TAG | assisted suicide
Writing in America Magazine, Jean Welch Hill, director of the ominously-named Peace and Justice Commission for the [Roman Catholic] diocese of Salt Lake City, argues against peace and justice for the terminally ill:
Imagine telling someone who is unable to walk that their life no longer has value. Or telling a loved one who needs help eating that they have lost all dignity. Or explaining to a friend that you can’t visit them anymore because their illness has made them unattractive.
Few would say any of these to a stranger, let alone a loved one. Yet the message of assisted suicide amounts to telling people who have lost the ability to function as they have in the past that they should just cease to exist. This has been the message we have heard for three years in Utah from proponents of assisted suicide legislation.
The definition of dignity implied in these proposed laws, which have followed the Oregon model, is not about the inherent worth of the person but about their physical state. We should keep in mind the great injustices that occur when we decide that human worth depends on perceived mental capacity or physical attributes.
This, I am afraid, is at best misleading and at worst dishonest.
What assisted suicide is about is allowing terribly ill people to decide for themselves that enough is enough. It is about autonomy, it is about dignity and, often, it is about the ability to bring unbearable suffering to an end.
Of course, there are many who have profound religious and philosophical objections to the idea of assisted suicide (even when it is accompanied with the sort of safeguards seen in Oregon). They are free to follow those principles up to the very end. But to insist, by force of law, that others should do likewise is about coercion, not compassion, a coercion made worse by the condescension in which it is wrapped. These poor dying folk, you see, are simply incapable of deciding what is right for themselves.
After all, they might even be nuts.
[M]ost terminally ill patients will overcome these fears with proper mental health care. Britain’s “Care Not Killing” Alliance cites a 2006 study by the Royal College of Psychiatrists, in which almost all patients who sought assisted suicide changed their minds after competent and effective ongoing psychiatric treatment.
It’s worth adding that in 2014, the Royal College of Psychiatrists issued a statement on assisted dying for the terminally ill that ended as follows (my emphasis added):
As individuals and citizens we also cannot fail to acknowledge that notwithstanding our appropriate cautions and caveats, there will still be those who continue to believe that their current circumstances are unendurable and unacceptable. Each of us will have our views on how we should respond to these situations. We do not think that the College should take a specific position on this. Finally, the decision on whether to legalise physician assisted suicide is a matter for Parliament and the Courts. The only position the College takes on this matter at present is that we will always act within the law.
As is usual in this debate, Ms. Hill isn’t slow to start talking about the slippery slope, citing some (genuinely) disturbing (at least as presented) data from The Netherlands appearing to show that, in some cases. doctors not patients are taking the decision to end patients’ lives. If that’s true, it’s very wrong, and the way to stop it is well-crafted legislation. But using the slippery slope as an argument against the autonomy of those who have slid very far down a hideous slope of their own is to add insult to appalling injury.
Hill concludes with a call for better care for those at the end of life, noting, not inaccurately, that it is not always available. She wants, she claims, to “fix the existing problems within our health care system and allow all people to truly die with dignity.” The first half of that sentence may be sincere, but it is also boilerplate. The second half is disingenuous. Ms. Hill only wants people to “die with dignity” on her terms, terms that not a few patients will find remarkably arrogant and, yes, horribly cruel.
And they would be right to do so.
Opponents of assisted suicide often warn how legalizing it would represent a slippery slope. That’s not an argument convincing to those who have slid very far down a slope themselves.
And nor should it be.
The family of a great grandmother who died from multiple sclerosis has published harrowing photographs of her final hours. Flora Lorimer’s husband and daughter say she wanted to die for two years before she finally passed away last month aged 68.
Tom, 69, and Tracey Taylor’s wish is that the shocking images will highlight Flora’s battle and persuade politicians to make assisted suicide legal in Scotland. Flora was diagnosed with the disease at 21 years old after noticing she had started dragging her leg. Her condition worsened and it got to the stage when it was taking an hour to walk half a mile to the shops from home. Before long the much-loved great grandmother needed a wheelchair.
Ms Taylor, from Glenrothes, Fife, told STV News: : “She cried all the time, in pain, all the time. I would come and visit every day and she would say to me, ‘I don’t want to be here tomorrow. Please take my life, I don’t want to be here tomorrow.’
“She’d had enough and we couldn’t do anything to help her – nothing.”
Asked why they had taken the decision to release the images, Ms Taylor said: “Everybody needs to see why we are fighting for this. People don’t see these pictures. These are the ones that are hidden away and they need to be shown.
“I got agreement from my mum. She wanted everyone to see why we are fighting for this and why she did want to die.
“It’s happening everywhere all over the world and it shouldn’t be. We should have the right to make our own decision….”
Flora’s condition began to dramatically worsen around two years ago when she lost the function in her hands and became too weak to even text friends. She lost the function to do anything for herself and became completely bed bound around a year ago.
It was from then, her grieving daughter and husband say, that Flora began to express her wish to end her battle with the disease.
Ms Taylor went on: “She had no leg use, no arm use, couldn’t wipe her nose, had to ask to have her head scratched and then eventually she couldn’t even talk. She could hardly communicate with us.
“She found it very hard. We could hear her, just, but she found it very hard to talk to us.
“I couldn’t kill my mum. I wanted to but I couldn’t. I couldn’t do that. I wanted the doctors to do that. I wanted the doctors to help her do it herself. She needed to do it herself, not us doing it. Whenever she was ready we would have all got together, let her take her pill, her wee drink of juice, let her go to sleep with all of us round her and drift away. But it wasn’t like that. It wasn’t like that at all. We were all around her but it wasn’t peaceful. She lay in her bed for over a year not moving, not doing anything, just lying there getting bed sores everywhere. She suffered – torture. She was tortured for two years because we couldn’t do anything.”
I respect—even if I disagree with— the arguments of those who object on rational grounds—the slippery slope and all that— to legalizing assisted suicide, but as for those, such as Boston’s egregious “Cardinal Sean” (who fought so hard against the Massachusetts’ ‘Death with Dignity’ initiative) whose objections are rooted in religious faith it’s a somewhat different matter. They are entitled to their beliefs in this matter, and to live (and die) by them, but to insist-as a matter of law-that others should be forced to do the same is arrogant, insolent and, all too often, horribly cruel.
Credit where’s credit is due: I am not exactly a member of the Jerry Brown fan club, but the California Governor’s decision to sign his state’s cautiously drafted assisted suicide law (perhaps too cautiously: to take one example, those with Locked-In Syndrome might still be left trapped in their hell) deserves some praise, not just for his signature, but also the reasons he gave for it.
Gov. Jerry Brown of California gave a deeply personal explanation on Monday for his decision to sign legislation allowing terminally ill patients to obtain a lethal dose of painkillers from a doctor to hasten their death. When the law goes into effect next year, California will become the fifth state, after Oregon, Washington, Montana and Vermont, to enact and retain aid in dying or physician-assisted suicide laws. Many other states are considering similar laws; they ought to follow the example of these pioneers.
The California law has robust protections to protect patients from recklessly taking their own lives. Two different doctors must certify that the patient has six months or less to live before prescribing the drugs, patients must be able to swallow the medication themselves, and they must be of sound mind and not under coercion from their families. Hospitals and doctors can decline to participate.
Governor Brown, a Democrat, said that he had carefully read the opposition materials presented by a number of doctors, religious leaders and champions of disability rights and had considered religious arguments that shortening one’s life is sinful. He also consulted with a Catholic bishop, two of his own doctors, and former classmates and friends, who took a variety of positions.
In the end, he reflected on what he would want in the face of his own death. “I do not know what I would do if I were dying in prolonged and excruciating pain,” he wrote. “I am certain, however, that it would be a comfort to consider the options afforded by this bill. And I wouldn’t deny that right to others.”
Well done, Governor Brown. That said, it remains troubling to read that, even after the vote in the California legislature, Brown thought it worth considering ‘religious arguments that shortening one’s life is sinful’. Much as I might disagree with them, there are good practical arguments to be made against assisted suicide, but why, beyond a certain point in the democratic process in a nation with a constitution providing for the separation of church and state, religious arguments should be given special consideration escapes me.
There’s been a lot of talk in recent years about how ‘religious liberty’ is under attack in the US, but that’s a stance that can easily turn into an insistence on religious privilege, an altogether less praiseworthy objective. Under the circumstances, the determination of various churchmen to ensure that all Californians should be forced to submit to the prescriptions of a faith that they might not share was more than a touch ironic.
And for all the other arguments that those churchmen make, that infamous slippery slope and so on, in the end their objections are religious, based, at their core, on the argument that the rights of their God trump those of the profoundly sick, an argument made none the more palatable by attempts to elevate ‘suffering’ into some sort of sacrament.
I posted a bit about this phenomenon the other day, but clear signs of a morbid cult of suffering can be found in an article in America magazine by Jessica Keating, the program director of the Office of Human Dignity and Life Initiatives at the University of Notre Dame. It was written in response to the assisted suicide of Brittany Maynard in Oregon earlier this year.
For those who cannot see beyond the material horizon of death, suffering that does not appear to have proximate material benefit is emptied of the possibility of meaning.
Indeed, euthanasia and physician-assisted suicide are as much about unseemliness and fear of suffering as they are about death.
With the advance of utilitarian idealism and medical technology, it seems that nothing but a peaceful death will be acceptable, wherein peace is reduced to the absence of pain, emotional and physical suffering or the loss of cognitive and physical abilities.
To describe the wish for a peaceful death as ‘utilitarian idealism’ is telling. Fundamentalism is what it is.
There is another narrative that is routinely neglected or, worse, rejected out of hand, a narrative grounded in the logic of the Cross. This is a narrative in which suffering unto death can be penetrated and transfigured by the mystery of love—particularly in cases like Ms. Maynard’s, when one is surrounded by loving family and friends. This transfiguration occurs in hidden intimacies. Choosing to die early forecloses such possibilities. Had she not taken her own life with the assistance of a physician, she, like many who suffer terminal illness, almost assuredly would have been stripped bare of her abilities, perhaps even her mind. Indeed, there was nothing material for her to gain in suffering, only loss. Almost assuredly there would have been no inspiring recovery story to tell at the end. Rather, Ms. Maynard might have become unproductive, unattractive, uncomfortable. She would just have been. But she would have been present in a web of relationships. Even had she fallen unconscious, she likely would have been read to, washed, dressed and kissed. She would have been gently caressed, held and wept over. She would simply have been loved to the end.
That was a destiny that was hers to choose or to reject. ‘The logic of the Cross’, backed by coercion, would have denied her that freedom, that autonomy, that dignity, that relief.
As I said, ‘religious privilege’.
In the course of commenting over on the Corner to a list of the ‘ten best revolutionaries’ (yes, the list was as dumb as you can expect), I included an extract from Paul Berman’s excellent Slate response to The Motorcycle Diaries, a hagiographic Che movie made about ten years ago.
Some of Berman’s piece was an attempt to insert a little accuracy into the historical record, but this too caught my eye:
[T]he entire movie, in its concept and tone, exudes a Christological cult of martyrdom, a cult of adoration for the spiritually superior person who is veering toward death—precisely the kind of adoration that Latin America’s Catholic Church promoted for several centuries, with miserable consequences. The rebellion against reactionary Catholicism in this movie is itself an expression of reactionary Catholicism. The traditional churches of Latin America are full of statues of gruesome bleeding saints. And the masochistic allure of those statues is precisely what you see in the movie’s many depictions of young Che coughing out his lungs from asthma and testing himself by swimming in cold water—all of which is rendered beautiful and alluring by a sensual backdrop of grays and browns and greens, and the lovely gaunt cheeks of one actor after another, and the violent Andean landscapes.
The cult of suffering—the idea that suffering is itself somehow ennobling—has long been a feature of some of the more morbid outgrowths of Christian tradition, and it can easily be detected in some of the opposition to assisted suicide.
In the course of an article for the Boston Pilot,a nun, Sister Constance Veit, wrote:
Compassion, or “suffering with” another, manifests what is best in us as members of the human family. As Little Sisters of the Poor we often witness the extraordinary things that happen at the bedside of our dying residents — striking acts of faith, graces of personal conversion and family reconciliation and exceptional gestures of empathy on the part of our staff members.
This past winter we were hit with a particularly tough strain of the flu. Several residents succumbed to the illness, including a woman who had been caught in the downward spiral of Alzheimer’s disease for over 15 years. In his funeral homily the priest, a family friend, suggested that as Alzheimer’s progressively robbed her of all that she had enjoyed in life, he had been tempted to wonder, “Why is she still here?”
The priest had a ready response to his own question, though: despite her silence and complete dependence this woman remained among us for so long to bring out the best in her caregivers, to teach us how to love. Father’s answer echoed an insight that St. John Paul II had shared 30 years ago in his apostolic letter on human suffering:
“We could say that suffering, which is present under so many different forms in our human world, is also present in order to unleash love in the human person, that unselfish gift of one’s ‘I’ on behalf of other people, especially those who suffer. The world of human suffering unceasingly calls for, so to speak, another world: the world of human love; and in a certain sense man owes to suffering that unselfish love which stirs in his heart and actions.”
What a mystery — these suffering souls whose mission it is to call the rest of us to a more noble existence, a more loving and generous gift of self! The graces bestowed on those who care for the ill and dying parallel those received by the sick who recognize God as the Master of Life and entrust themselves to him. One of the reasons why assisted suicide is so tragic is that it would deprive the sick and those who accompany them of these important graces.
That last paragraph is, I have to say, disgusting. Sister Veit’s argument that those wrestling with the later stages of a cruel disease are on a “mission” on behalf of the rest of us, a mission that they had never asked to be on, is an expression of fanaticism, terrifying in its absence of empathy for her fellow man.
We are often to told that assisted suicide could represent a slippery slope to moral catastrophe. To read Veit’s words—and to understand what, in practice, they really mean— is to realize that we are already there.
The Economist is a magazine (or ‘newspaper’ as it likes to style itself) that has badly lost its way, abandoning the quirky classical liberalism of a three or four decades ago for a bien pensant Davos liberalism that is as condescending as it is misguided.
On occasion though, hints of the old Economist can emerge, as a recent piece in support of doctor-assisted suicide demonstrates.
Here’s an extract:
The idea fills its critics with dismay. For some, the argument is moral and absolute. Deliberately ending a human life is wrong, because life is sacred and the endurance of suffering confers its own dignity. For others, the legalisation of doctor-assisted dying is the first step on a slippery slope where the vulnerable are threatened and where premature death becomes a cheap alternative to palliative care.
It is worth interrupting to add that the argument of a slippery slope will have little resonance with someone, suffering say from locked-in syndrome, who may well believe that he has already slid down the slope and into the ditch to which the likes of Boston’s Cardinal Sean O’Malley (a prominent opponent of Massachusetts’ sadly unsuccessful 2012 right-to-die initiative) would so prayerfully consign him.
Back to The Economist:
These views are deeply held and deserve to be taken seriously. But liberty and autonomy are sources of human dignity, too. Both add to the value of a life. In a secular society, it is odd to buttress the sanctity of life in the abstract by subjecting a lot of particular lives to unbearable pain, misery and suffering. And evidence from places that have allowed assisted dying suggests that there is no slippery slope towards widespread euthanasia. In fact, the evidence leads to the conclusion that most of the schemes for assisted dying should be bolder.
The popular desire for assisted dying is beyond question. The Economist asked Ipsos MORI to survey people in 15 countries on whether doctors should be allowed to help patients to die, and if so, how and when. Russia and Poland are against, but we find strong support across America and western Europe for allowing doctors to prescribe lethal drugs to patients with terminal diseases. In 11 out of the 15 countries we surveyed, most people favoured extending doctor-assisted dying to patients who are in great physical suffering but not close to death.
No wonder that, just as adultery existed in Spain before 1978, so too many doctors help their patients die even if the law bans them from doing so. Usually this is by withdrawing treatment or administering pain-relief in lethal doses. Often doctors act after talking to patients and their relatives. Occasionally, when doctors overstep the mark, they are investigated, though rarely charged. Some people welcome this fudge because it establishes limits to doctor-assisted dying without the need to articulate the difficult moral choices this involves.
But this approach is unethical and unworkable. It is unethical because an explicit choice that should lie with the patient is wholly in the hands of a doctor. It is hypocritical because society is pretending to shun doctor-assisted dying while tacitly condoning it without safeguards. What may turn out to be more important, this system is also becoming impractical. Most deaths now take place in hospital, under teams of doctors who are working with closer legal and professional oversight. Death by nods and winks is no good.
Better is to face the arguments. One fear is that assisted dying will be foisted on vulnerable patients, bullied by rogue doctors, grasping relatives, miserly insurers or a cash-strapped state. Experience in Oregon, which has had a law since 1997, suggests otherwise. Those who choose assisted suicide are in fact well-educated, insured and receiving palliative care. They are motivated by pain, as well as the desire to preserve their own dignity, autonomy and pleasure in life.
Another fear is that assisted dying will downgrade care. But Belgium and Holland have some of the best palliative care in Europe. Surveys show that doctors are as trusted in countries with assisted dying as they are in those without. And there are scant signs of a slippery slope. In Oregon only 1,327 people have received lethal medicine—and just two-thirds of those have used it to take their lives. Assisted dying now accounts for about 3% of deaths in the Netherlands—a large number—but this is less a rush to assisted dying than the coming to light of an unspoken tradition in which doctors quietly brought their patients’ lives to an end.
How, then, should assisted dying work? For many the model is Oregon’s Death with Dignity Act. It allows (but does not oblige) doctors to prescribe lethal drugs to patients with less than six months to live who ask for them, if a second doctor agrees. There is a cooling-off period of 15 days.
We would go further. Oregon insists that the lethal dose is self-administered, to avoid voluntary euthanasia. To the patient the moral distinction between taking a pill and asking for an injection is slight. But the practical consequence of this stricture is to prevent those who are incapacitated from being granted help to die. Not surprisingly, some of the fiercest campaigners for doctor-assisted dying suffer from ailments such as motor neurone disease, which causes progressive paralysis. They want to know that when they are incapacitated, they will be granted help to die, if that is their wish. Allowing doctors to administer the drugs would ensure this.
Oregon’s law covers only conditions that are terminal. Again, that is too rigid. The criterion for assisting dying should be a patient’s assessment of his suffering, not the nature of his illness. Some activists for the rights of the disabled regard the idea that death could be better than a chronic condition as tantamount to declaring disabled people to be of lesser worth. We regard it as an expression of their autonomy. So do many disabled people. Stephen Hawking has described keeping someone alive against his wishes as the “ultimate indignity”.
Indeed it is.
But it is an indignity that men like Sean O’Malley, prelates who have been so busy of late proclaiming the primacy of ‘religious liberty’, are prepared to insist on. Liberty, it seems, is not for all.
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%.