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Wednesday, November 12, 2008

Assisted Suicide and Disability

Assisted suicide has thrust itself in the news. In Washington voters recently passed an Oregon State type assisted suicide bill. Other states such as California and Vermont might legalize assisted suicide as well. In the U.K. the death of Daniel James has promoted headlines and a fierce debate about the merits of euthanasia. Some characterize Mr. James parents who escorted their paralyzed son to a Swiss assisted suicide "clinic" as being saintly and loving; their actions were a rational response given their son's disability. Most of my friends, largely academics, support assisted suicide. Polls also show the majority of Americans support assisted suicide. I readily understand why many support assisted suicide. I vividly recall seeing my father in ICU after he had a major stroke. What I remember the most aside from seeing my father on the brink of death were the other patients. Many of the people I saw would not recover and had no loved ones to care for them. I recall thinking at the time that people may be living longer but wondered about the quality of that life. I also recall questioning whether the resources spent to extend those lives was worthwhile. My emotional response was soon tempered by the harsh reality that once society determines who is "valuable" enough to live we have decided that some human life is not worth living. Society may be killing its members out of kindness but the end result, death, speaks volumes about our culture and what sort of life we value.

I oppose assisted suicide because it is too easy to kill. Proponents of assisted suicide point out that the merits of assisted suicide are self evident. Why extend the life of people who are terminally ill and in severe pain? Shouldn't an individual have the right to determine if their life is worth living? The problem with this line of reasoning is that those who choose assisted suicide are often not terminally ill. In Oregon where assisted suicide has been legal for over a decade psychiatrists that interviewed those that wanted to die discovered one in four people had undiagnosed clinical depression. In my estimation assisted suicide discriminates against people that have been historically disenfranchised. Here I refer to people that are physically or mentally disabled. The fear of disability permeates our culture and many people believe death is preferable to life with a disability. This is why Mr. James parents helped end their son's life. This fear of disability is also why Mr. James parents have been lauded in the press. This sort of logic scares me to death--pun intended.

Some readers may doubt the grounds upon which I am fearful. Surely a paralyzed man such as myself with a home, family, and job will be treated the same as a person that walks into a hospital. Wrong, very wrong. Doctors are human beings whose education does not preclude their ability to unknowingly or knowingly discriminate against disabled people. If and when I enter a hospital I know I am a liability and will not receive the support needed. Thus if I expressed an overwhelming desire to end my own life I wonder what the response would be. Would the attending physician request a psychological consult or would this person think my desire to die was understandable given the fact I have been paralyzed for over 30 years. This is what I am fearful of, disability based bigotry. This line of reasoning, death is preferable to disability, provided the social justification for loving parents to kill their own son. If parents can rationalize killing a child, I shudder to think what society has in store for me.

Proponents of assisted suicide are quick to point out that people who are suffering from fatal diseases should have the right to end their own life. Why should a person and a family suffer when death is inevitable? This logic is often accompanied by a heart wrenching story about a terminally ill person. Not only does a dying person needlessly suffer but the family is plunged into debt because they lacked adequate medical insurance. The only response to this tragic story is that the ill should be in control of their life and death. Wesley Smith characterizes the intent of assisted suicide as "unquestionably intended to be kind; but they are not. With such deaths emotively and sympathetically reported in the media, and with every lawsuit that chinks away at the laws intended to protect people with serious difficulties from suicide, mercy killing becomes more easily envisioned, more comfortably embraced" (Smith, Secondhand Smoke).

Mr. James death and his parents decision to facilitate it so soon after he was disabled haunts me. I mourn the life of a man I did not know and cannot begin to fathom the actions of his parents. I worry about the implications of James' death. Will a doctor that read about James death decide a person who had a traumatic spinal cord injury life is not worth living and withhold treatment? Selfishly I worry about myself. Will a doctor decide my life is not worth living? I also worry about the degree to which Mr. James death has affected the euthanasia debate in the U.K. Will his death impact Debbie Purdy's case. Ms. Purdy has MS and wants to know if her husband will be arrested should she decide to end her life at the same Swiss clinic where Mr. James died.

One other variable merits mention with regard to suicide and the fear of disability. If I have one learned one thing about life with paralysis it is that caring for such a body is expensive. I know this as does the medical establishment and insurance industry. Given the current global economic crisis the cost of caring for those people with a disability is under intense scrutiny. Budgets across the country are being slashed and the first services that are eliminated affect those that can least afford it--people with cognitive disabilities. Waiting lists for essential services are the norm and growing. Many I know worry American society is taking a step backward to an era when people with cognitive disabilities were warehoused in institutions. Conditions at these institutions were deplorable. The point I am trying to make is that all life has value. The debate about assisted suicide has broad and long lasting implications. There is in my estimation nothing for medical ethicists to agonize over in terms of assisted suicide. Facilitating the death of a human being is wrong and cannot be justified at any level.


David McDonald said...

Living in Oregon, I can tell you assisted suicide is not going as planned.

1.) Nurses took it upon themselves to "assist" unto death some elderly people in their care.

2.) A woman was "offered" assisted suicide by the state instead of the cancer drugs she requested.

3.) The overall rate of suicide is going up yearly.

yanub said...

If there is one "right" I don't need help maintaining, it's the right to die. As far as I have ever heard evidence, it is the common fate of every living thing. I'd be a lot more impressed with a society more eager to make sure we all can live--not just exist--rather than offers a quick exit to those it would neglect.

william Peace said...

Yanub, The Hippocratic Oath was written about 2,500 years ago and doctors are instructed "To do no harm" and encouraged to "lead lives of uprightness and honor". Prescribing lethal doses of medication harms (kills) a patient and I see no honor in this.

David, None of the three points you make surprise me nor do I question the accuracy. Collectively they highlight the fact modern medicine has become increasingly depersonalized and focused on the economics of patient care. We pour money into critical care, technology, and scientific innovation but ignore the value of humanism in medicine. What I wonder ever happened to the idealism, altruism, empathy, and compassion that drew people to medicine? We as a society have created many remarkable ways to extend life but lost sight of the very life we seek to extend. The Physician's Oath and Prayer attributed to Moses Maimonides of the 13th century held "May I never see in the patient anything but a fellow creature in pain". This line of reasoning undermines the inherent bias of wealth and power and speaks volumes about social justice in medicine. In short, this is an ideal we need to return to.

Kay Olson said...

I realized two things while reading this. The first is that I have a primary doctor who is Catholic -- and I suspect, pro-life -- and while I am a feminist who believes in choice as the key to reproductive justice, I also rely on her personal ethics as one buffer that protects me from society's larger attitude about disability. I'll have to ponder that for awhile to figure out what, exactly it means for me.

And second, I'll bet a lot of disabled people deny or leave untreated symptoms of depression because to bring them up is to come face to face with this mindset that we are supposed to be unhappy with our particular lives.

william Peace said...

Kay, Your comments remind me that a curious and uneasy relationship exists between traditionally liberal disability rights groups and the deeply conservative right to life groups. I for one have no idea how to disentangle or assess the relationship between these two groups. You comment about people with disabilities not seeking treatment for depression is correct. I would add a host of other routine and serious health care issues are ignored or dismissed by disabled people. This has much to do with economic deprivation and a persistently high rates of unemployment among people with disabilities. Another variable is the rehab culture many disabled people experience where an extreme form of independence is ingrained.

M. said...

The point is that assisted suicide should be legalized for _everyone_, not just the terminally ill or the disabled. The issue is not really about disability. If we own our own bodies, we have the right to choose to end our lives, and if we are not capable of doing it, other people should be able to lend a helping hand.

Assisted suicide being illegal (in most parts of the world) is one of the biggest human right violations in the modern society. It's fascism.

"Pro-life" is just an euphemism of being anti-choice.

Kateryna of the Cenotaph said...

I know this is a very old blog post, but, thank you. I found your posts today after I was told to just go and die. In my anger I felt threatened too, because, what if some doctor decides to think the same thing.

It is not selfish to be anti assisted suicide when so often people see death as a cure. I will never be free from my disability, because I was withheld medical treatment at the time of the initial injury. If the doctors had not ignored the broken bones in my back I could be a walker at this time.

If they can be so negligent before the injury is permanent, will people be assisted to death in order to hide malpractice? Will people be so willing to embrace death? I think too, of Teri Chaivo, and how her assisted death was utterly painful, her body suffered.

Thank you for being so eloquent with the dangers of assisted suicide. I too question the religious implications of such things. It is not against my religion to commit suicide but when the entire world suddenly embraces this, does this mean the established ruling class religions are failing to teach the dangers of death to people?

Death is the only thing that is truly permanent. Someday spinal injuries might be treated, which means someday they may not be equated with death.

Perhaps, the able bodied need a crash course in what it is to be disabled, in a dream world where they cannot escape, cannot deny, and are facing for a time the same challenges as each disabled person. Trapped in their homes, their minds, and pain wracked bodies. Then, would death become acceptable? I doubt it. I believe that the humans of this world could, and will rise above this pedantic and childish reaction.