The failure of the freedom-based and utilitarian arguments for assisted suicide.

available on Medline. 151. See generally Compassion in Dying v. Washington, 79 F.3d 790, 827 (9th Cir. 1996)("The state clearly has a legitimate interest in safeguarding the interests of innocent third parties such as minor children and other family members dependent on persons who wish to commit suicide."), rev'd. sub nom. Washington v. Glucksberg, 1.17 S. Ct. 2258 (1997). 152. 2 Marcel Proust, Remembrance of Things Past, 750 (1913-26)(C. K. Scott Moncrieff, trans., 1932). 153. A similar question can be raised about the relationship between patients and their families and friends: [Tihe absolute fixed tabu against suicide... has served to make the patient's right to expect the care of her family or community fixed and unquestioned. As long as a human being's natural life exists the family and/or institutional caretakers are morally obligated to offer support and care. * * * When the option or choice to end a life is morally permitted, then the interpersonal situation changes. One must justify his or her choice to go on living and ask why one should voluntarily continue to exact care or be dependent on others. Sidney Callahan, "A Feminist Case Against Self-Determined Dying in Assisted Suicide and Euthanasia," I Stud. In Prolife Feminism 303, 313 (1995). 154. See, e.g., Leon R. Kass, "Neither for Love nor Money: Why Doctors MustNot Kill," Public Interest, Winter, 1989, at 25, 35 ("The patient's trust in the doctor's wholehearted devotion to the patient's best interests will be hard to sustain once doctors are licensed to kill."); Orentlichter, "From the Office of the General Counsel: Physician Participation in Assisted Suicide," 262 JAMA 1844, 1844-45 (1989): If the physician appears sympathetic to the patient's interest in suicide, it may convey the impression that the physician feels assisted suicide is a desirable alternative. Such an impression may not be very comforting to the patient. Moreover, if the patient 249 250 THE AMERICAN JOURNAL OF JURISPRUDENCE (1997) between patients and physicians on 'end-of-life care that included explicit mention of euthanasia or-physician-assisted suicide' would reduce patients' trust in the physician." 155 This should be a special concern to those who reject the liberal view of medicine-the highly individualistic one which awards a central place to rights--and instead accept a "relational" account. Dr. Cassell urges physicians: [R]each out to the suffering person to bring him or her back with the rest of us. You must communicate to the person that no matter what happens or how difficult it is, you are going to be there and help. * * * Social contacts must be facilitated. Relationships within the family should be bolstered. Barriers to familial closeness erected during serious illness by, for example, untruths, false optimism, repugnance, and fear can usually be removed with little effort by teaching members of the family how to interact with a sick person. 156 The case for this "relational" approach is especially compelling in instances of the terminally ill who begin to discuss suicide: The vast majority of terminally ill patients who consider or discuss suicide do not kill themselves. For terminally ill patients, as for their nonterminally ill counterparts, talk of suicide is a signal to physicians and family that the patient's fears and needs have not. been adequately addressed. Therefore, the first task for physicians . . . is to elicit the patient's concerns and try to relieve them.... Most terminally ill patients find reasons to continue to live after their concerns or symptoms are assuaged. 1 57 decides to reject suicide, will the patient have the same degree of confidence in the physician's commitment to his or her care as previously? In short, assisted suicide might seriously undermine an essential element of the physician-patient relationship, the patient's trust that the physician is wholeheartedly devoted to caring for the patient's health., (Reference omitted). 155. Emanuel, supra note 125, at 1808. Smaller percentages of patients and the general public thought that such discussions would have that effect. Id. "19.0% of patients and 26.5% of the general public thought they would change physicians if their physician told them he or she 'had provided euthanasia or assisted suicide for other patients."' Id. 156. Cassell, supra note 137, at 246-47. 157. Ann Alpers & Bernard Lo, "Physician-Assisted Suicide in Oregon: A Bold Experiment," 274 JAMA 483, 484 (1995)(references omitted). Cf. Council on Scientific Affairs, American Medical Association, "Council Report: Good Care of the Dying Patient," 275 JAMA 474, 475 (1 996)("many persons initiate a discussion about suicide to evaluate the degree to which others are concerned with their well-being and to evaluate their own selfworth."). See generally Shneidman, supra note 96, passim.