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The right to die

Interview: Volker Wagener / dcNovember 4, 2014

Brittany Maynard's choice to end her own life has renewed discussion about assisted suicide. German medical ethicist Jochen Vollmann discusses quandries surrounding patients' right to die.

An IV is pictured near a patient's hand
Image: Fotolia/Oleksandr Bondar

DW: Is there such a thing as a right to die?

Jochen Vollmann: There is a right to a self-determined life, and that includes a self-determined death. The controversial question is: which forms of end-of-life decisions are subsumed under that? Currently we're talking about physician-assisted suicide of patients who are terminally ill, who have a short time to live, and who are suffering unbearably. It's my opinion that patients in such an ethical dilemma should have the chance to make a decision for themselves, and that doctors are able to assist them under clearly defined conditions.

Previously, the topic of euthanasia for medial reasons was something that mainly affected older people. Do you think we'll now see a rise in suicides among younger people?

I think that's very unlikely. Empirical figures dating from 1997 that we have from the state of Oregon, where Maynard lived, show a much different picture. (Ed. note: Oregon resident Brittany Maynard, 29, chose to end her own life after being diagnosed with inoperable brain cancer) The patients who choose to die there are older, terminally ill people with above-average education, above-average socio-economic status, and access to medical care - including palliative care and hospice care.

Prof. Jochen Vollmann
Medical ethicist Jochen VollmannImage: Ruhr-Universität Bochum

Who should be able determine at which point a person is considered terminally ill? Where do you think the line should be drawn?

There has to be a self-determined, voluntary, well-informed wish on the part of the patient. Unbearable suffering is something that is certainly not objective, because suffering is only bearable or unbearable depending on the perspective of the person who is suffering. However, medical conditions can be defined - for example, an illness that results in death. And there is of course also the possibility of defining the seriousness of the illness within a certain framework. In the case of the US patient, the diagnosis was very clear that her cancer would certainly have led to death, although there's still a level of uncertainty in making a prognosis about whether it would be in six, eight, or 10 months. But the ethical decision does not depend on the prognosis about life expectancy.

Do we need new laws, or should there even be laws about how we deal with illness and inevitable death?

It's different from country to country. In Germany, we have a long tradition in criminal law that neither suicide nor assisting in suicide is punishable. So from a legal standpoint, we're a very liberal country. The current debate here has mainly been sparked by the fact that, under the laws governing the medical profession, the individual state medical boards have passed different bans (on assisted suicide) for doctors. This professional legislation - which, in my view, is highly questionable - has led to a societal debate about the law, whether it's about making changes to criminal law or civil law. In such a difficult ethical dilemma, patients and doctors need a legally defined framework.

If assisted suicide due to incurable disease becomes a kind of "trend," won't there be an expectation, either from society or from health insurance funds that certain patients should choose to die?

First, I don't think that suicide will become a 'trend.' The empirical data from Oregon show that it becomes an issue for a very small patient group: in only two out of every 1,000 deaths did the patient choose to end his or her life. Furthermore, people are still highly resistant to the idea of taking their own lives, such that only people who have a very strong character and who have thought long and hard about their ethical dilemma would choose this path. The fear that assisted suicide could become a widespread phenomenon, or become a way for insurers to save costs at the end of life, is not well founded in my view. The question of saving costs is more likely to arise when it comes to the more common but ethically less controversial types of decisions at the end of life, such as stopping medical treatment or going without treatment.

Professor Jochen Vollmann is the head of the Institute for Medical Ethics and History of Medicine at the Ruhr University in Bochum. Among his research interests are end-of-life decision-making and patient advance directives.