Being a Burden: Improper Reason for Seeking Assisted Dying?

February 6, 2019

A common argument against legalizing assisted dying for the terminally ill is that most will seek it for the “wrong” reason; specifically, they will hasten their death to avoid becoming a burden to others. For example, a statement issued recently by opponents of a Maryland bill to legalize assisted dying argues that in states where assisted dying is legal, patients “are requesting the lethal drugs because they feel like they are a burden on their family, not because they are in pain.” The frequency with which this argument is advanced is inversely proportional to its merit.

To begin, this claim is not even a half-truth. Data from Oregon, the state where assisted dying has been in place the longest, indicates that the primary reasons terminally ill patients seek to hasten their death are loss of autonomy and loss of ability to engage in enjoyable activities. About 90% of patients cite these reasons. By contrast, only about 45% of patients cite concern about being a burden on others. (Inadequate pain control is cited by about 25% of patients.)

But more significant than the shaky factual basis of this argument against legalizing assisted dying is the questionable ethical premise of this argument. It is simply presumed that concern about being a burden is an improper reason for seeking to hasten one’s death. Why?

Consider the context of those who seek assisted dying. By definition, they are terminally ill, that is, they are approaching death within a few months. Statistics establish the vast majority are suffering either from cancer or a neurological disorder such as ALS. They are often frail, with limited mobility. Moreover, one reason most patients don’t complain about pain is that powerful sedatives are often used to control pain. This can leave patients incapacitated. (Anyone who has had to avail themselves of narcotic analgesics after surgery is familiar with their effects; I know when I had to ask for a dilaudid injection after one surgery, I became incoherent within minutes and then went to sleep.) This lack of functional capacity is why almost all patients cite loss of autonomy and ability to engage in activities as reasons for hastening their death. Under these conditions, their lives have become a burden to them. It is perfectly rational for such individuals not to wish to impose on others the task of caregiving when such caregiving will merely squeeze out some more weeks of increasingly miserable existence.

Let me expand on this last point. Many of us will have serious health problems at some point in our lives. During those times, we may be unable to care for ourselves, in whole or in part. We hope, and perhaps even expect, those close to us will assist us during these times, and feel no shame or reluctance in asking for such assistance. We welcome such assistance because we anticipate we will be able to regain something like our prior functioning and will go on to get some enjoyment out of life. But it is precisely that anticipation of regaining the ability to enjoy life that is absent in the case of those who are terminally ill. Under these circumstances, the desire not to ask for extended caregiving from others is not a sign of some character weakness or psychological deficit; it is an expression of rationality.

There are many bad arguments against legalizing assisted dying, but the “burden” argument is singularly unpersuasive.