Paul Lamb, a 63-year-old man who was paralyzed from the neck down following a car crash nearly 30 years ago, recently said: “The worst thing in the world is for someone to say ‘you’re going to be in pain for the rest of your life, and I’m going to make sure you’re here for a lot of years’. It can be construed somewhat as torture.” Although the U.K. Supreme Court ruled against Mr. Lamb when he argued that the U.K.’s prohibition of assisted suicide violated his right to a private life, he remains a staunch advocate for his and others’ right to die with dignity.
Every year, some terminally ill individuals seek the assistance of physicians in order to end their lives – either through physician assisted suicide (PAS) or euthanasia. PAS is defined as a physician’s facilitation of a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act. Euthanasia is defined as a person’s – physician or otherwise – administration of a lethal agent to a patient for the purpose of relieving the patient’s intolerable and incurable suffering.
While most countries ban both PAS and euthanasia, some are revisiting such prohibitions. Are these prohibitions in line with current international human rights standards? Or is there room to argue that such standards protect a “right to die with dignity”?
A Right to Die vis a vis the Right to Life
While international human rights treaties have not established a “right to die”, many contain explicit protections of the right to life. Under international human rights law, the right to life creates both negative and positive obligations for States. In other words, States must not only refrain from taking actions that violate the right to life, but also act affirmatively to create conditions necessary to protect that right.
Experts have debated whether the right to life could be interpreted as including a “right to end life.” However, the European Court of Human Rights (ECHR) – the only human rights court to have adjudicated this issue – held that the European Convention on Human Rights’ right to life “…cannot, without a distortion of language, be interpreted as conferring the diametrically opposite right, namely a right to die.” Nor does the right to life, according to the ECHR, “create a right to self-determination in the sense of conferring on an individual the entitlement to choose death rather than life.”
The Human Rights Committee (HRC), which monitors the implementation the International Covenant on Civil and Political Rights, has expressed similar concerns in its concluding observations to States that permit euthanasia. The HRC, for example, expressed its concern at the extent of euthanasia and assisted suicides in the Netherlands and urged “that this legislation be reviewed in light of the Covenant’s recognition of the right to life.”
Right to Die vis a vis Other Human Rights
Other international human rights standards could be interpreted to provide for a “right to die”, such as dignity, privacy, and autonomy, among others. Yet the Parliamentary Assembly of the Council of Europe recommends that states “respect and protect the dignity of terminally ill or dying persons in all respects” by upholding prohibitions against intentionally taking the life of people who are terminally ill or dying.
Conversely, bioethicists have expressed support for the establishment of a right to a dignified death. UNESCO’s Universal Declaration on Bioethics and Human Rights (UDBHR) codifies both principles autonomy and dignity (Articles 5 and 10, respectively), and some bioethics scholars have relied on either or both of these principles to defend a right to a dignified death.
As more and more countries begin to revisit and, in some cases, repeal their prohibitions on PAS and/or euthanasia, the international human rights community may need to reconsider its stance on a right to die with dignity.