The practice of ending the life of a person suffering from an incurable disease and experiencing unbearable suffering as a result of that disease at their request is a subject of public debate and legal proceedings. Though many ethical and moral problems remain acute, euthanasia is now legal in many European countries. In the US, advocates and opponents of the legalization of euthanasia face each other in state and federal courts in different jurisdictions.
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The review explores the article “Should Physician-Assisted Suicide Be Legal?” by T. Mechmann and A. Carra (2017) that describes the details of the historic case of Myers v. Schneiderman in the Court of Appeals in the state of New York. Edward.T. Mechmann and Alexis N. Carra, the Director and Program Assistant of the Public Policy Office, respectively, represent the Archdiocese of New York in the Myers litigation. Though multiple sources weigh in on the problem of end-of-life care, the article focuses only on the case of Myers v. Schneiderman.
The review finds that while euthanasia is legal in some US states, in others the battle for the right to die continues. In the state of New York, legislative efforts of patients’ rights groups, such as End of Life Choices, Compassion & Choices, and others, to legalize physician-assisted suicide (PAS) failed. In contrast, many secular and religious groups, such as Not Dead Yet, the Center for Disability Rights, the New York State Disability Conference, and Agudath Israel, oppose PAS and work against PAS initiatives.
The whole premise of the article under review is biased against the right to assisted suicide. It is assumed that human life has an intrinsic value and physical or mental disability or “the fear of becoming disabled or dependent on others” does not justify ending it (Mechmann & Carra, 2017, p.1351). Apart from incurable diseases, people who make assisted suicide requests are often affected by socio-economic disparities and public value judgment. In rejecting PAS, the Court protects the elderly, the disabled, and the mentally ill from being pressured into choosing to end their lives.
Mechmann and Carra (2017) strongly oppose the legalization of PAS and provide numerous legal and moral arguments to support their beliefs. However, they do not dwell on the argumentation offered by the PAS proponents and do not explore the personal stories of the five terminally ill patients who filed the complaint. Moreover, the authors opt to use the term “suicide,” disregarding the plaintiffs’ preferred use of “medical aid in dying.”
The research is based on the official documents of the Court, previous relevant cases, media reports, and statistical reports. The authors cite relevant legislative documents verbatim, base their thinking on statistics, and discuss international precedents. Unfortunately, sources that criticize the ban on PAS or offer alternative points of view are disregarded. Legislative acts from the states that legalized euthanasia are omitted. Thus, the overall accuracy and depth of the research are questionable.
To address the subject of the study, Mechmann and Carra (2017) apply the methodology of
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- historical analysis,
- terminological clarification,
- intersectoral research,
- comparative analysis, and
- constitutional analysis.
- The study starts with describing previous legislative efforts of patients’ rights groups, such as End of Life Choices, Compassion & Choices, and others, to legalize physician-assisted suicide. It is noted with relief that most of them failed apart from the legalization of assisted suicide in Oregon in 1994. In 1994, PAS advocates initiated litigation “to convince the federal courts that PAS was a protected right under the United States Constitution” (Mechmann & Carra, 2017, p.1338). This, however, was defeated. Subsequently, the fight for PAS moved to the courts of lower jurisdiction to seek legalization under state constitutions. The article stresses that in Myers v. Schneiderman, the plaintiffs were defeated at five lower courts but unexpectedly won the right to present their case to the Court of Appeals. At this point, the authors and other proponents of the ban were deeply concerned about the result.
- Further, the authors introduce the first object of legal contention: the definition of suicide. An extensive overview of the interpretations of the statutory term “suicide” as it is used in the Penal Law is provided. Mechmann and Carra (2017) side with the opinion that assisted dying still constitutes suicide, which has always been illegal in the Anglo-American common law tradition. In their view, “medical aid in dying” does not accurately describe a situation when a “physician is directly in the line of causality that brings about a patient’s death” (Mechmann & Carra, 2017, p.1343). It is concluded that suicide is still suicide, whether medically assisted or not.
The terminological and conceptual differences between physician-assisted suicide and other causes of death are discussed and identified. Firstly, the fundamental difference between “terminal sedation” and assisted suicide is investigated. Mechmann and Carra (2017) refute the plaintiff’s analogy between the two by insisting that in the first case, “death is accepted,” whereas in the second case, “death is caused” (p.1344). In contrast to palliative use of medication that may sometimes result in death, assisted suicide has a clear intention to cause death.
Secondly, it is made clear that there is a conceptual differentiates between suicide and declining medical treatment. The article argues that declining medical treatment and PAS are not “the same and cannot be treated as such” (Mechmann & Carra, 2017, p.1345) as in the first case the death is caused by the prescribed medication, and in the second case, it is caused by the underlying decease. Thus, Mechmann and Carra (2017) refer to the plaintiffs’ attempts to redefine suicide and muddle its distinction from lawful types of medical care as “legerdemain.” The authors stress that the intentionality of the physician’s actions is a crucial factor here. PAS involves an act committed with the intent to cause death and thus constitutes a crime, unlike permissible palliative care and sedation that are intended to relieve the patient’s suffering.
- It is shown how the legalization of PAS would influence other areas of public life. The article quotes verbatim the per Curiam opinion of the Court of Appeal on the reasons for banning PAS and further elaborates on additional grounds to resist the legalization of PAS. Mechmann and Carra (2017) argue that the legalization would derail state efforts to discourage and prevent suicide, whereas “the PAS ban upholds the state’s duty to protect vulnerable people” (p.1350). The authors recognize a substantial danger of “suicide clusters” in the event of PAS legalization. In support of their position, they quote the Annual New York State’s Suicide Prevention Plan 2016-2017. Mechmann and Carra (2017) are concerned that PAS can potentially be expanded to people who are not terminally ill or do not experience “unbearable suffering.”
- The article draws on the international experience and discusses how far PAS has gone in countries where it has been legalized. It is revealed that involuntary euthanasia of “people who did not even ask for death, including children” (Mechmann & Carra, 2017, p.1348) is now allowed in Belgium and the Netherlands. This, however, does not put off PAS proponents who prefer to effectively leave the decision about PAS at the physician’s discretion.
- Having discussed the reasons and justifications behind the Court of Appeal’s decision, the authors provide the constitutional analysis of the law. The plaintiffs’ complaint suggested that the Due Process and Equal Protection Clauses of the State Constitution were violated in denying the right to physician-assisted suicide. The Court refuted both claims as being without merit (Mechmann & Carra, 2017). As for the violation of the Due Process Clause, it is disputed whether PAS is a fundamental human right. As for the violation of the Equal Protection Clause, it is strongly contended that there is sufficient similarity between declining medical treatment and planned suicide.
The article concludes with the commendation of the Court of Appeal’s brevity and unequivocally in rejecting the right to physician-assisted suicide. The Myers v. Schneiderman litigation will leave a permanent mark in the US legislation and the decision of the Court will be used as a template for subsequent cases. Mechmann and Carra (2017) are hopeful that other state constitutions will never recognize PAS.
To sum up, Mechmann and Carra discuss the background and implications of the case that raised several questions about euthanasia. Though they are biased against what they call physician-assisted suicide, they present well-researched and credible arguments. They object to the very idea of legalized euthanasia by consistently referring to it as suicide. Mechmann and Carra reject all similarities between legalized euthanasia and medical end-of-life care. The authors insist that neither the Due Process Clause nor the Equal Protection Clauses of the New York State Constitution are violated since their primary focus is to protect the intrinsic value of life.
Mechmann, E. T., & Carra, A. N. (2017). Physician-assisted suicide and the New York State Constitution. Albany Law Review, 81(4), 1337–1357.