(The usual disclaimer: the following is to float some ideas; I don't necessarily endorse any of them.)
Death is usually a bad thing, but there are exceptions. A life which promises nothing but suffering makes that 'nothing' look good in comparison. So I take it that euthanasia is justified at least in certain medical cases involving a debilitating terminal illness. This post is intended to build on that assumption (so if you categorically oppose euthanasia, just pretend otherwise for the sake of argument). What I'm wondering is: does this assumption commit us to a much more radical acceptance of state-supported suicide, and if so, is that a bad thing?
The bridging idea here is that terminal illnesses are not the only form of suffering. You don't need to be in a hospital bed to judge that your life is no longer worth living. So if we accept that people have a moral (and legal) right to end their own lives in the one case, wouldn't those same rights also extend to the other?
To clarify: I'm generally no fan of rights talk, but simply use them as a shortcut to utility. The real issue for me, then, is that if we trust the terminally ill to accurately judge when their continued living would create negative utility, why shouldn't we also trust the physically healthy (who may be suffering just as much in other ways)?
One possibility is that the terminally ill are more likely to be correct in their pessimistic judgments. If they are going to die soon anyway, and their physical health is deteriorating, then it may be unlikely that life could surprise them in a positive way. However, otherwise-healthy people contemplating suicide are probably more likely to be irrational in doing so. It would certainly be tragic to throw away one's life because of a temporary bout of depression.
But that doesn't necessarily imply a total ban is best. Perhaps we should simply require that the state be extremely careful in assessing those who declare a desire to end their lives.
There could be some benefit to the State providing a euthanasia service. For one thing, by making counseling a compulsory requirement for applicants, it might help prevent suicides. If someone goes and jumps off a bridge, there's not much we can do to help them (not without some difficulty, at least). But if they go to a state facility, we might be able to get them the help they need.
A second advantage, regarding those few who cannot be dissuaded, is that this way they might at least have a more pleasant end. Suicide is often grisly and painful. If the State can provide a quality service which makes a suffering person's last moments more bearable, then I guess that's some small blessing, right?
Perhaps the biggest problem I can see with this idea, is that the service would probably either be futile or monstrous. Presumably the vast majority of people who (want to) commit suicide are making a mistake. So if the state service accurately assesses that, then it would almost never go through with killing anyone. But if someone really wants to die, and knows the State facility won't grant that wish, then they'd have no reason to go there. They'd just kill themselves the old-fashioned way. So the service would be pointless. Alternatively, if they carry through and kill people who continue to irrationally wish it, then the service is monstrous. (Surely the last thing we want is to encourage more tragic/unnecessary deaths.)
So there might be a problem in finding the right balance here. How paternalistic should we be with regard to the choices of the suicidal? Perhaps some sort of compromise is in order. One might require that the person complete a range of requirements (e.g. extended counseling), but once they finally do so, the ultimate choice is entirely their own. That might be enough to entice the suicidal, while nevertheless making a positive difference by saving people's lives.
Perhaps an even bigger problem would be getting people to use such a service in the first place. If someone really can't bear to live any longer, then they're probably just going to 'off' themselves immediately, rather than trudge over to some government office and get bogged down in bureaucratic requirements (e.g. the counseling) for weeks or months. This is really the same old conflict between 'monstrous' and 'futile'; between the individual's suicidal wishes and the State's interest in saving them.
But at least it might get the attention of those who don't really want to kill themselves, but aren't sure what else to do. The service might be able to help them; but then it would seem no different from the "Lifeline"-style counseling services we already provide.
To be a worthwhile new service, the Universal Voluntary Euthanasia centre would actually have to kill people. And that's not a pleasant thought. What's worse, to be a success we would likely have to market that service to those who would otherwise commit suicide on their own. We'd have to convince people that the UVE service is preferable to a DIY approach. "Leave it to the professionals", or some such message. But can you advocate a suicide provider without (ipso facto) encouraging suicide itself? If not, it looks like we'd end up firmly down the 'monstrous' side of the scale.
I guess from a utilitarian point of view, these practical difficulties are enough to set UVE apart from the more traditional, medical euthanasia. While the latter may be beneficial, we can see why the former would likely do more harm than good.
So, my biggest question is whether anyone can see a way to get the described UVE service to work; a way to balance the twin threats of futility and monstrosity.
A second question is whether one can justify allowing traditional euthanasia, but not UVE, on non-utilitarian grounds.