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‘Terminalism’: U.S. Assisted-Suicide Laws Discriminate Against the Dying

by | Apr 11, 2024

By Wesley J. Smith

I just came across a bioethicist’s article from several months ago that actually promotes the equal moral worth of dying people. And published, no less, in the Journal of Medical Ethics, which usually pushes radical ideas of bioethical madness such as equating pregnancy with the measles.

But not this time. Dr. Philip Reed, a philosophy professor at the Jesuit Canisius College, argues against what he calls “terminalism,” that is, “treating the terminally ill worse than they would expect to be treated if they were not dying.” From “Discrimination Against the Dying:”

Familiar analogues of racism and sexism are instructive. To discriminate against a certain race is to treat persons of a certain race worse than they would be treated if they were of a different race. Black people are discriminated against, for example, in the housing market when they are turned down for a mortgage that would have been extended to white people who had the same financial credentials. Similarly, the dying are discriminated against when, for example, they are denied effective treatment that they would have been offered had they not been dying. . . .


In a loose sense, ‘terminalism’ might not only refer to the discrimination against the dying but also prejudice or other negative beliefs about and attitudes against them. Again, as familiar analogues of racism and sexism reveal, prejudices amount to conscious or implicit biases that persons hold against a targeted group, such as that they deserve less respect than those outside of the group.

Reed gives several salient examples of terminalism in public policy. The first, I agree with wholeheartedly — that is, Medicare forcing terminally ill patients to forgo life-extending or curative treatments as a condition of qualifying for hospice services. It is cruel and unnecessary — and doesn’t save money — as an article I co-authored with the bioethicist Art Caplan a bit ago in USA Today discussed.

Reed and I differ on our “right to try” law. He believes it discriminates against the dying because they receive untested and unsafe medicines. But that isn’t necessarily true. Sometimes medications that offer great hope are denied to the dying only because they have not received formal approval. That said, I also have some qualms about right to try, but let’s delay that discussion for another day.

Reed focuses forcefully on the inherently discriminatory nature of assisted-suicide legalization, to my applause:

Right to die laws (euthanasia and assisted suicide) also exhibit terminalism when they restrict eligibility to the terminally ill. For example, in the US states where one can legally access aid-in- dying or physician- assisted suicide, one must have a prognosis of 6 months or less to live. . . . Such restrictions are terminalist: assisted death laws that limit their services to the dying discriminate against them because death is offered to them to solve their problems. Such laws treat the dying worse than if they were not dying in so far as, on account of their dying, they might be better off dead.

Exactly. And they are not offered suicide prevention as other categories of suicidal people — say, veterans or troubled teenagers — are. Reed makes a salient point in this regard:

It is easy to see the discrimination of right to die laws if we change the eligibility criteria to another socially salient group: if assisted suicide or euthanasia were legal exclusively for women or disabled people, the message would be that life as a woman or a disabled person is (very often) not worth living.

Yup. That’s why most disability-rights activists are dead set against legalizing assisted suicide: They realize that people with disabilities are next in the assisted-suicide crosshairs — as already happens in countries such as Canada that do not limit euthanasia to the terminally ill. Indeed, people with disabilities have asked for euthanasia in Canada because they could not obtain needed support services.

Moreover, this is why his essay is not an argument for expanding eligibility for death by doctor. Reed doesn’t get into this much with his focus on the dying, but when you create a caste of killable people, it is — by definition — discriminatory. And objectifying, for example, society can easily perceive the euthanasia/assisted-suicide eligible as mere organ resources ripe for the harvest or their hastened deaths as a splendid means to save money in the health-care system.

And, as we have seen in countries that have fully swallowed the hemlock principle that some lives are so unworthy of living that they can be killed or assisted in suicide, those categories continually expand over time.

The only way out of that dilemma is death on demand for anyone who wants it for any reason — the ultimate destination of the euthanasia movement. That would be a profound abandonment of the despairing — already the law in Germany — but I guess we could say it would not be discriminatory because everyone would be abandoned equally.

Reed ends strongly:

The reason that terminalism matters is that dying persons matter. Our willingness to treat such patients badly assumes a kind of fatalism—where we imagine that a life with very little future means a less valuable life. . . . Confronting terminalism forces us to ask an uncomfortable question: what do we owe the dying and how might we treat them as equals with those who have indefinitely long to live?

In other words, dying isn’t dead; it is a stage of living. Reed’s message is simple but important: Terminally ill people should be treasured and treated as full members of the moral community, supported and cared for, not abandoned to the despair of suicide.

Editor’s note. Wesley’s great columns appear at National Review Online and reposted with his permission.

Categories: Assisted Suicide