Do we humans have a “right to die” and a “right to assistance in dying”? These questions will soon take center stage in the American culture war. If you choose someone to make your decisions about dying in the event that you are unable, will that person be allowed to carry out your wishes? In the US today, that depends on where you live and whether someone powerful wants to intervene, as Governor Jeb Bush and Senator Bill Frist intervened against Terri and Michael Shaivo, forcing Terri’s brain-dead body to function for seven years after Michael authorized removal of her feeding tube.
Laws against suicide are nearly irrelevant to the individual who ends his own life without discussing it. Legal issues arise if he discusses it with family, friends or health care providers. Can they help him die without pain? Can they be present and comfort him in his last moments? Or are those who know his plan obligated to intervene? What should law enforcement, medical, and mental health professionals do? Can a sane and rational person plan his own demise?
Oregon, Washington and Vermont allow physicians to advise patients on the subject and to prescribe drugs to hasten death if the patient’s situation meets state-specific criteria like terminal illness, severe pain, and limited life expectancy. Montana and New Mexico have court decisions that establish a right to assistance in dying without clear criteria for justification. The New Mexico decision said, in part, “This court cannot envision a right more fundamental, more private or more integral to the liberty, safety and happiness of a New Mexican than the right of a competent, terminally ill patient to choose aid in dying.”
The international “death with dignity” movement advocates allowing individuals to make their own choices and allowing (not requiring) health professionals to advise and assist them. On February 6, 2015 The Supreme Court of Canada ruled that it is unconstitutional to deny physician-assisted death to…“a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition…that causes enduring suffering that is intolerable to the individual…”
Whether we are actively religious or not, most American ethical and moral judgments are consistent with traditional Judeo-Christian teaching that ending one’s own life, with or without assistance, is wrong. Consequently, most states have laws that deny individuals the right to choose the time and means of their own death. American opinions are changing. The United Church Of Christ, Unitarians and a few others say that it can be an appropriate choice. Many mainline Protestant religions (Methodist, Presbyterian, Episcopalian, and American Baptist) don’t formally oppose making assisted death legal but still teach that it is wrong. America’s two largest Christian denominations, Roman Catholic and Southern Baptist insist that it should be illegal; and the Southern Baptists “…call upon federal, state, and local governments to prosecute under the law physicians or others who practice assisted suicide.” Controversy is inevitable because many 21st century Americans value personal liberty over religious dogma and want to make private decisions rather than having them imposed by law.
Like other culture war debates, this one has participants who characterize those who disagree as evil. One Christian fundamentalist spokesman, Franklin Graham, demonized the other side when he said of Europeans, “…where Christianity has been in decline as the deceptive forces of secularism and materialism have grown…it’s not surprising to find the practice of euthanasia so entrenched…biblical Christianity is the only antidote to the devilish, dark culture of sin and death that seeks to enslave and ultimately damn people for eternity.” Likewise, the Scottish Islamic Medical Council applies fundamentalist Sharia Law saying, “…the end of any human’s life is fixed only by our Almighty God, the Creator and the Owner of all life…suicide and euthanasia are both forbidden in Islam…Hell is the outcome and punishment in the after-life.”
“Death with dignity” proposals merely legalize individual choices. They don’t encourage assisted dying or require health care providers to participate. Will Americans allow personal liberty or retain laws that impose rigid values on all citizens? That question will be arising in state legislatures and courts over the next few years. It is time to learn about the idea, talk it over, and prepare for the coming debate.
Assisted suicide may not be the best way to open a discussion of end of life issues. An examination of the practices of the medical profession might make a better beginning point. We forget that not very long ago, physicians had little they could offer dying patients other than pain relieving drugs. Recent decades have brought added many more tools to their arsenal in the battle against death; diagnostic testing, drugs and all manner of procedures.
The modern doctor seems to have forgotten what our physicians of the past knew very well, that death always wins in the end. Now, they bring the full array of their weapons in the struggle against death to win small slivers of time, sometimes only days. But in the struggle to lengthen life, they lose sight of well being. All too often the treatments reduce well being to purchase those few days or weeks.
As medical technology progressed, patients began to look upon their doctors with awe. Expectations grew that any disease could be cured and that a robust life could be extended for decades. A disconnect grew between patients who chose to believe that aggressive treatments would win them many good years while the medical professionals understood that the gains would be much shorter and the cost to well being would be high.
Most of us love life and want to go on as we are for as long as we can. The difficulties of engaging in frank conversations about treatment alternative and their likely outcomes results are immense, but more frankness is needed. Doctors need to provide a more accurate view of the efficacy of treatments. That might be the first step toward allowing patients to develop a more realistic understanding of their mortality and taking a greater responsibility for treatment options.
Thanks to Mike for the insightful comment. Patients, families, doctors and other health care providers struggle every day with the issues he has described. Probably most would agree that the quality of understanding and communication should be improved.
Our individual rights to make our own decisions about the “end of life” issues are generally not limited by laws, especially if we have expressed our wishes through a durable power or attorney for health care or a living will. “Assisted death” on the other hand, is prohibited in most of the USA. The social movement to remove those prohibitions and to see assisted death as an individual right was the subject of the column.
Bottom line, I agree with your comments about end of life issues and I see “assisted death” as a separate but related issue on the horizon.