Document Type
Essay
Abstract
Because government funds to institutions and individuals finance a significant amount of medical care in the United States, the prospect of conditions or “strings” attached to that funding is an ever-present specter. Furthermore, the fact that institutions and individuals require licenses to provide medical care also raises these possibilities as the brave new world of medicine poses far more moral dilemmas than anticipated even a brief time ago.
This has led many institutions and individuals to refrain from various activities, believing that to do so would constitute direct or material cooperation in an evil activity. Their ability to avoid participation in these activities is a matter of grave and growing concern. Likewise, the possibility of conditions imposed on individuals and institutions as a requirement for financial support or necessary licenses may threaten their ability to act in accord with their beliefs on the morality of various medical interventions.
Much of today’s most contentious and high-profile discourse about unconstitutional conditions and coercion in the medical arena centers on issues pertaining to gender and reproduction. Not yet receiving as much attention is the ability of institutions and individuals to resist involvement in assisted suicide—even though this is “among the most controversial topics in the United States today. It is such a contentious issue because it extends beyond politics, delving into matters of personal autonomy and morality. Quite literally, it is a matter of life or death.” Now that assisted suicide is legal in a growing number of jurisdictions, a storm may be brewing. Precisely because that storm is not yet as fierce here as it is in other areas, steps to ensure strong conscience protections must be taken today so that the specter of coercion does not arise tomorrow.
The broader debate on unconstitutional conditions is beyond the scope of this Article. Instead, what follows are reflections that focus on a narrow, related issue: the protection of conscience rights in the specific context of assisted suicide. Certainly, the parameters of unconstitutional conditions doctrine will be shaped by the current discussions of that doctrine in the medical contexts of abortion, reproduction, and gender. However, these brief reflections argue that, today, attention must be paid to developing robust conscience protections in the context of assisted suicide, even though it has not yet come to a head in quite the same way.
In reflecting on this question, it is vital to protect both individual providers and institutions from legal coercion. Only by doing so today will they be able to mount vigilant defenses against future attempts to impose unconstitutional conditions in this arena. These reflections do not propose how best to do so. Instead, they are intended to raise questions and sound an alarm to spur further development of protections in this field.
The first Part of these reflections considers why it is critical, and not premature, to address this issue today. The second outlines the extent to which assisted suicide is expanding its reach in state law. The third will explain how current conscience protections in existing state statutes are disappointingly inadequate and anticipate upcoming threats. Finally, these reflections explore what must be done to solidify protection against coercion when it comes to this most serious threat to the lives of vulnerable people.
Recommended Citation
Lucia A. Silecchia,
Assisted Suicide, Forced Cooperation, and Coercion: Reflections on a Brewing Storm,
98
Notre Dame L. Rev. Reflection
S68
(2023).
Available at:
https://scholarship.law.nd.edu/ndlr_online/vol98/iss4/6