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Monday, November 28, 2011

Assisted Suicide: Never Enough

I do not trust groups such as Compassion and Choices who vigorously lobby for assisted suicide legislation. There is no question Compassion and Choices has deep pockets, is media savvy, and an effective lobby. The message is simple--they do not want people to die in pain and great suffering. It is hard to argue this point. Too many Americans die badly. However, I contend we do not need assisted suicide legislation but rather a vibrant hospice movement. While we have many fine hospices, Americans believe hospice care is tantamount to giving up. The result is people die badly and enter hospice care far too late. This only fuels the simplistic message Compassion and Choices advocates--even with hospice care we die badly. We must do better! In my estimation this line of thought is not only misleading but dangerous. Why do I feel this way?

First, all those that advocate for assisted suicide legislation are asking the wrong question. At issue is not how we die but rather how we live. I would posit we should seek to empower those who are at risk populations--the elderly, disabled, and terminally ill. How can we insure families with an elderly parent that has dementia receive adequate support? How can we insure families do not incur great debt caring for a loved one that is terminally ill? What can we learn from people that are near the end of their life? I may appear naive in posing these questions but I am not. I went through the medical mill as a child and recently as an adult. There is no doubt in my mind that to date we Americans have consistently refused to engage in a serious discussion about end of life issues. This refusal has hurt far too many people and spawned zealots such as the deceased Jack Kevorkian, a deeply polarizing figure. Nuanced debate is totally absent. We have two sides, those for and those against assisted suicide. If I have learned anything in life, it is that we do not often get to choose the way we die. When we let others make this decision for us we have entered into dangerous territory. Any discussion of quality of life is subjective in the extreme. Long ago when I was paralyzed my level of injury was considered very high (T-3). Paraplegics such as myself abounded but I met virtually no quadriplegics. One night I asked why there were so few quadriplegics. I was told think about it. I did and remained puzzled. High level injuries, above C-8, were not often treated. The reasoning was simple--life as a quadriplegic was not worth living. Fast forward to the present--all high level spinal cord injuries are treated. The decision making has far less to do with medical facts but American cultural perceptions. This was true in 1978 and it remains true in 20011. The presence of a disability is stigmatizing. For some it is a fate worse than death.

Second, assisted suicide advocates are never satisfied. They use the terminally ill to demonstrate their compassion but are perpetually pushing for wider use. Writing about assisted suicide in the state of Washington in the Olympian on November 16, Brian Faller argued it was time to think about expanding the legislation. He wrote "to improve the chances of passage, the Death with Dignity Act was written to apply only to the choices of the terminally ill who are competent at the time of their death.
This raises the question whether, if the act continues to work as intended, we should extend the choice of voluntary euthanasia to:
• Persons who are not terminally ill but suffering a severely debilitating medical condition they judge to be unbearable.
• Persons who are not competent at the time of their death but who previously made a competent choice of euthanasia as evidenced through a special type of advance directive." If we expand legislation as suggested by Faller I would be eligible to take advantage of assisted suicide. This scare me to the very core. It truly inspires fear. Even this is not as disturbing as what is going on in the Netherlands where assisted suicide has been legal for a decade. Euthanasia advocates are lobbying for mobile euthanasia teams who will "teat" the elderly and disable in their own homes. The Dutch Medical Association has approved euthanasia for people with dementia. This is particularly worrisome because in the near future it will be possible to test people for Alzheimer's disease before symptoms develop. That is people who are clear and lucid will be told they are going to develop dementia. What is the point of such a test when no cure exists? Researchers and clinicians say such testing will help families prepare for the future. Will that future include assisted suicide? Undoubtedly.

Further examples abound but suffice it to say once legalized assisted suicide will be used in greater and greater numbers. This is the case in Washington and Oregon as well as the Netherlands. So don't be fooled by the seductive and sentimental tactics espoused by advocates for assisted suicide. I saw this first hand at the Dr. Oz Show. It was shockingly effective, chilling really how he whipped the audience up into a frenzy of approval. I implore readers to think rationally about assisted suicide. It is in your best interests as well as mine.


Eric Fischer said...

Unfortunately the trend is indeed as you state; an ever widening acceptance of euthanasia. The final hurdle is, if I am up to date, being discussed in Holland now:euthanasia for the depressed.
But know that despite this there is a misconception as to how readily people can make use of the euthanasia law in Holland. As I know from personal involvement, the process is cumbersome, heavily bureaucratic, with presently about one third of physicians agreeing to the process.

painting with fire said...

You are very correct about the lack of decent support for late in life care and family support. I was the main care-giver for my mother-in-law for the last couple of years. She didn't live with us but was in assisted living. The degree of support given to us when she finally moved to hospice for what turned out to be the last 48 hours of her life was astonishing - I wish we had that level of compassionate support as a society built around care of families caring for children, for the elderly, for people living with a disability of any duration. Or course that would require a commitment to spend serious amounts of money and a focused, intelligent discussion of how to fund such care. It doesn't say much positive about the kind of society we turn out to be that we don't do this or even have an honest discussion about it.

I am pessimistic that this issue will get addressed in any useful way given the current level of discourse on so many issues and the utter failure to address budgetary issues, climate change and the like - not to trivialize end of life care but rather to doubt that those placed to effect policy have the courage of their convictions on any major issue.

william Peace said...

Eric, I find the Netherlands use of assisted suicide troubling to say the least. Each year suicide becomes more common, the number of people that die increases, and those eligible wider. And yes assisted suicide is available to those clinically depressed. And yes 1/3 of MDs do support assisted suicide and practice it. And the general population supports it by an overwhelming majority.
Leslie, In this era of draconian budget cuts there is no chance elderly, disabled and terminally ill people will get adequate support. Hospice care should be far more widely used. Too many go into hospice care mere days from death when they should seek hospice far earlier. Support is great as is pain management. Sadly, I share your pessimistic views.