Physician aid-in-dying, aka physician assisted suicide, has been debated in many articles over the past 10 years. It is often enlightening to read the online comments that frequently follow such stories. A common theme is that we opponents are heartless zealots who don’t appreciate the suffering of others. A sample comment: “Obviously they’ve never been with a dying patient, or they would feel differently. I saw my parent die a painful death, a death I wouldn’t wish on a dog! I want this option so I can avoid the same pain and suffering!”
I would never minimize the emotion, fear and sincerity inherent in such comments. But, rather than being callous toward suffering, we who oppose prescription death are concerned with the great suffering that may occur as a result of legal assisted suicide.
Vermont recently became the third state to enact “right-to-die” legislation, following Washington and Oregon. However, good law has little or no negative unintended consequences. Unfortunately, the legislation enacted in Vermont does not pass that test. The potential is enormous for misuse, abuse and coercion. The legislation was cobbled together seemingly overnight in a last-ditch effort to create a compromise. It contains almost no safeguards, and will undoubtedly expose the most vulnerable citizens to potential abuse.
For example, the law allows a patient whose ability to communicate is compromised, to request the lethal drugs through an interpreter—defined as a person who is “familiar” with that patient’s manner of communicating. This could be an heir who has financial motives for wanting the person to die before the illness consumes his financial resources. As any estate lawyer will attest, it wouldn’t be the first time a family member with less than noble motives influenced an elderly person to sign papers that were not in his or her best interest.
Also, once a patient has a prescription in hand, there is absolutely no oversight whatsoever for the collection or the ingestion of the drugs. Even if a person ultimately decides against suicide—he might be forced or persuaded to take a lethal dose by an unscrupulous caregiver. There would be no investigation of the person’s death and the cause of death would be documented as the underlying illness. These are just two of the dozens of possible scenarios.
Proponents of assisted suicide say it’s about “choice,” but putting suicide on the approved list of end of life ”treatment” options will reduce choice for the vulnerable. Since Medicare does not pay for long term care, and Medicaid only kicks in when all assets are gone, it’s reasonable to project that poor people without family to care for them may feel they have no other choice but to end their lives in this way, particularly when their doctors present it as a viable treatment option. “Choice” to die quickly becomes “duty” to die.
Another myth promoted by proponents of assisted suicide is that it will be used only by those in extreme pain. In fact, pain is not among the top reasons given for requesting assisted suicide in places where it is legalized, like the state of Oregon. Tellingly, fear of being a burden is.
We believe the health care system can do better than to “treat” a suffering person by helping him kill himself. Palliative care and pain management have come a long way in the past 20 years, but not all people have access to the best that is available. That must change. Sadly, as our population ages and the burden on the health care system grows, it will become increasingly more difficult to make that change in an environment where prescription death is an option. There have been cases in which the Oregon health plan denied treatment for people with terminal illnesses, but offered to pay for their prescription suicides instead.
It’s time to rethink the meaning of “dignity”. Needing help does not equal loss of dignity, despite widespread attitudes which embrace independence and control among the highest goods. For the disabled, and for those at the end of life, submitting to the service of others is a reality of life, but it is not undignified. My own mother is an example. At age 90, she has advanced congestive heart failure and has been at home, in hospice care, with full time support from her children, since January. An exceptionally strong woman who raised eight children, has been widowed twice, and has lived alone for the past 20 years; my mother defines independence. Yet, in her frailty, she has been able to accept gracefully help from the children she raised, giving us the ultimate gift in the twilight of her life by allowing us to serve her in the same way she once lovingly served us.
Herein lies the true dignity.
Carrie Handy holds a Bachelor of Journalism degree from the University of Missouri-Columbia, and is a free-lance writer , journalist and public relations consultant with more than 30 years of experience working in health care and in the nonprofit sector. A trained hospice volunteer, over the past two years she has been actively involved in advocating and caring for several terminally-ill relatives, including her mother. She is a board member of True Dignity Vermont, a grassroots, citizen-led initiative that has worked vigorously to oppose assisted-suicide in Vermont.