Saturday, May 9, 2009

Why Physician-Assisted Suicide is Not Good Enough

The political position in favor of a general right to suicide has few advocates; in terms of numbers, it is a rather extreme position. Much more common - common enough to be the majority in a few states - is support for a limited right to suicide for terminally ill people, with physicians as gatekeepers for that right.

I have often written on why restricting suicide rights to terminally ill people makes no ethical sense. But there is another major problem with "Death With Dignity" laws like that of Oregon and Washington: physicians are the gatekeepers to the right to suicide, taking control of death away from the individual. "Patients" must depend on physicians in order to be allowed to die. And enough physicians are refusing to "assist" that the right to suicide is empty of practical meaning.

It has been months since Washington's Death With Dignity law passed, which allows a terminally ill person to access a prescription for a lethal drug. But the scheme requires the cooperation of doctors; and in areas outside Washington's big cities, doctors simply aren't cooperating, reports Kim Murphy in the Los Angeles Times ("In rural Washington state, law allows assisted suicide, but most doctors don't," May 7, 2009).

Personally affected by this injustice was Stephen Wallace, a victim of terminal pancreatic cancer. Wallace was unable to find a single physician in his area willing to make the lethal prescription at his request. From the article (emphasis mine throughout):
Cancer of the pancreas has a cruel reputation, delivering what some say is the most intense pain humans can imagine. It killed Wallace on April 8.

"It was very hard to watch my father die that way," said Tricia Crnkovich, who took turns with her brothers and sisters in Wallace's small bedroom as he shrank from 250 pounds to 60, losing most of the weight in the two months before he died. "I'll tell you, if I ever get cancer," she said, "I don't want to put my kids through that."

Wallace's treatment at the hands of medical professionals was appalling. Even beyond the fact that his request to die was ignored, his pain was not being adequately managed because of "concerns" of his nurses.

. . . . Crnkovich said her father had been given strong medications when he went home from the hospital, but that his nurses had resisted increasing the dosage as his pain grew more intense.

Soon Wallace's mental state began to deteriorate. Because the assisted-suicide law requires a 15-day waiting period between the first oral and the first written requests for lethal medication, and an additional 48 hours before the prescription can be written, he no longer qualified.

"He couldn't talk for the last eight days," son Steve Wallace said. "He was not in contact with reality. I'd come in there, and he'd call me somebody else."

Mr. Wallace's nightmare had come true. He had, the article states, watched his wife die of cancer, in miserable and unrelieved pain; he did not want to die like that.

Near the end, Steve and Ginny could hardly stand to be in the house because his father was in so much pain. By the time the doctor said his medication should be increased despite the nurses' concerns, it was too late.

"He was just moaning and screaming, and it got really bad on Friday," Ginny said. "By Monday when we left, he was just screaming at the top of his lungs."

Meanwhile, major hospitals in Washington are refusing patients' right to die as a matter of policy, making the extremely limited right to "Death With Dignity" even more meaningless. From the Seattle Times:

Olympia area hospitals won't offer assisted suicide services

OLYMPIA — Providence St. Peter Hospital and Capital Medical Center officials said Thursday that the hospitals will not participate in physician-assisted suicide under the state's new Death with Dignity law, but instead will refer terminally ill patients to their primary doctors.

Providence Health & Services spokeswoman Karina Jennings said Thursday that the same standard applies for all of its medical facilities and nursing homes in Washington and Oregon. The key reason: Providence is a Catholic health care organization, and physician-assisted suicide is "not a path conducive to our values," she said.

"We don't believe that health care providers should be put in the position of taking someone's life," Jennings said.

Because of its extensive involvement in health care, the Catholic church is able to impose its values on millions of non-Catholics - and Washington's law does nothing to prevent this. We have already seen the morally repugnant position of the Catholic Church on assisted suicide and suffering: suffering is good for you. Says the Most Rev. Carlos Sevilla:

Initiative 1000 is an attack on our most fundamental beliefs and teaching, and placing it on the November ballot would contradict our proclamation of the gospel of life . . . Pain and suffering and illness are important parts of our faith experience. [Emphasis mine.]

He would probably be so bold as to say to Stephen Wallace's children that screaming at the top of his lungs in pain as he died was an important part of Wallace's faith experience. Which might have come as a surprise to Wallace.

The ethical arguments about physician-assisted suicide often focus on physicians' autonomy, emphasizing the right of a physician to avoid helping someone commit suicide (or, as hospital spokeswoman Karina Jennings misleadingly puts it above, "taking someone's life"). But the physician's "right" must be considered against the background of "rights" that have, in our system, been taken away from the patient and given to the physician. Perhaps a physician shouldn't have to assist in a suicide; but the patient will not be able to help himself and exercise his own autonomy without the physician's action, because of the drug prohibition. The only comfortable sort of suicide - a suicide by overdose of fast-acting barbiturates - is only "assisted suicide" in that competent adults are generally prohibited from accessing the necessary drugs. Given our existing laws, it is either naive or cruel to refuse physician "assistance" (drug provision) to a would-be suicide.

At any rate, suicide should not be a medical matter. Physicians should not be the gatekeepers of suicide rights - it is unfair to physicians and unfair to people who want to die. The choice to die, and the responsibility for the act, should fall on the individual, not on his physician. From Thomas Szasz, in Fatal Freedom: The Ethics and Politics of Suicide:

Although performing an abortion and developing effective methods of birth control entail the use of medical knowledge and skill, abortion and contraception are not medical matters. The same is true for suicide. Although killing oneself with a drug entails the use of medical knowledge and requires access to the necessary substance, suicide is not a medical matter. We ought to deal with death control the same way we have dealt with birth control: by removing it from the purview of Medicine and the State, by repealing all medical and legal interference with the act. [Bolded emphasis mine; italics in original; citations omitted.]

2 comments:

  1. I recently watched the movie "The Mosquito Coast". Near the beginning, the protagonist recounts an incident in which his mother (dying in a hospital) asked him to give her rat poison to finish her off. I didn't think about it then, but on reflection his reaction to it (walking away because he couldn't bear to see what was happening to her) was a great example of his self-centered nature. I wonder how the director (or author, haven't read the original novel) intended for the audience to react to the ethics of that situation. In the show Dexter the example amateur euthanasia is clearly portrayed in a positive light, but considering the rest of the show perhaps that isn't saying much.

    ReplyDelete
  2. People who are most likely to support a right to suicide (in my not-empirically-verified but extremely informed opinion) are people who have seen a close family member die slowly and painfully.

    But yes, most people can't bear to watch. So they don't have to think about it.

    ReplyDelete

Tweets by @TheViewFromHell