The Personal, the Political, and Assisted Suicide

It's tempting to think about problems in terms of government actions: laws passed, elections won, court rulings issued. Those are easy things for the media to cover; pre-packaged milestones. But public attitudes often develop in ways that have little to do with the election cycle, or with politics at all.

Assisted suicide and the broader question of "the right to die" is a classic example of a public issue that evolves slowly, privately, as people work through the moral implications in their own lives. In one of those "official" milestones almost overlooked amid all the post-election Obama-mania, Washington state quietly became the second state to approve physician-assisted suicide this week.

This is not an issue that seems to be shaped by big political events. Oregon voters first approved their Death With Dignity act in 1994, but since then five other ballot propositions in various states have failed. The U.S. Supreme Court has largely left this up to the states, ruling in 1997 that there was no constitutional right to assisted suicide, but also rejecting the Bush administration's attempt to block the Oregon law in 2006.

Attitudes also don't seem to be driven by media attention, either. The Terri Schiavo case riveted the nation for weeks in 2005, providing the worst-case scenario in an end-of-life situation: a comatose woman without a written advance directive, a divided family, and intense pressure from advocacy groups. It's true, a lot more people seem to have been interested in getting a living will after that case. In the end, however, the controversy made very little difference in basic public attitudes, at least based on survey data.

The reason for that may be that on this issue, personal experience outweighs traditional political action. And this is very much a personal issue for Americans. One-third of the public says they've had to decide whether to keep a loved one alive using extraordinary means. Six in 10 say they've discussed these questions with their parents. Nearly as many say they would consider ending their own lives if they were terminally ill. Few want the government to make these choices for them.

Another factor here is time. On almost any issue, the public needs time to think: time to consider the alternatives and implications of a problem. Everyone knows their first impression isn't always their final one, but somehow policymakers and the media forget that in decision making, taking flash reactions as the final word. In fact, that's just the beginning of the public's efforts to figure things out for themselves.

The public's actually been thinking about end of life issues since medical technology first started raising the question of "a good death" forty years ago. Basic attitudes have changed dramatically since the 1950s. But there are still lots of contradictions in public thinking. Surveys show, for example, that support falls when the poll question uses the word "suicide," a classic warning sign of inconsistent public thinking. Support rises when the question mentions safeguards.

The public will continue working this through. The advancement of medical science and the simple fact that people age and fall ill guarantees that. And the judgments the public reaches will have more to do with the values and experiences of a small group of people gathered around a hospital bed than with anything that happens in a polling place or a statehouse chamber.