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Sunday, May 4, 2014

Has the End of Life Been Hijacked?

I regularly find myself puzzled by advocates for assisted suicide.  There is a fervor for death I find unsettling. That fervor is palatable in some people. Here I think of Thaddeus Pope, a legal scholar I respect but a man I do not understand. Why I wonder do advocates for assisted suicide get so excited when they engage me and others who are opposed to assisted suicide? I also wonder what do they really think of me? Am I respected as a scholar and activist? I simply do not know. In fact I sometimes feel like a speed bump in the road--a warning to slow down that can and is often ignored.  What I do know is that far too many people in this country die badly. Alone, often scared, and almost always in a hospital. This is not good. This is the common ground advocates and opponents share--we want the end of life to be as humane as possible. We are profoundly different in the way we approach this fundamental dilemma.

As I drove up to Syracuse early this morning I was thinking about end of life issues and how it feels nearly impossible to change other people minds. I find this frustrating in the extreme. I also feel there is a core problem I am missing. So as I pumped gas into my car I was dumbstruck to read an article in the Vancouver Sun. The Canadians I feel have a more nuanced approach to end of life care. I could be wrong but long ago a Canadian Border Guard told me "Unlike you Americans we still value dissent". As I read "Death with Dignity Isn't About Euthanasia, Says Palliative Care Expert". See: In this article Harvey Chochinov. Here is an excerpt from an otherwise mundane article:

While palliative care — in which patients are kept comfortable, clean and pain free — is a growing part of the public conversation about death, Chochinov says Canada lacks national guidelines for the humane treatment of a dying person.
Instead, he says, the very notion of dying with dignity has been “hijacked” by the right-to-die movement.
“I think we’re going entirely in the wrong direction by saying the way to deal with our inadequacies in end-of-life care is by a euthanasia policy. I think we need to do something much more constructive, such as giving doctors good training in pain management.”
Even where doctor-assisted death is legal, a small fraction of the population requests it, he notes.

The right to die movement? When death become a right? We are all going to die. Death is a biological certainty.  Death is not a right but part of the life cycle. Like Chochinov I believe we need to have a vibrant national debate about how we deal with the end of life. I agree we need to foster a constructive discussion. Jack Kevorkian put this discussion on the front page of every newspaper in the nation in the 1990s.  Kevorkian, unknown to many young college students, was a polarizing figure--a ghoul really.  He was a polarizing influence. Who I wonder can bridge the gap between people such as myself who oppose assisted suicide and those that fiercely advocate for it in the form of state laws and the push for VSED as a viable final solution.  Is it even possible to build a bridge between two mutually antagonistic groups? When I read the rhetoric on both sides I think any sort of common ground will never be found. I hope I am wrong. I am however convinced of one thing: framing end of life, death itself, as a right and forming a right to die movement is inherently wrong.  In short, I second Chochinov's call for better medical training and pain management and more--more as in teaching physicians to be kind and compassionate to the patients they treat who are approaching the end of their life or are mere hours from death.  This is hard work. Emotional labor too few physicians are willing to engage in. Now that is subject worthy of sinking our collective teeth into.


Alex Schadenberg said...

I agree with your comments completely. I think you have hit the nail on its head.

Michael Watson said...

I agree that the real issues are not, for the most part being addressed. One of those is a medical system that fears death, which, paradoxically, creates situations of great suffering and the fear that we will be kept alive long after our quality of life has gone.

Thaddeus Mason Pope, JD, PhD said...

Bill, I think there is common ground. I understand your concern is about prejudice-driven coercion and manipulation do use VSED or AID to hasten death.

If that is the concern, then safeguards can be implemented. But others want to wholly deny these options to those who want them.

william Peace said...

Michael, I think my views are out of the norm having spent so much time on neurological wards as a chid when death was the norm. Death is inevitable and not something to be feared. All one can do is get the most out of life on a daily basis.
Thaddeus, My concerns as you know are varied and I do worry about coercion. To reduce my concerns to be simply about safe guards is far too narrow in scope. I would also suggest safeguards too often fail to protect vulnerable people. Safeguards did not protect Ashley X was surgically sterilized and growth was attenuated. Safe guards did not protect Christina Symanski who experienced a slow painful death via VSED. SCI is not a terminal illness but it was deemed as such. I have dread your recent easy on VSED and remain deeply skeptical.

Unknown said...

I believe that you and Thaddeus Pope both ignore the fact that medical treatment that supports the "right to die" and the "right to live" are not civil or legal rights settled in law.

The elderly/disabled on Medicare/Medicaid are targeted by Medicare and Big Insurance for end-of-life savings and the law on the books is not protecting us.

Passive euthanasia by way of unilateral covert/overt DNR code status for the elderly/disabled on Medicare/Medicaid is already a reality when hospitals are NOT being reimbursed by Medicare/Medicaid for life-extending and life-saving treatments.

Assisted Death that undermines laws against "assisted suicide" by providing the appearance of state-sponsored sanction of suicide just opens the door wider to overt state-sponsored euthanasia of the elderly/disabled for fiscal expediency.

End of Life has been Hijacked for the Fiscal Expediency of the State and Medicare and its private for-profit Big Insurance partners.

All of this talk about "choice" is just a red herring that diverts attention from actual practices.

william Peace said...

Carol, Great comment. I would suggest people are given the illusion of choice and not legitimate agency in old age, terminal illness and disability. You are also correct insurance companies wish we did not exist.