TAG | assisted suicide
Brittany Maynard died tragically young, but with dignity and in as much control as an unkind fate had allowed her, taking advantage of the law in Oregon that allowed her to obtain a prescription for the barbiturates that would end her life before cancer did its terrible worst.
Writing in the Dallas News, Marcia Angell, the widow of a physician denied similar relief thanks to the cruelty of Massachusetts law, makes a powerful case for other states to follow Oregon’s example.
Here’s an extract:
Whereas hastening an inevitable death was once regarded almost exclusively as a medical issue, we are beginning to focus on what patients want, on their right to self-determination. And people are increasingly asking why anyone — the state, the medical profession, religious leaders — would presume to tell someone else that they must continue to die by inches, against their will….
The Supreme Court has twice maintained that that’s a medical question and as such should be left to the states, which regulate medical practice. The medical profession, meanwhile, has been among the main obstacles to more laws like Oregon’s. The American Medical Association’s official policy is that physician-assisted suicide is “fundamentally incompatible with the physician’s role as healer.” One possible explanation for this opposition, particularly among palliative care specialists, is that assisted dying underscores their limitations in dealing with suffering at the end of life.
But that stance puts the focus in the wrong place. This is not primarily about physicians or their self-image; it’s about patients — specifically patients for whom healing is no longer possible. We give patients the right to hasten their deaths by refusing dialysis, mechanical ventilation, antibiotics or any other life-sustaining treatment. Why deny them what is essentially the same choice, especially since it is limited to terminally ill patients?
In 2012, I was among the lead petitioners to put a Death With Dignity law on the ballot in Massachusetts, and I campaigned hard for its passage. Until a month before the election, polls showed overwhelming support. But in the final weeks, the Catholic Church, both nationally and within the state, began pouring money into TV ads implying that people would be coerced into killing themselves, and physicians and pharmacists would be required to help them. After opponents outspent proponents by about 5 to 1, the referendum lost.
This, of course, is the same Roman Catholic Church that has spent so much of the last year or so talking about ‘religious freedom’. It’s important to understand that’s a concept where both words matter. When the church makes that argument, it is not arguing for the cause of liberty in any generalized sense. Rather it is insisting on the right, under certain circumstances, of churches and their followers to assert their beliefs over the general law.
There is something very appropriate in the way that Thomas More was often cited as an inspiration for the church’s campaign. Contrary to what his modern apologists, papal and otherwise, have liked to claim, More was no supporter of freedom of conscience. What he wanted was his conscience to prevail over the consciences of others, consciences for which he had little regard. Dissent was not an option.
It’s not too difficult to draw a line between More and the way that the Catholic Church (aided by other religious groups) did so much in Massachusetts to insist that its views on ‘assisted suicide’ should be imposed on others. Of course, that imposition was the result of a democratic vote. That matters. Nevertheless the fact that the church did so much to suport that imposition on all the people of Massachusetts, regardless of religious affiliation or their own views on this matter, is a useful reminder of its distinctly narrow notion of freedom.
Meanwhile the National Catholic Reporter writes:
The Vatican’s top ethicist condemned Brittany Maynard’s decision to end her life, saying there was no dignity in her physician-assisted death…
“Assisted suicide is an absurdity,” Carrasco de Paula told the Italian news agency ANSA. “Dignity is something different than putting an end to your own life….”
“Killing yourself is not a good thing; it’s a bad thing because it says no to life and to all that means in relation to our duty in the world and to those close to us,” Carrasco de Paula said.
The fact that life was effectively saying no to Ms. Maynard seems to have passed de Paula by, as does the fact that Ms. Maynard’s decision appears to have been supported by her loved ones. As to his remark about duty, it says a lot that de Paula doesn’t say to whom this “duty” is owed.
And of course the slippery slope makes its inevitable appearance in an argument that ignores the fact that the terminally ill have already slid down it:
Carrasco de Paula said assisted suicide was also dangerous because it offered a potential “solution” for a society that sought to abandon the sick and quit paying the costs of their illnesses.
De Paula, who is head of the Pontifical Academy for Life, an institution described by the NCR as being responsible “for ethical issues in the Catholic church” is, of course, entitled to his views. They are what they are, and they are unlikely to change. Roman Catholic teaching is what it is. But so is its refusal to respect the freedoms of those with which it disagrees. Its behavior in Massachusetts was a disgrace.
Maynard’s closing statement included this:
“Today is the day I have chosen to pass away with dignity in the face of my terminal illness.”
And so she did. RIP.
Vermont may be a lefty sort of place, but occasionally it gets some things right. MSNBC reports:
After 10 years of emotionally-charged debate, Vermont became the first state in the country to pass a doctor-assisted suicide bill through the legislative process. Governor Peter Shumlin signed the “Patient Choice and Control at End of Life Act” into law Monday allowing physicians to prescribe a lethal dose of medication to dying, mentally competent patients who want to end their lives. This would apply only to residents of the state.
“Vermonters who face terminal illness and are in excruciating pain at the end of their lives now have control over their destinies. This is the right thing to do,” said Gov. Shumlin, a Democrat.
Three other states have similar “death with dignity” laws on the books. Oregon and Washington enacted these laws through ballot measures. In Montana, a court ruling made it legal in 2009. Similar to Oregon and Washington, the new Vermont law provides built-in safeguards to make sure these patients meet certain requirements and that they are of sound mind. For the next three years, sick patients must formally make the request at least three times. And the patient’s primary care doctor and a consulting physician must agree with the diagnosis that the person is, in fact, terminally ill and able to make an informed decision. The Health Department will get reports from doctors on how many patients they prescribed lethal drugs. After July 1, 2016, Vermont won’t require as much monitoring and reporting under the law.
According to the AP, Vermont Health Commissioner Dr. Harry Chen estimated doctors will write between 10 and 20 lethal prescriptions a year, but not as many patients will go through with the process and actually take the lethal drugs…
Over at the Wall Street Journal Paul McHugh complains about this modest measure in an unconvincing article that is childish:
And then there is this talk about “death with dignity,” as the Oregon and Washington laws are titled. Surely what we want is “life with dignity.” Seeking life, we’re ready to endure much in order to keep it going. Think of the life-saving and life-preserving colonoscopy—all dignity drops with your trousers.
And comes complete with guilt-by-association:
For you see, the terminators ultimately are not merely interested in killing people who are suffering the throes of a final illness. They have even others in mind, as history tells us. The drive to allow doctors to “assist” in suicide is not recent. Its roots are in the Progressive era of the early 20th century, when many Americans placed utter confidence in reform and in technocratic elites. Then the enthusiasts for euthanasia lined up with those clamoring for government intervention in the name of eugenics and population control.
And, well, this:
Another argument for physician-assisted suicide is that many patients with cancer live too long in pain. The suffering could be reduced if their legitimate wish for death were fulfilled. These are the arguments pressed by Dr. Timothy Quill and many in the Oregon “death with dignity” group.
But scientific publications from oncologists such as Kathleen Foley, who studies patients with painful cancers, reveal that, quite to the contrary, most cancer patients want help with the pain so they can continue to live. Suicide is mentioned only by those patients with serious but treatable depressive illness, or by those who are overwhelmed by confusion about matters such as their burden on loved ones and their therapeutic options. These patients are relieved when their doctors attend to the sources of their psychological distress and correct them.
The simple (and encouraging) answer to that is that a huge majority of cancer patients do indeed choose to live on, and, yes, proper counseling and treatment for depression can encourage them to make that choice.
That said, there are doubtless some terminal patients who—quite rationally—decide that enough pain is enough, and that it’s time to move on. The Vermont law will help some such individuals reassert, one last time, control over the lives that are theirs, and theirs alone.
In a 2002 New York Times piece, Dr. McHugh (a Roman Catholic) was described as “religiously orthodox, politically liberal (he is a Democrat) and culturally conservative”. The latter is an infinitely debatable term. If we look, however, at the other two attributes listed– religious orthodoxy and political liberalism—it’s not hard to see why respect for individual liberty ranks so very low on his list of priorities.
This article by the British cook, writer and entrepreneur, Prue Leith, on the death of her brother is a harrowing read, but it is a reminder of the suffering that those such as Boston’s Cardinal O’Malley (a key opponent of the recent Massachusetts ballot initiative on assisted suicide) insist on imposing on others.
Here’s an extract:
In the end, David, determined to end the pain, refused any more antibiotics, so allowing the next dose of pneumonia to kill him. Dying of pneumonia is a horrible death. Basically you drown, slowly and painfully, as your lungs fill with mucus and you cannot breathe. David’s family had to endure the sound of laboured breathing for the last five days, a constant loud “death rattle”. They had to bear the sight of their father and husband, thick green discharge running from mouth and nose, veering from semi-coma to excruciating pain.
Death is always distressing, but in 2012, with all our talk of respect and consideration for others, how can it be that a wife ends up praying for her husband to please, please, just die?
Surely all that is needed is something like a hospital protocol that if the patient and the next of kin want to end the misery, and two doctors agree that the patient will be dead in a month anyway, they can increase the dose of drugs to the level sufficient to alleviate the pain, even at the risk of death.
If that is a step too far, can we not at least accept Lord Joffe’s proposed Bill, which would allow, if not “mercy killing”, at least “assisted suicide”? This would make it lawful for doctors to prescribe, though not to administer, a drug that would cause death. The patient would have to request it, and take it while still capable of doing so.
The present state of affairs is monstrous. With 80 per cent of the [British] population in favour of assisted dying, what are they waiting for?
Over at the Corner, Wesley Smith posted a comment on Boston’s Question 2 (assisted suicide). You can find it here.
Here was my response:
Wesley, you write:
“Pro-assisted-suicide activists often claim falsely that opponents want to force (Catholic) religion on rational people.”
Clearly there are people of many different faiths and of none who are opposed to assisted suicide. They are so for a wide variety of reasons, sometimes rooted in religion, and sometimes not. As the Boston Globe puts it in the extract from the editorial you cite, “reasonable people” can disagree over this issue.
Equally (as I am sure you would accept) the Roman Catholic Church is a part of the coalition opposing Question 2 and that (unsurprisingly) it is so for primarily religious reasons. That’s not in the slightest bit shocking, but nor is it something to be denied.
Then we come to these words in the Boston Globe editorial cited by you:
“[A] yes vote would not serve the larger interests of the state.”
As you note, it is a liberal newspaper.
The newspaper’s conclusion is that various constituencies ( ”the medical community, insurers, religious groups, and state policy makers”) should keep talking, and talking mainly about what should be done for people rather than by people. And as they keep talking, somewhere someone (trapped suddenly, say, in locked-in syndrome) will find himself deprived of his individual autonomy in the most profound manner imaginable. He may, quite rationally, decide to make the best of it, or at least to cope, and that, of course, is his inalienable right. But what of the patient who decides, no less rationally, that he would rather not face the years of imprisonment (as he sees it) in his own body that may lie ahead? You can explain to him about the dangers of legalized assisted suicide, and of the perils of the slippery slope, but something tells me that he will conclude that he has slid down a slippery slope all of his own. And has been left to rot there.
Wesley replied here.
The Economist notes:
The prospect of the loss of autonomy, of dignity and of the ability to enjoy life are the main reasons cited by those wanting assisted suicide. Having the option of assisted suicide means that terminally ill people can wait before choosing to end their lives. That may have been what happened to Gloria Taylor, a Canadian assisted-suicide campaigner with Lou Gehrig’s disease (a degenerative illness). After winning a landmark court case four months ago that gave her a “personal exemption” to seek a doctor’s help to commit suicide at the time of her choosing, she died earlier this month—from natural causes.
Intuitively this makes sense.
And as for that slippery slope that the scaremongers are always brandishing, protections can be built in that ought to fence it off:
[F]or the limited measures introduced so far, safeguards abound and evidence of abuse is scant. Oregon’s legislation, introduced in 1998, is widely admired. Under it, an eligible applicant must be a mentally competent adult, suffering from a terminal illness and with less than six months left to live. His decision must be “informed”, meaning he must have been told about alternatives such as hospice care and pain control, and he must have asked his doctor at least three times to be allowed to die. A second doctor must review the case both for the accuracy of the prognosis and to certify that no pressure (from inheritance-hungry relatives, say) has been exerted.
That is too restrictive in some respects (it wouldn’t help those with locked-in syndrome, who can live on for decades), but the other protections make good sense.
And how steep is that slope? Not very.
Almost all existing or proposed assisted-suicide laws contain similar safeguards. Some also require the applicant to be suffering “unbearable” physical or mental pain. Only in Belgium, the Netherlands and Switzerland, where assisted suicide has been permitted since 1942, are the non-terminally ill eligible. Yet even that liberality has not stoked the numbers. The annual total of assisted deaths among Swiss residents is still around 300, or 0.5% of all deaths. Dignitas, the only organisation in the world willing to help foreigners die, had 160 clients in 2011. In Oregon assisted suicides represent 0.2% of all deaths. In Belgium, where voluntary euthanasia is also legal, assisted dying accounts for less than 1% of the total. Even in the Netherlands, which takes a notably relaxed approach to both forms, it represents less than 3%.
Writing in The Wall Street Journal, a Roman Catholic priest, Tadeusz Pacholczyk, tries to throw in (I think) a little irony in support of his church’s campaign against assisted suicide:
In the November elections, voters in Massachusetts will decide on “Question 2,” a ballot initiative to allow physicians to prescribe (but not administer) a lethal dose of a toxic drug to assist their patients in committing suicide. Advocates of physician-assisted suicide assure us that this can be a good choice for someone who is dying, or who wants to die.
If physician-assisted suicide really represents a good choice, we need to ask: Why should only physicians be able to participate? Why should only physicians be allowed to undermine public trust in their profession through these kinds of death-dealing activities?
Why not include police? If a sick person expresses a wish to die, the police could be notified, and an officer would arrive bearing a suitable firearm. He would load it with ammunition, cock the gun and place it on the bedside stand of the sick patient. After giving instruction on the best way to angle the barrel, the officer would depart, and the patient could then pick up the device and take it from there—police-assisted suicide.
Oh good grief. Please try harder, Father. You surely can do better than that. Mercifully, Pacholczyk then changes tack. He offers up a couple of true life stories that allegedly make the case against assisted suicide:
I remember reading a letter to the editor in the local paper of a small town many years ago. A woman wrote in about the death of her grandparents—well-educated, intelligent and seemingly in control of their faculties—who had tragically committed suicide together by drinking a deadly substance. They were elderly and struggling with various ailments.
Her firsthand perspective was unflinching: It took her years to forgive her grandparents. She was angry at what they had done to her and her family. She felt betrayed and nauseated. She could hardly believe it had really happened.
The woman was still upset that they hadn’t reached out to the rest of the family for assistance. She dismissed the idea that suicide could ever be a good thing as a “total crock and a lie…”
Because, you see, it was all about her. What her grandparents wanted for their own lives counted, apparently, for nothing. She cannot have loved them very much. Not really. Not truly.
And then we have this:
A friend of mine in Canada has struggled with multiple sclerosis for many years. He often speaks out against assisted suicide.
Recently, he sent me a picture of himself taken with his smiling grandchildren, one sitting on each arm of his wheelchair. Below the picture he wrote, “If I had opted for assisted suicide back in the mid-1980s when I first developed MS, and it seemed life as I knew it was over, look what I would have missed. I had no idea that one day I would be head over heels in love with grandchildren! Never give up on life.
In the early stages of his disease (and perhaps even now) this man could have opted for suicide by his own hand. He has chosen not to, and he continues to lead an apparently rich and fulfilled life. Good for him. He made the right choice, but what is right for him is not right for everyone, and is no argument at all for depriving (in particular) the helpless of their chance for release.
By the weakness of this almost insultingly feeble article, Father Pacholczyk reveals yet again how little intellectual force there is to the argument against assisted suicide once those who make it stray from the religious ideology on which their case is, in reality, based, a religious ideology that should not be enforced on those who disagree with it.
The answer to Massachusetts’s Question Two should be yes.
Cardinal O’Malley (The National Catholic Register reports):
Cardinal Sean O’Malley of Boston is leading a statewide fight to defeat the Death With Dignity Act, a November 2012 ballot measure that would legalize assisted suicide in Massachusetts.
He has outlined the Church’s underlying moral concerns regarding the threat to human dignity and patients’ rights posed by assisted suicide in a video homily broadcast at Boston-area Catholic churches. He’s also writing a series of columns critiquing the measure, and he has worked with the Massachusetts Catholic Conference to form the Committee Against Physician-Assisted Suicide, a coalition that includes religious, medical and disability groups across the state.
A Kennedy (Joseph Kennedy III) and The Republican (Sien Bielat) contesting Massachusetts’s Fourth Congressional District:
They found common ground on a couple of issues.
Both opposed the so-called “right to die” ballot question that would allow doctors to prescribe lethal drugs to terminally ill patients…
Writing in The Daily Telegraph, Peter Mullen, a British parson, attempts to clothe his religiously-based objections to assisted suicide (“As a Christian, I do not believe we have the right to die at the moment and by the means of our own choosing. Suicide is a mortal sin.”) in what he pretends are “utilitarian” arguments:
First to be considered is the effect on the morals, the conscience and the psychology of the doctor who has allowed himself to conspire in the killing [suicide] of another human being.
Well, that rather presumes that the doctor believes that there is something wrong with acceding to his patient’s request, something that is unlikely given the right that would undoubtedly be given to doctors opposed to assisted suicide to hand this task over to someone else.
I note too that Mullen has nothing to say about “the effect on the morals, the conscience and the psychology of the doctor” who has allowed himself to conspire in the prolongation of the agony of a patient looking for release.
His argument limps on:
Every case of assisted killing [suicide] will be different from every other case. How, for example, in the case of a very sick person, do we assess the balance of his mind: is he capable of being certain that he wishes to end it? And who is to vouch for that certainty?
Who is this, “we”, Vicar? If the patient is sane, the decision is his. I don’t believe in there being a right to assisted suicide, or many other non-legislated rights for that matter, but I do think that a civilized society ought not to stand in the way of a patient to ask for the help he needs to bring his suffering to an end.
Then there’s this:
And it could even be that someone one day expresses the wish to die but that, days or weeks later, he changes his mind. Of course, if he is dead that possibility is no longer open to him.
Oh please. Most of those who support changes to the law also support waiting periods and other safeguards. That said, a society that attributes real value to individual self-determination will also recognize that individuals make mistakes and that sometimes those mistakes are irrevocable. That goes with the territory.
And, of course, there’s this old chestnut:
And then it is well-known that human beings are not perfect. Might some relatives of a very sick man try to persuade him to do away with himself – perhaps even to inherit his money?
Yes, that would be wicked, but how much more wicked is it really than denying a patient the right to end his agony in the name of a religious belief that he does not share?
Mullen, I’d hope, is not a cruel man, but the consequences of his absolute certainty can, at their worse, be monstrous. He should have the humility to remember the wisdom of Oliver Cromwell’s great request:
I beseech you, in the bowels of Christ, think it possible that you may be mistaken.
The debate about assisted suicide has been reignited after the [English] High Court ruled that two men with locked-in-syndrome cannot be legally helped to die. Tony Nicklinson, 58, and a second man known as Martin, 47, mounted legal challenges in attempt to secure immunity from prosecution for any professional who helped them to die. The men are completely physically dependent and can only move their eyes and eye lids yet remain cognitively sharp. Both want to die but neither is capable of taking their own life.
Lawyers acting for Mr Nicklinson, who suffered a catastrophic stroke in 2005, argued for an extension to the common law defence of ‘necessity’ for murder because the alternative – forcing him to stay alive – is worse. They also argued that the government is in breach of his Article 8 right to ‘privacy, dignity and autonomy’, a right he cannot exercise independently because of severe disability. The court rejected the “bold” submission, stating that there was no precedent anywhere in the world and such socially controversial changes were only for Parliament.
The decision was condemned by Mr Nicklinson and his family but welcomed by medical leaders and religious groups.
Both men are likely to appeal and will most likely end up in the Supreme Court.
Martin, who also suffered a stroke, bid to have the Director of Public Prosecutions (DPP) amend current guidance regarding assisted suicide. The clarification he sought would have meant that if a doctor or lawyer were to help Martin to end his life by taking him to the Swiss clinic Dignitas, they would not face criminal and/or disciplinary action. Martin cannot currently fulfil his wish to end his life as his wife, a nurse and carer, is not willing to actively assist in any steps leading to his death.
The three judges, who said the court had been “deeply moved” by both men’s circumstances, ruled that such matters were for Parliament to decide…
Sadly, the judges were correct. There is no innate “right” to assisted suicide, and it’s not for the courts to discover one. It’s up to Parliament to decide.
And so Parliament should: by changing the law to allow those two men, and others like them, to end their suffering if they so choose.
Get on with it.
That’s the theory. But here’s how it really works. The Daily Mail reports:
The Council of Europe has ruled that euthanasia and assisted suicide should be banned in every country across the Continent. In a declaration that will have huge implications on human rights laws in its 47 member countries, the Strasbourg-based organisation announced that such practices ‘must always be prohibited’.
The move will represent a major setback to assisted dying campaigners in the UK who want Britain to follow Holland, Belgium and Switzerland in allowing doctors to help to end the lives of their patients. The explicit condemnation of euthanasia was inserted into a non-binding resolution entitled ‘Protecting Human Rights and Dignity by Taking Into Account Previously Expressed Wishes of Patients’.
The resolution had originally simply focused on the human rights questions of ‘advance directives’, or ‘living wills’, in which people set out how they wish to be treated if they became mentally incapacitated.
But members of the Parliamentary Assembly of the Council of Europe argued that living wills, which became legal in the UK under the 2005 Mental Capacity Act, were inextricably connected to euthanasia. They successfully moved an amendment forbidding euthanasia by 34 votes to 16 with six abstentions.
The amendment said that ‘euthanasia, in the sense of the intentional killing by act or omission of a dependent human being for his or her alleged benefit must always be prohibited’.
Among those fighting for the amendment was British member Edward Leigh, the Tory MP for Gainsborough.
It’s that “always” that sticks in the craw. What it means (thankfully the resolution is not binding) is that Leigh, and those like him, are insisting that their prejudices should prevail over an individual’s power to decide his or her own fate. The consequences of such absolutism can, of course, be grotesque suffering. A patient with locked-in syndrome, for example, who wishes to end it all has no need to worry about some “slippery slope”. He is already a prisoner, imprisoned in a body that has become its own dungeon, guarded by doctors who have thrown away the key.
And quite why Leigh, a Tory supposedly, a euroskeptic allegedly, believes that a transnationalist body should have the power to police Britons in this way escapes me. He is, it appears, an opponent of the right of Britons to govern themselves — and in more ways than one.