The right to receive assistance in suicide and euthanasia, with particular reference to the law of the United States

Whether to legalize assisted suicide and euthanasia is among the most hotly debated legal and public policy issues today in the United States, as it is in many countries. In this Thesis, I first (in Chapters I and II) isolate the critical questions in this debate, the answers to which will likely determine the fate of assisted suicide and euthanasia in America's courts and legislatures: Is there historical precedent for allowing the practices? Do fairness concerns dictate that we must permit assisted suicide and euthanasia because we allow patients to refuse life-sustaining treatment? Do principles of personal autonomy compel legalization? Does legalization represent the “greatest good for the greatest number” on a utilitarian scale?
In the next portion of the Thesis (Chapters III through VIII), I address each of these questions.
I conclude that there is some, but limited, support in the historical record for legalization (Chapter III). I find that many of the proffered distinctions between refusing life-sustaining care, on the one hand, and assisted suicide and euthanasia, on the other, cannot withstand scrutiny. Nonetheless, I suggest that at least one rational basis does exist for distinguishing between the practices (Chapter IV).
I consider legal doctrine surrounding autonomy and personal privacy, and conclude that it is likely too weak a foundation on which to build a judiciallycreated right to assisted suicide (Chapter V). Because scholarly and legislative debate will not be confined by judicial doctrine, however, I consider three competing moral-political theories of autonomy. I find that two such theories could afford a right to assisted suicide and euthanasia, though, if so, they would likely require that the right be extended to all competent adults, not just the terminally ill or those suffering untreatable pain (Chapter VI).
I acknowledge that substantial utilitarian arguments exist for normalizing assisted suicide and euthanasia, but I also identify utilitarian arguments against the practices. I suggest that the existence of strong arguments on both sides of the utilitarian calculus raises the further question whether consequentialist reasoning can be usefully employed to arrive at a definitive policy outcome when, as here, incommensurable goods are at stake (Chapter VII). I then consider recent works by Richard Posner and Richard Epstein, using their writings as case studies for assessing the soundness of my conclusions, suggested in preceding chapters, regarding the autonomy and utilitarian arguments for assisted suicide (Chapter VIII) .
In the last portion of the Thesis (Chapters IX and X), I submit that there is a secular moral theory which, to date, has been largely neglected in contemporary American debate over assisted suicide and euthanasia. This theory rests on the notion that the intentional taking of human life by private persons is always wrong. I conclude by developing this theory, considering a number of potential criticisms, and explaining how it might apply to a variety of end-oflife situations.

Advisor: Finnis, J