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Why Suicide Shouldn’t Be a Choice
Brittany Maynard — the face of the assisted suicide campaign
Here in California, SB128 has made it out of the Senate and is heading to the Assembly for debate and a vote. SB128 is a bill to make doctor-assisted suicide legal in California.
When people think about this issue, the scenario that comes up always is that of terminally ill patients who want to end their pain and suffering. You can find support for this position even among Republicans who are older and/or libertarian. The coalition opposed to the measure is constantly struggling to point out that assisted suicide on the basis of personal choice is an argument for suicide-on-demand. You can look at this piece to see the abuse taking place in Belgium, but it also happens here, where miscommunication between doctors leads to one endorsing suicide and another suggesting further treatment.
My colleague, Wayne Johnson, wrote this piece for the Flash Report — a blog of California-based issues — responding to the libertarian argument. It’s a quick read but here’s an excerpt:
“When someone is diagnosed as having less than six months to live, why shouldn’t they be given the choice to end their life on their own terms instead of enduring months of pain and suffering?”
That’s a straightforward question, and it deserves an answer. After all, whose life is it anyway?
The problem, of course, is that once the issue is reduced to a subjective personal choice we are, for all intents and purposes, out of the suicide prevention business.
…
We have to ask, since suicide is already legal in California, why the push to put society’s stamp of approval on it? After all, if it’s really just a personal choice, why should the rest of care one way or the other?
And yet, we do.
We care about the sick, the poor and the unemployed. We care about the heartbroken teenager, and the kids whose parents are going through an ugly divorce. Our heroes are the good Samaritans and the rescuers, those who place themselves at risk for others. Those who care. And if we deserve to be called a just and compassionate people, we will continue to not only care, but to intervene.
Your thoughts?
Published in Culture, Law
And a lot of that makes sense: it’s the living who have more processing to do, not the deceased. That is an important, but different, matter than “does the government have the right to intervene if someone wishes to kill themselves,” which as another poster pointed out is a kind of legislation that will be as successful as Prohibition, and for the same reason.
http://mentalhealthdaily.com/2014/07/24/is-suicide-illegal-suicide-laws-by-country/
It occurs to me that many advances in medical technology cause moral dilemmas for the ones who have to practice then. After all, when medical technology wasn’t very advanced, there was little that could be done aside from providing basic comforts as you watched someone die.
Now that we have more options available like, say, transplant and dialysis, how much to believe the patient when he says he doesn’t want those options (or the patient’s family if they say he doesn’t want them), and how much to pressure patients into receiving treatment on the grounds that they’re merely depressed or whatever, and their bad feelings would pass if they just got treatment, must make at least some doctors morally uncomfortable.
The government is not conflict free on this issue, nor is the medical profession. Medicare bears the cost of long-term chronic care, even pallative care. Then there is the cost of end of life medical intervention, which can be shocking. When we took my mother-in-law to the hospital after an incident (three years surviving small cell lung cancer) we were told she might survive the brain surgery to required to remove the metatastic tumors in her brain. This was proposed as a legitimate option. My mother (pancreatic cancer) was offerred surgery at the end, though it offered no chance of survival, just a few desperate additional weeks clinging to death. These measures, offered and sometimes elected, come at great cost and this is largely born by the government.
Then there is the death tax. Estates diminished by end of life interventions are depleted and yield less tax revenue. Live people have no estates to tax.
We should be wary of this suicide movement. Murder is murder, whether yourself or someone else. Likewise, rational life end decisions should consider the fact of a final reckoning and must consider whether the quality of a death deferred is worthy of the pain, cost and suffering associated with radical medical intervention.
Sorry, I am still working through the conundrum of Belgian doctors euthanizing patients without “consent” somehow not being murder. (or being called murder – euthanize, such a polite, antiseptic, word.)
Especially in the EU, where the state isn’t allowed to impose a death penalty.
Contrary to popular belief, the EU has the death penalty, they just don’t impose it for criminal offenses; They reserve it for the weak and infirm and often as a means to save money.
In at least a few cases of alleged euthanasia, all that’s going on is a dispute between the family and doctor as to whether the pain medication given was excessive and hastened death, and if so, was that excess deliberate? Or alternately, did the doctors deliberately and deceitfully avoid doing all that the survivors wanted them to do to keep the patient alive?
A person without advance directives may not be in a state to say that he refuses to be slow-coded, or whether his end-of-life goals prioritize longer survival, or pain control that comes with a risk of hastened death.
The one time I received a morphine shot, I quickly became unable to breathe. No one intended for the morphine to do that. And of course the hospital staff did all they could to make sure I got through that temporary inconvenience. But would it make sense to do all you could for someone already very near death with no hope of recovery?
Have you turned British, Midge? That there’s some Anglo-style understatement.
Midge, you may wish to link to your post on… I forget the exact title, but “those of us who shouldn’t exist” gets the gist of it, as I recall. Basically, those with from-birth or at least near-birth chronic conditions for whom essentially all of living is “on support” of some kind or another. IMO, it’s a real eye-opener for those who assume that living is easy.
And the unborn who are the weakest of weakest.
It was a temporary inconvenience. The nurse was right there, and everything was restored quite quickly. The breathing reflex took a while to come back, but I know some breathing exercises, and if I concentrated hard enough, I was able to make myself breathe soon enough.
The bigger point is these things happen, even when they’re clearly not deliberate. The reason people worry about doctors nefariously hiding behind these ambiguities for immoral purposes is because there’s a lot of ambiguity to start with.
I think most conservatives assume that life isn’t – or shouldn’t be – easy. The sheer weirdness of relying on prolonged medical support, though, can baffle even the most fervent devotees of the strenuous life. Here’s the post.
I actually do some research in this area with a social psychologist (see our dry academic papers coming out in the next few months ; )
But you’re both right. While advance care directives are important to complete, it is difficult to anticipate what exact questions and limitations will be confronted, and it is difficult to accurately predict how we will fill at the time…either about ourselves or others we care for. Often functioning and mental trajectories don’t follow what is predicted or aren’t linear, complicating already difficult decision making.
Here is a paper (for those so inclined that discusses it) discussing medical decision making and general including pain control.
http://www.cmu.edu/dietrich/sds/docs/loewenstein/hotColdEmpathyGaps.pdf
Sorry to keep going on, but I deal with this all the time.
My 82 year old mother (still mentally intact, still living independently with some help) has one kidney (renal cancer about 25 years ago).
She is adamant she will NEVER have dialysis. She doesn’t want to be stuck doing hemodialysis in a clinic three days a week and being “a burden to others.”
Thus, whenever she is in the hospital (most recently for a knee replacement) she makes me say I won’t put her on dialysis. Then I say, I understand you don’t want dialysis, but if after surgery your kidney’s need some temporary support, I’m going to say yes. She says no. I say, if you’re unconscious, my instructions trump your instructions. So, you would have temporary dialysis in the hospital…then we could make arrangements if she declined after she came off of it–or she might qualify for home dialysis or things may change or we may never face this situation.
Either way, there is likely a gap between how she would decide right now, when she is anticipating the decision, and when she comes face to face with it.
As with many things I’m of two minds about this. On the one hand, when asked if I have a living will, I state that I don’t but my wish is to live no matter the expense or effort. I further state that my wishes do not matter in the long run as the doctors, etc. will do what they please regardless of my wishes.
On the other hand, dying is easy. I simply stop taking my medications for about three days and I’m done. I’ve often thought of that as an indicator of when to go…when I can’t remember to take my meds.
It’s difficult to reconcile the logical with the emotional on this issue for me, for all it’s importance. I feel sometimes it’s something I have little control over for myself as I’ve no way to make sure my desires are enforced. I can make my wishes known but in the end it will be someone making the decision to pull the plug in order to save some money. I can, however, check out any time I want by simply stop trying so hard to live.
If my personal feels are so muddled, is it any wonder I have trouble reconciling the larger picture of proper social standards on the subject? How are you personally affected by your decisions in your own life?
I think the pro-suicide side of the argument feels like it is something under our control. We’re the ones that try to communicate that these matters are beyond us and so it’s folly to try to play God in these circumstances. That’s probably coming more from religious groups.
I think it’s worth reiterating that you have the right to refuse care so we’re not really talking about when to decide when all hope is lost for survival. While this scenario is used as a pretext for the bill legalizing doctor-assisted suicide they activists pushing this issue are for suicide on-demand.
There’s also a distinction between taking your own life and enlisting others to facilitate that decision. There, we’re talking about imposing obligations on a third-party, not an individual right.
Sorry if this has already been covered, but suicide is already a choice. Any terminally ill patient has the legal and (usually) practical option to find any creative or utilitarian means of ending their life. What we do not do is to permit physicians to collaborate with the terminally ill patient in this endeavour.
One of the reasons that we don’t is that we would be changing the nature of the medical profession, perhaps in ways we cannot imagine. We currently enjoy a lot of trust in physicians; the Hippocratic oath and thousands of years of medical ethics has created a culture wherein doctors try to save their patients and alleviate pain, not end their lives. That is a tremendous benefit that many people take for granted.
The other problem is that once suicide becomes a legitimate form of medical treatment, it becomes a legitimate form of medical treatment. Several years ago, Oregon floated the idea of paying for assisted suicide for some types of cancer, but not for chemotherapy. The advantage of keeping suicide outside of medicine is that insurers, the overburdened and indebted government, and family members can’t push it as a valid option.
If suicide is to be legal- and by suicide, I mean the active ending of a life, not just ceasing to take medications or other interventions- why not let the attorneys bureaucrats handle it? Forms in triplicate, filed with the State, fees paid and all. Doctors should be no where near the process. When I go to the doctor, his job is to help me live, not to lead me to a liability-free, cost-effective death. If people want to pursue this, fine, but it is not a medical issue and doctors should have nothing to do with it.
In the link regarding the Belgian cases there is the opening sentence, “A study published this month in the Journal of Medical Ethics examined the “deliberate” euthanasia of patients in Belgium without their explicit, voluntary consent as required by law.”
Explicit, voluntary consent – without which a doctor becomes a serial killer, kind of like Charles Cullen.
Forgive me, if this also has been already covered. But in Oregon and Washington there has already been lax oversight. Kate Cheney, was 85 and died of assisted suicide, even though she had early dementia. Her first doctor would not prescribe the drugs. Her daughter went to another doctor. The second doctor ordered a psychiatric evaluation which found that she lacked “the very high level of capacity required to weigh options about assisted suicide. The daughter went to yet another doctor, who insisted on seeing Cheney alone. He deemed her competent, while noting that her choices may be influenced by her family’s wishes and her daughter may have been somewhat coercive. She soon took the drugs and died, but only after spending a week in a nursing home. (Oregonian Oct. 17th 1999)
She is only one of several examples of coercion.
Doctors practice medicine. Sometimes give inaccurate prognoses.
This prescription, is the same one that is given to prisoners who are put to death. We all have read the stories of it being considered inhumane to kill someone with these drugs. No guarantee your loved one will go “peacefully”.
Doctors are forced to lie on the death certificate. I assume this is to make sure life insurance policies remain intact, because if you write suicide — it could prove the policy was no longer valid.
Once the prescription is given, there is no follow-up if they ended up not taking it. Where does the RX end up?
AND? My parents have taken me off the DNR paperwork, because of my stance on this bill. This shows two things; One, I will always be a child in my parents eyes– and b., People do not understand this bill vs. the right to refuse care or that those who are against this becoming law want to keep people on life support forever. People who are against this bill, be it for religious reasons, or ethical reasons– more often than not simply do not what their lives or the lives of others having value associated with their life They most certainly do not want their lives/deaths in the hands of the Government.
People with disabilities are very concerned. I have voiced my concerns on how this bill, if it became law, would impact our Veterans– we already disregard them and fail to give them the care they need. Sure, go fight (or be forced to stand down) for our country, but dang if you come back disabled or depressed– here is this cheap alternative. I mean after all, your life no longer has any value.
Once a law is put in place it becomes socially acceptable then it becomes moral.
This is not about choice or rights, its about our Liberty. It’s a cookbook. (Twilight Zone)
AND I resent Sen Wolk greatly for taking the bill off the floor because she knew she didn’t have the votes.