Opinion ID: 1442532
Heading Depth: 1
Heading Rank: 2

Heading: State-Assisted Suicide: Our Clouded Ability to Assess the Suicidal Basis of Mr. Bergstedt's Request to Die

Text: [V]alue judgments ... about the worth of Mr. Bergstedt's life have clouded [the] ability to properly assess the suicidal basis for Mr. Bergstedt's request to die... . [6] As I have already suggested, having the benefit of arguments on only one side of any controversy is a severe limitation upon decision-makers' ability to arrive at an informed and just decision. This limitation has in no small measure clouded the truth and the ability of almost everyone to assess the suicidal basis of Mr. Bergstedt's request to die. Added to the one-sidedness of this case are other clouding factors that I think may well have affected its outcome: the extremely dramatic and sympathetic nature of Mr. Bergstedt's plea for mercy; faulty reliance on right-to-die cases which deal with the comatose and the terminally ill and have no application here; and, cloudiest of all, the flawed impression that persons whose lives depend on life-sustaining devices may kill themselves at will, merely by calling removal of essential-to-life machines a refusal to accept unwanted medical treatment or by calling their users' immediate and directly resultant demise a natural death. I see Kenneth Bergstedt's breathing device as being more than medicine. It is true that the machine was introduced during a medical emergency by medical personnel. It is true also that medical and mechanical monitoring of the device must be continued and that medical personnel or paramedical personnel are required to fulfill the daily needs of persons in this kind of condition. Notwithstanding all of this, I cannot escape the conclusion that, after twenty-three years of living and breathing in this machine-aided manner, the whole process becomes something quite more than mere medical treatment. The mechanical breather becomes a new way of life for its user, and life cannot go on without it. Mr. Bergstedt lived at home. The treatment in any real sense is over; and just as heart pace-makers, artificial venous or arterial shunts, a variety of prosthetic devices and other such medically sponsored and introduced artifacts may begin as a medical treatment modality, the ventilator begins as a form of medical treatment but ends up as an integral part of its dependent user. Even if it is insisted that these things continue indefinitely to be considered as treatment, they indeed become far, far more than just treatment after years and years of dependency on them. When Kenneth Bergstedt asked the court to give legal sanction to the death-inducing act of disconnecting his breathing apparatus, he was not to my mind merely exercising his right to be let alone, [7] and his right to refuse unwanted medical treatment. Withdrawal of medicine or so-called life support may be a humane way of letting nature take its course in the lives of the near-dead or irreversibly comatose, but it is a different matter when withdrawal of these items is admitted to be the immediate and proximate cause of the death of a person who concededly is seeking to take his own life. Use of the term natural death in this case is only a natural and understandable way of averting the excruciating truth. Bergstedt's explicit and express desire and intention was that of putting an immediate end to his own life. That is not what one would call a natural death. There was nothing natural about Mr. Bergstedt's death; he killed himself. Masking this unpleasant but inescapable fact has the unfortunate result of masking the really hard question presented by this case, and that is this: If, when and how should a person in Kenneth Bergstedt's condition (or perhaps other comparable conditions) be given legal permission to have outside assistance in taking his own life, without the incurrence of civil or criminal liability by anyone involved in the process? By avoiding the question, we avoid the answer; and by avoiding the answer, we invite future agonies suffered by persons like Mr. Bergstedt, who, in my view, was not given an acceptable solution to his plight. Mr. Bergstedt is dead now, and this may let us look at these cases in a more dispassionate way and address the problems presented by this case in a proper and rational manner. Once again: In light of his expressed intentions and in view of the direct and active way in which he chose to end his own life, Mr. Bergstedt cannot be said to have died a natural death. Mr. Bergstedt's injuries, though perhaps permanent, have not incapacitated Mr. Bergstedt completely. He is not `terminally ill' or otherwise close to death. His request to forgo mechanical respiration has been made in a context suggesting that his intent may be suicidal... . [8] Mr. Bergstedt was not dying, except in the sense that we are all dying, and he was not in the least danger of imminent death. He had been living steadily for over twenty-three years, breathing with the aid of a ventilator, until he reached a time in his life when he decided to die because, like most other suicides, life had become, temporarily at least, intolerable for him. The means by which he chose to take his own life was to have someone remove his breathing device during a time that he was sedated for the calculated purpose of bringing his life to a painless end. The result of the ventilator's removal, known to him and to everyone concerned, was immediate death. Withholding the ventilator was for this man not a withholding of medical treatment, it was the withholding of life itself. If we reflect for a moment on the nature and use of this ventilator, it does not take long to see that the machine had become an integral part of Mr. Bergstedt's person and was not mere treatment. Life support systems such as ventilators, electric wheelchairs, or other automated devices enhancing one's functions are real extensions of the person, and should be treated as such. Persons with disabilities use artificial supports as a matter of daily course, and find them vital to carrying on their productive lives. Mr. Bergstedt's ventilator should not be transformed into a form of extraordinary support because his father is in ill health and Mr. Bergstedt thus far has not received appropriate professional and peer assistance in coping with personal fears. [9] (My emphasis.) Kenneth Bergstedt did not want to die a natural death; he wanted to die an immediate death. He sought an immediate death by means of disconnecting the extension of his person that had enabled him to live and breath for the preceding twenty-three years. Construing the ventilator in this case as a form of extraordinary support that can be removed at will is a terrible and terrifying rationalization and, as well, a prejudicial treatment of Mr. Bergstedt because his assisted suicide was sanctioned and facilitated only because of his disabled condition. It is crucial that the court not put its judicial stamp of approval on negative stereotypes about disability. This would result if it were to allow the state to assist an individual to die only because he or she has a disability. Judicial decisions which are based upon societal prejudices merely reinforce those prejudices, making them even more difficult to eradicate. [10] I register now my strong disapproval of our courts' putting their judicial stamp of approval on allowing the state to assist an individual to die only because he ... has a disability. What other conditions, physical or mental, I ask myself, will be brought to the courts as grounds for judicially approved and assisted self-destruction? We now have a growing population of people who are alive but throughout history would have been dead. Some live under conditions under which many if not most of us would probably not want to survive; yet there are those who do survive and who continue to survive under the most trying of circumstances. The distinguishing aspect of the described persons is that, unlike most of us, they do not have, because of their paralytic condition, the power to bring their lives to an end, however intolerable their lives might become. They are trapped. Life is thrust upon them  forced upon them. If a person like Mr. Bergstedt comes to the courts saying, I have come to the end of my rope; I cannot stand it any more; you must give me the means to end my own life in peace and in dignity; it is difficult indeed to say no. Unfortunately it does not belong to the judicial realm to say yes. The judicial department of government is not the proper agency to address the novel and perplexing question presented here, namely, the question of under what, if any, circumstances should a right to state-assisted suicide be granted. Although not called upon to do so by the writing of this dissent, I have some more to say on the subject.