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Suicide in the context of terminal illness, or a loss of quality of life, physician-assisted suicide … I have conflicting feelings. I am adamantly opposed to physician-assisted suicide. If people want to kill themselves, they can acquire their own means to do so. Yes, this is a disadvantage to some, but by insisting all have the same opportunity we open the doors wide for abuse.
These thoughts are shaped by my religious beliefs, as well as my experiences with kids and adults with developmental disabilities, and my work with medical patients. I certainly don’t expect anyone who doesn’t share my religious beliefs to agree.
However, I often hear arguments such as, “If I lose my ability to think, I’m not myself,” or, “If I’m a burden, I’m not myself,” and others that seem to value humans for their ability to think, or care for themselves. Quality of life is often a key component to these arguments.
These messy thoughts are captured in an article in The New York Times Magazine today called The Last Day of Her Life. It discusses the diagnosis and demise of a prominent psychologist and gender studies professor, Sandra (Sandy) Bem. When she was diagnosed with Alzheimer’s, she “vowed that she would figure out a way to take her own life before the disease took it from her.” The confided these plans to her inner circle, who “tried to tune out [their] own anticipatory grief” to “focus on helping Sandy die the way she wanted to.”
As the disease progressed, her life became more limited, and her personality changed, but she continued to enjoy it. Her inner circle began to hope she would reconsider her plan: “The old Sandy, who valued her rationality and her agency, had been clear that she would be unwilling to keep living when she could no longer articulate coherent thoughts. But this newer Sandy didn’t seem unhappy living her life in this compromised way. Ultimately, who should make the decision to die, the old Sandy or the new one?”
The magazine discusses Ronald Dworkin’s famous or infamous arguments in Life’s Dominion: An Argument About Abortion, Euthanasia and Individual Freedom:
[He] wrote about a kind of hierarchy of needs for people in Sandy’s situation, who want their autonomy to be respected even as disease changes the essence of who they are and what autonomy means. He differentiated between “critical interests” (personal goals and desires that make life worth living) and “experiential interests” (enjoying listening to music, for instance, or eating chocolate ice cream). Sandy was appreciating her experiential interests — playing with Felix and working in her garden — but her critical interests were far more sophisticated and were moving out of her reach.
I like his distinction between critical interests and experiential interests. But he values critical interests over experiential ones. This reflects a preference I often see in very bright or educated people. Dworkin is even more specific:
Critical interests should take priority when making end-of-life choices on behalf of someone whose changed state renders her less capable of deciding on her own, Dworkin wrote, because critical interests reflect your true identity. The new Sandy seemed to love being a grandmother, but it was important to take into account what the old Sandy would have wanted.
I often wonder: If someone was adamantly against ending his own life when he was able to articulate his critical interests, but changed his mind when his interests were limited to experiential ones, would Dworkin still be support his original choice? Or does he like his reasoning because it so often works out as he wishes it to?
The next comments are from Sandy’s ex-husband (emphasis mine):
“I still feel as though I’m me,” she told him on one ride. “Do you agree?” He did, sort of. In fact, he was surprised by how much herself Sandy could still be, even as she became less and less the formidable thinker he had always known. He was surprised too to discover that it didn’t matter to him. “I realized how little of the fact that she was an intellectual played into my feelings for her,” he said. “They were feelings for her, not her intelligence. And they were still all there.”
They were still all there … even when her ability to think critically was gone.
As you can probably imagine, this story ends with Sandy taking her own life. What do you think about this? What experiences have shaped your thoughts?