plus years after the Netherlands became the first nation to legalize euthanasia, and with a growing number of other locales permitting it, and therefore with a growing databank of human beings whose cause of death is euthanasia or assisted suicide, it is perhaps a hopeful sign that we are still debating whether suicide for the sake of a “good” death is a good or bad thing.

On the other hand, even today, despite the antics of some pro-abortion activists, abortion is not generally championed as a good in itself, but as an action made necessary by unfortunate circumstances such as failed contraception and bad timing. When euthanasia or assisted suicide is proposed, however, proponents usually adopt less defensive language. One likely reason is that the person dying is presented as the beneficiary of the right, rather than a sacrificial offering on the throne of a woman’s right to choose. On paper, at least, the deceased in an assisted suicide is making the decision. “My body, my choice,” but with the difference that it really is “my” body, rather than someone else’s body temporarily incubating in mine.

Dig a little deeper, however, and things soon become messier. Although nations that have already taken the plunge soon seem comfortable with increasing numbers of citizens planning the timing and circumstances of their death (see the Netherlands and Belgium, where most of those surveyed seem to think scheduling death a good thing), those jurisdictions that have not yet legalized assisted suicide often dance around the edge for years, like prospective swimmers afraid that the water will prove too cold. There are legitimate reasons for this squeamishness.

To begin with, there is the second half of the term, “suicide.” Suicide is something that we have hotlines to prevent. We have Suicide Prevention Month. We label suicidal ideation a mental health concern. In the transgender world, reluctant parents of a girl desiring to “present” as a boy are pressed to go along to prevent a possible suicide (“Do you want a live son or a dead daughter?”). So we are accustomed in most contexts to consider suicide not merely a bad thing, but just about the worst possible bad thing, so bad that you are willing to permit your minor child to take powerful puberty blockers or undergo mutilating surgery to prevent it.

Then there is the medical community’s longstanding predisposition to hold off death by every possible means. This is perhaps the flip side of assisted suicide, deriving from similar assumptions about the human project to control life and death (or at least the timing of it). On the face of it, however, it does muddle the assisted suicide landscape. Depending upon the medical condition and the people treating it, an elderly person can legitimately fear both excessive and insufficient medical treatment. In addition, the patient, too, entertains opinions about desirable levels of control over life and death. Do we most fear the “Do Not Resuscitate” order on our medical chart, or being jolted back from the threshold of death so that (like the resurrected Lazarus) we will one day, perhaps quite soon, have to die all over again? Our predilections about the timing of our own future death are deeply contingent upon the particulars, and also upon our stock of hope, resilience, trust, and ultimately even piety.

This just scrapes the surface of why prolifers can find the euthanasia/assisted suicide conversation uncomfortably complicated to navigate, however clear our basic principles. In contrast, the anti-abortion position (despite the hard cases like rape and incest) is one of the simplest and most morally pristine ones imaginable. The prolifer is already born, so he or she is not acting out of direct self-interest; the intended victim is incapable of personal guilt for anything and is completely dependent on others to continue living. The unborn is the ultimate innocent victim.

But assisted suicide exposes our 21st-century biases to an even greater extent, if possible, than abortion; it feeds off our passion for autonomy and understandable revulsion against pain, weakness, and dependency. One of the most frightening fates most of us fear in advanced old age is senility— seemingly condemning us to the very antithesis of a dignified death. And this is not a merely modern fear. The author of the Old Testament book of Sirach touches on this very topic:

Oh son, help your father in his old age, and do not grieve him as long as he lives; even if he is lacking in understanding, show forbearance; and do not despise him all the days of his life. For kindness to a father will not be forgotten, and against your sins it will be credited to you—a house raised in justice to you, in the day of your affliction it will be remembered in your favor; as frost in fair weather, your sins will melt away. Whoever forsakes his father is like a blasphemer, and whoever angers his mother is cursed by the Lord. (Sirach 3: 12-16)

Now, precisely because Sirach exhorts his listener so passionately to continue caring for and respecting an aged parent, even if his mind is impaired, we understand that his contemporaries might have been tempted to do otherwise. That is surely why he emphasizes the incentives—“against your sins it will be credited to you,” and “in the day of your affliction it will be remembered in your favor”—and spells out the repercussions for those who act otherwise: They will be “cursed by the Lord.”

After all, because our minds are tugged this way and that by our desires and emotions, we often fail to do what we know is right. But Sirach’s audience would have recognized his counsel as a clear corollary to the corresponding commandment that Moses carried down from Mt. Sinai: “Honor your father and your mother, that your days may be long in the land” (Exodus: 20:12; my emphasis). St. Paul points out in Ephesians 6:2-3 that this is the first commandment to which a promise is attached—a promise similar to that spelled out by Sirach.

So while our ancestors apparently resembled us in being tempted to neglect or mistreat their feeble and senile elders, they differed from a good number of us in refusing to regard those elders as lacking inherent human dignity and therefore, perhaps, better off if their end were expedited. Neither Sirach nor Moses says anything about fathers and mothers needing to demonstrate they have earned good treatment before being given it. That’s because according to their moral code, human dignity is not something we achieve (and therefore something we can lose).

Senility is not among the many evils that Job has to endure: He “only” lost his children, wealth, and health. Still, Job struggles throughout the book to fathom the ways of God: particularly why bad things happen to good people and vice versa. Job’s God either will not or (more likely) cannot illuminate us fully on the whys. When at last God responds to Job’s anguished questioning, he leaves the whys unaddressed and instead highlights his immeasurable greatness: “Where were you when I laid the foundation of the earth? Tell me if you have understanding, Who determined its measurements?” (Job 38:4).

Job’s somewhat surprising (to modern ears) response is, “I have uttered what I did not understand, / things too wonderful for me, which I did not know I had heard of you by the hearing of the ear, but now my eye sees you; therefore I despise myself, and repent in dust and ashes” (Job 42:3, 5-6).

In our more self-idolizing era, we can be somewhat repelled by passages like these that almost seem to show God disrespecting Job. Maybe browbeating him into silence. Perhaps even blasting him with macro-aggressions. Don’t we perhaps think that Job—that we—deserve more?

To the extent that we do think so, this is a relatively late-breaking reaction in human history. It is the same instinct that led the English Romantics of the late-18th and 19th centuries to identify Satan as the real hero of Milton’s Paradise Lost. (Satan, of course, is a pure spirit and therefore incapable of dying, but if he could, we are sure that there would be a death with dignity!) Whether or not Milton was, as William Blake contended, “of the Devil’s party without knowing it,” that description rings more or less true of most of us today, given our jealous prizing of our own way and our own dignity.

I am far from underestimating how very hard it is to accept diminishment, both physical and mental, on the often-difficult road to death. The very human and legitimate process of mourning what we once were is something every generation in human history has been familiar with. The difference between then and now lies in how we regard human beings and human life, and therefore what we do with diminishment, pain, and handicaps. Faced with the “hard cases” that populate the public realm of assisted suicide, and that are often all too familiar to us in our private lives, we need to learn how to evaluate human dignity and therefore human worth beyond the calculus of achievement, self-respect, or self-satisfaction. Prolifers encounter this challenge in the familiar territory of the unborn. But while unborn babies cannot construct syllogisms, solve long-division problems, or surf the internet, the arc of their lives is still rising and not falling. They (and the newborns that, unmolested, they emerge as) learn more, do more, understand more each day. They are almost all potential, all hopefulness. Recognizing their value should be a relatively easy lift, except for the Peter Singers among us.

But looking to achievements, even potential or eventual ones, as the source of human dignity turns out to be a dead end. However lovely they are to contemplate, we do not earn our human dignity, our human worth, by our actions and attainments and productivity, and therefore we cannot possess our dignity as something earned or acquired. Human dignity is ours in the way that everything else about us—our eye color or intelligence or athletic ability or charm—is ours. It is a gift, like life itself.

It is human to seek control over our circumstances and our environment.

And just as each new marker of autonomy attained by the baby, the child, the adolescent, is exultantly celebrated, each decline as we move into middle age and then elder status causes pain. With time, we recognize that in certain quantifiable respects we are becoming less than we once were. Depending upon how and when we die, we may eventually surrender much of what we cannot help but feel made us valuable to others and even to ourselves—perhaps especially to ourselves.

Who are we then, if at some point we can no longer accomplish all or most of what we once could, whether physically or mentally? Here our commitment to reverence for human life “from conception to natural death” should offer clues. The newborn, and before that the late-term fetus, and before that the first-trimester embryo, and before that the blastocyst, all lack the multitude of life-coping skills and other attainments that the very aged or severely handicapped or those in the latter stages of any degenerative disease have now lost. Yet we who defend the unborn’s right to life do not perceive in their temporary poverty a barrier to their dignity as human beings.

There is this psychological difference: that when we defend the right to life of the unborn, we feel we are safeguarding for them a great gift. But when it comes to assisted suicide, we may feel (feelings too often being treacherous guides) the reverse: We may feel we are imposing a heavy burden by denying those who wish to die a desired exit strategy. Such feelings derive in part from the impoverished way of thinking we absorb from the times we now live in. We may even be tempted to succumb to our opponents’ view that our position largely rests upon slippery slope logic. Our fear of exploding suicide rates, they say, scares us into condemning the incurably comatose or the late-stage Parkinson’s patient or the quadriplegic or the person with severe chronic pain to continue life past the point where it can be endured or borne with dignity.

But this is one of those (not uncommon) cases where the evidence for the slippery slope argument is strong. Opponents of assisted suicide are not floating a “you never know what might happen” hypothetical that, if the most heart-tugging classes of assisted suicide were offered the Sarco suicide capsule or some other pain-free ending, the next thing you know every teenager anguished over acne would be clamoring for the right. Instead, we can point to the hard data from assisted-suicide-friendly jurisdictions—an embarrassment of riches demonstrating not only how rapidly the numbers rise after legalization, but how quickly the net widens to include categories we were originally assured would never be considered.

A collateral effect of this net-widening is to make it harder to bifurcate our mixed messages about whether suicide is a good thing. Perhaps we need a set of Venn diagrams differentiating between teens who are depressed and therefore in need of mental health treatment and teens who are depressed and therefore need to be accommodated by assisted suicide. Or how do we distinguish between the lonely and depressed elderly whose hopelessness can be treated and those deemed hopelessly unfixable?

I opened with The New Atlantis article on Canada’s explosion of problematic but unexamined MAID cases. Recall that it was only in 2016 that Canada stepped into the brave new world of assisted suicide—and then consider that last year, according to Health Canada, one in twenty Canadian deaths were from assisted suicide. About one in fourteen deaths in Quebec occur through MAID, a rate of assisted suicide higher than that of any other jurisdiction worldwide. Canadian applicants for MAID are asked to list all the kinds of suffering they are experiencing to determine if their condition can be evaluated as “grievous and irremediable.” Almost half (47.1 percent) included “isolation or loneliness” among the causes of their suffering, and just under half listed “perceived burden on family, friends or caregivers.”

So the slippery slope is scarcely imaginary. But that still leaves us with the task of justifying the denial of assisted suicide for the hard cases, “just because” other vulnerable categories of people would be imperiled by this license. To voluntarily suffer on behalf of others is noble, but that nobility lies precisely in its being voluntary. We are not morally bound to bear a heavy burden solely to prevent fellow human beings in less extreme cases from imprudent or inadvisable suicides.

In reality, however, even hard cases derive a benefit from bans on assisted suicide. Admittedly, this is clearer in certain cases than in others. Consider those who would choose to await natural death if not for their guilt over the burden they are posing to loved ones—or, worse, consider those bullied into a premature death by uncaring or greedy family members. But aside from such cases, all human beings—especially those who are old or infirm or in pain or alone—benefit from the legal recognition of the truth that their lives have inherent value, that their lives have dignity, for no other reason than that they are human, endowed by God with consciousness and the ability to love and be loved.

Nothing can rob us of this dignity that is our birthright—neither disease nor incapacitation nor mental illness nor unproductivity—because human dignity is not derived from any of these. We are more than what we can do or have done. Our dignity does not derive from what we are capable of either now or in the past. It does not derive from how people choose to treat us— Blacks in the Jim Crow era did not lose human dignity because they were treated as inferior, and the comatose do not do so because they are referred to as vegetables. Like the gift of life we received at conception—unearned and unpaid for no matter how many accomplishments we later amass—our human dignity also is an inalienable gift.

All of us spend a lifetime (however long or short that may be) making good or bad use of this gift of life and the many other gifts accompanying it. At the end of life, or at the point when we wish to end it, maybe, like Job, we need to trust God to know what he is about. Maybe we should trust the God who bestowed our human dignity on us in the first place to know what it is to die with dignity.

And even those of us who do not quite trust life or its Giver may draw inspiration and instruction from the Socratic notion that, not being self-created, we have a certain duty, like soldiers assigned to a post, not to desert that post without leave. The good soldier, willing to suffer and die for his country but not to abandon his life without need, has his own God-given dignity too.

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Original Bio:

Ellen Wilson Fielding, a longtime senior editor of the Human Life Review, is the author of An Even Dozen (Human Life Press). The mother of four children, she lives in Maryland.