Saturday, December 6, 2008

Death With Dignity

Image via Haral Fischer Varlag

When asked if the state of Montana has the power to keep a terminally ill man alive against his will, Judge Dorothy McCarter ruled, "The Montana constitutional rights of individual privacy and human dignity, taken together, encompass the right of a competent terminally (ill) patient to die with dignity." Going further, Hon. McCarter wrote, "The patient's right to die with dignity includes protection of the patient's physician from liability under the state's homicide statutes."

Recently, Washington State passed the Death With Dignity Act. On October, 27, 1997, Oregon made history by being the fist state to pass such legislation after a 3 year fight to enact voters' will as demonstrated in the successful 1994 Ballot Measure 16.

Oregon, Washington, Montana (pending further legal challenges), join Belgium, Switzerland and the Netherlands in their progressive stance on legal aid in dying. In Canada, Sue Rodriguez, suffering from the terminal illness, ALS, posed the question, "Whose body is this?" all the way to the highest courts in the land. Despite losing her legal battles, a physician, in the presence of a member of the Canadian Parliament, assisted Ms. Rodriguez in ending her life. Neither the doctor nor the MP were charged with crimes.

Who is sponsoring the fight against initiatives to allow the practice of physician-assisted suicide (PAS)? Despite internal debate with respect to how PAS aligns with their professional motives, doctors appreciate the protection from the law. Patients, suffering unspeakable anguish and facing the prospect of nothing other than a continuation of such anguish for their remaining heartbeats have mercy available to themselves and their families while maintaining agency over their lives and bodies. Medical ethics groups and other rights' groups tend to look approvingly upon such legal protection, as the question over state force vs. autonomous sovereignty are well argued and reasoned in such instances. In Gonzales vs. Oregon, the United States Supreme Court ruled 6-3 that, "The CSA (Controlled Substances Act) does not allow the Attorney General to prohibit doctors from prescribing regulated drugs for use in physician-assisted suicide under state law permitting the procedure."

So, who is fighting against the Death with Dignity movement and why? For one, some legislators are not bringing such bills to a vote while hiding behind weak excuses such as insurance complexity and legal hang-ups. These are certainly not the causal arguments against PAS. According to the Seattle Times, "the Catholic Church's political arm has aggressively opposed such measures." Yet, that same article notes that a lot of the hangup appears to be lexical, "A 2005 Gallup Poll appeared to show that voters were more enthusiastic — by 17 percentage points — about allowing doctors to take an incurably ill patient's life than to "assist the patient to commit suicide." The question here does not appear to be about faith, as the faithful's opposition generally revolves around the notion that life itself is a god given gift, and that gift requires protection and care.

That argument is noteworthy for its lack of recognition that medicine, not god, has often kept the terminally ill alive. A Christian Scientist, or one of the other groups who refuse medical treatment would be dead long before the terminally ill patients seeking a legal right to death with dignity would ever consider their decision. Moreover, if this is a consideration of faith, why do the faithful get to impose their will on the less-or-non-or-divergently-faithful via the state? Certainly, if a person of faith chooses to die an agonizing death, waiting for the hand of god to take them, they already have every freedom and right available to them to do so. Is it just to allow them to force that decision upon other terminally ill people who may seek a different path?

I do not accept that such force, making death with dignity beyond the law, is just. We are not discussing cases such as that of Terri Schiavo here. Nor are we discussing the admittedly radical stance on suicide I hold and has already been discussed on this blog. Here, we are discussing a very narrow instance of a cognizant and terminally ill person choosing, for themselves to have a prescription for a lethal dose(s) of medication written for them. Again, the question is asked, why shall the state force sufferers of terminal illnesses to live against their will?


  1. further evidence that, at least as a whole, we are viewed as property of the state, despite what we have been conditioned to believe about individual autonomy and freedom

  2. OK, I'll bite.

    I re-read the exchange on assisted suicide from October, and in that one and this I see a thread that I would like to follow.

    Let me start by asking the meaning of the “dignity” part of “death with dignity.” Does it mean the absence of pain or discomfort? Does it mean “convenience?” Avoiding the untoward presentation, or the unfortunate discovery by the wrong person? I suppose that dying in one’s sleep, in one’s pjs, is “dignified;” but for whom? The deceased cannot enjoy dignity: he’s dead, right? His body will be picked up, lugged about (during which time all sorts of undignified things may happen), cleaned, embalmed or not, burned or buried, and so forth. No dignity attaches to any of this: death removes one from the category of things that can be dignified.

    OK; a process, I suppose, can be dignified. Having tea is more likely to be such than having a colonoscopy. But the process of dying, I suspect, is concerned with more fundamental issues: regret, self-justification (see Neil Diamond’s “Done Too Soon,” or Robert Browning’s “The Bishop Orders His Tomb in St. Praxed’s Church”), fear of the unknown, and so forth.

    Dying almost always takes place in extremis; a person who commits suicide is, by definition, in an extreme state, regardless of whether he is (regarded by others as) mentally sound. If he has the ability to concern himself with how it’s going to look, or feel, then I begin to form the suspicion that he is not in such a state.

    Assuming we all agree that a person has the right to commit suicide, how easy should we make it for him to do this? Should we offer a menu of tasteful alternatives? Should pharmacies carry pills (prescription? Over-the-counter?) for the purpose? Should young people, being taught that they have the right to vote, and bear arms, and of privacy, etc, also be informed that they have the right to commit suicide with the assistance of one or more societally-approved persons or easy-to-acquire mechanisms?

    One more thing: we in this society are all concerned that everything should be straightforward, and easy. No complicated hoops to jump through –we want what we want, and it is the job of the society to get out of the way of the endless pursuit of our personal satisfaction. Suffering is so wildly unfair that we will build you a house, on tv, and give it to you, if somehow you experience it. The corollary to the American notion that, if something bad happens, it must be someone’s fault (otherwise why would God have given us the plaintiff’s bar?) is that nothing must be spared in the quest for perfect accommodation. Want to go to college? It’s your right to get as much as you need in the way of loans, and then to have them largely forgiven a few years later. Want to vote? We’ll come to you! Lose money in the market? Not your fault!

    Want to die? Just stop by the home remedies counter in the pharmacy, right next to the seasonal items.

    Well, some of these may be less outlandish than others; one can push things too far.

    But here’s the thread:

    The more I think about this extreme situation the more I am reminded of another recent discussion, that of torture. In my opinion, torture is also an extreme situation. I believe I maintained that it is not possible for the law, or standard ethical rules, to cover every possible case. Make torture absolutely illegal, I argued, because it involves a fundamental value of our culture. If a person (possessed of the appropriate information) decides that he must torture because of a moral calculus involving competing claims, he will do so (1) with the knowledge of the personal risk he takes, and (2) after having given it the proper consideration. He won’t do it because someone in an office somewhere has told him that it’s okay, etc.

    Similarly for suicide. You can do it, of course; we cannot prevent it, even if we wanted to. But we don’t have to make it easy, because it shouldn’t be easy. No buying the right pill to keep handy in case Mary Sue breaks up with you and you feel really crappy some morning. No free pass on some express train to oblivion: you have to climb the same old dirty steps, and there’s dog shit on the pavement, and you have to wait in the cold. No thoughtfully-provided conveniences, like the hot towels at the best restaurants. This is not Plan B, an emergency way to avoid an unwanted pregnancy; this is a human life, even if it is only yours.

    Sure, we will look with restraint and sympathy on the 95 year-old who helps his 92 year-old, helpless, bedridden spouse with the exit process. And we’ll extend the same consideration to the physician who assists. But only on a case-by-case basis, and you have to take your chances that we’ll decide correctly. That, after all, is why the impartial and impersonal law is administered by men: not just to arrive at the truth, but to arrive at justice.

    I am willing to be un-convinced, here. But not by an argument that it’s your life, and you can do what you want with it. That avoids the issue.


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