Jules Good: Assisted Suicide is Not Bodily Autonomy

For years, Democrats have supported assisted suicide legislation, also referred to as “medical aid in dying”, under the notion that it is a bodily autonomy issue akin to abortion. Leading assisted suicide proponent organizations like Compassion and Choices and Death with Dignity have expertly oversimplified assisted suicide into a “my body, my choice” issue, and have spent millions of dollars per year peddling that messaging to legislators across the country. But if we take a closer look at the true meaning of bodily autonomy, the key differences between a policy of legal abortion and a policy of assisted suicide, and the systemic injustices that pervade both issues, it becomes very clear that conflating abortion and assisted suicide is not only inaccurate, but incredibly dangerous. 

What is bodily autonomy?

Let’s start with the basics of bodily autonomy. Put very simply, bodily autonomy is the ability to make choices about what does or does not happen to one’s own body. We often think about bodily autonomy in the context of abortion, but it has a wide variety of applications from seatbelt laws to gender identity and expression. It is a phrase that became popular in the feminist movements of the 1970s to combat the idea that women and others who can give birth are the collective property of a patriarchal system who have a duty to reproduce and conform to narrow gender norms regardless of circumstance. Importantly, for someone to have true bodily autonomy, they need to be able to make choices about their body without coercion. Coercion can be active or passive; while someone actively threatening to harm a person if they get an abortion is certainly coercion, so is the lack of options for safe abortions that resulted in many people having to choose between carrying a pregnancy to term or having an unsafe abortion in a non-clinical setting, which sometimes led to their death. A decision made under the threat of harm is not truly a choice– it is a surrender to the more personally tolerable of two hardships.

How do a policy of legal abortion and a policy of assisted suicide differ in terms of their relationship to bodily autonomy?

A policy of legal abortion– meaning that the law allows for all people to access it regardless of who they are– protects the most marginalized people in our country. It has been proven that countries and states with abortion bans see higher maternal mortality rates than in countries where abortion is legal. This is largely because when safe, medically supervised abortion is illegal, people will resort to other methods that endanger, and, in many cases, kill them. The people who are most likely to need an abortion due to complications with a pregnancy are those who have the least access to quality health care. The maternal mortality rate for Black people is almost three times as high as it is for white people in part because Black people are twice as likely as white people to receive late-term prenatal care or none at all. Many Black people go through their entire pregnancy without seeing a single doctor due to lack of healthcare access. This means that fatal problems go undiagnosed, and problems that could be prevented via abortion care result in unnecessary maternal death. Even Black pregnant people with access to prenatal care are more likely to face socioeconomic barriers that result in negative health outcomes. In this sense, abortion is a critical form of healthcare that saves lives, and though the decision to have an abortion is often difficult, a policy of legal abortion means that more pregnant people can survive pregnancy-related complications even if they do not have access to other forms of pregnancy care. To summarize: a policy of legal abortion protects bodily autonomy by mitigating the active and passive coercion of pregnant people so they can make independent choices to save and improve their own lives. 

On the other hand, a policy of assisted suicide– meaning that the law provides a mechanism by which people can die via a lethal prescription– threatens the most marginalized people in our country and limits the exercise of true bodily autonomy to those with the most resources. This is primarily because our healthcare system punishes people for being poor. Poor people are simultaneously more likely to have health problems and less likely to have access to treatment for those problems. So if someone is significantly sick and/or disabled and unable to afford or access appropriate health care, their only other options are to hope they magically get better, adjust to life with their illness and go into insurmountable medical debt, or find a way to die faster than nature would allow them to. There’s no winning. 

A policy of legal assisted suicide and its social normalization disincentivizes institutions from increasing access to true health care. It’s a convenient escape from institutional responsibility. This is already happening in Canada, where proponents are rejoicing over the saved healthcare costs that legal assisted suicide and euthanasia bring, while simultaneously Canadians living in poverty feel that they are running out of options and pursuing assisted suicide and euthanasia. Proponents of assisted suicide in the U.S. argue that American policies are only for terminally ill people predicted to have six months or less to live, so no one else needs to worry. Canada’s legislation started with similar restrictions and has rapidly expanded to the point where people with non-terminal disabilities are eligible, and even those with a mental illness, in the absence of any condition that causes physical pain, could qualify starting in March 2023 though the mental health expansion has been delayed. 

Leading proponents of assisted suicide in the US predict our policy will see similar changes in the coming years. It is apparent in bills being considered this legislative session, where states with legal assisted suicide are proposing amendments that would significantly loosen eligibility requirements for both patients and providers. Bills that would legalize assisted suicide for the first time in a given state contain far fewer safeguards than they did even five years ago. The only assisted suicide policy that is guaranteed not to harm our most vulnerable community members is the assisted suicide policy that does not pass.

How can we actually protect everyone’s bodily autonomy, including marginalized peoples?

There are so many ways we can foster comfort and choice at the end of life without threatening the lives of people who aren’t ready to die. Advocating for full-spectrum palliative care with adequate pain relief, nutrition, and emotional care is of utmost importance. Modern medicine has advanced to a point where no one needs to die in severe pain. The issue is not that appropriate end-of-life care does not exist, it’s that it isn’t accessible to everyone. Good palliative care gives people a range of options about what curative treatments they wish to continue or discontinue, whether they want to be at home or in a medical setting, and what comfort measures they want to use. Giving everyone access to this range of options is a genuine example of bodily autonomy. 

As Anita Cameron, celebrated disability justice activist and Director of Minority Outreach at Not Dead Yet has written, we need to “provide people with disabilities supports to live, not tools to die”. Disabled peoples’ bodily autonomy is constantly under threat as we are denied access to home and community based care, institutionalized against our will, forced to live in congregate settings because of a severe lack of accessible affordable housing, forcibly sterilized, disproportionately incarcerated, made to endure electroshock torture, denied access to oral and dental care, and killed by our caregivers. It is unsafe and unjust to pass a policy that makes it easier for vulnerable people to die while making it harder to hold medical practitioners accountable when there are so many systemic issues that put disabled people at greater risk of significant illness and death. If state governments are truly interested in protecting bodily autonomy, they should start with addressing at least one of the previously mentioned issues– not with legalizing assisted suicide.

The policies we pass reflect the values of our governments. As such, it is crucial to consider the impact a given policy will have not only on the privileged person or even the “average person”, but on those living on the margins. While people with adequate access to quality health care, needed home care services, loving families, and a strong support system may not be harmed by a policy of assisted suicide, people without such privileges will be. It is unconscionable and inequitable to only concern ourselves with the bodily autonomy of a select few. If we truly want to promote bodily autonomy for everyone, we cannot allow assisted suicide to be legalized.