They tell us that suicide is the greatest piece of cowardice… that suicide is wrong; when it is quite obvious that there is nothing in the world to which every man has a more unassailable title than to his own life and person. – Arthur Schopenhauer

In an attempt to get a dialogue going once again on the issue of euthanasia, the NY Times published a piece recently that brought together the authoritative voices of various advocates and opponents of laws that seek to end the suffering of terminally ill patients by allowing them to choose to die with dignity with what’s become known as physician-assisted suicide(PAS).  I have conveyed my sentiments on this issue in two previous posts of mine here and here.

I support the end-of-life right for people who painfully suffer from incurable diseases to die with dignity, through either direct PAS or one that allows that patient to do so on their own with a physician prescribed medication.  In the U.S. the states of Oregon and Washington currently have “Death with Dignity” laws that subscribe to the method by which the patient, after careful scrutiny by physicians, family members and the state, are allowed to ingest a physician-prescribed medication to end their life.  Montana would have been the third after their Supreme Court ruled in 2009 that physician-assisted suicide is legal, but it’s inception into the law of the land has been held up in the state’s legislature currently through the efforts of religious right-to-life groups like the Montana Family Foundation. 

One of the contributors in the NY Times article opposed to such right-to-die legislation made an admirable attempt to defend her views but who I thought fell short.  Marilyn Golden is a senior policy analyst at the Disability Rights Education and Defense Fund(DREDF).  From what information I can gather about the DREDF it appears to be a reputable organization that, according to their website’s mission statement, is a strong advocate for people with disabilities so they can “live full and independent lives free of discrimination.”

Ms. Golden’s argument in her essay however highlighted only one incident to support the notion that Oregon’s law is weak, citing the case of Michael P. Freeland who according to one source had a history with mental illness.  Though Mr. Freeland received a lethal dose of a barbiturate from a licensed physician, he never actually took the drug but died instead a year later from the lung cancer that pushed him to seek help under Oregon’s Death with Dignity law.  Barbara Coombs Lee, the president of the Compassion in Dying Federation in Oregon whose group worked with Mr. Freeland makes a good counterpoint to Ms. Golden’s assertions.

“None of the physicians who were caring for him judged him incapable of making this very important health care decision, and he proved them right,” Ms. Lee said. “He never did spontaneously, irrationally and out of some depressive pathology take his medications. He never took them at all. I would look at this case and say it shows the system works.”    SOURCE

In all fairness to Ms. Golden, she does seem to make a reasonable case against the minimal data collection process of the state as being “flawed”.  But I say this without having seen or read any arguments from those who support Oregon’s process.

The other legitimate point made by those who are opposed to legalized euthanasia is that our current state of health care in this country does less to prolong the life of all individuals, especially the poor, giving the appearance that our society is too willing to allow people to end their lives rather than supply them with the resources to live out their lives with quality health care.  This of course is not a problem for more wealthy people who can afford all the latest health care technology and pharmaceuticals available in the free markets.

But for people whose incomes are stretched to make ends meet, they may find themselves with an insurance policy that has very high deductibles or have no policy at all because of unaffordable premiums, making out-of-pocket costs for quality health care beyond their reach.  There are also those who may be able to afford both high premiums and high deductibles but who have been rejected by insurance companies until the recent passage of the Affordable Health Care Act that prohibits denial of coverage because of a “pre-existing condition”.    This too however may disappear if the Supreme Court rules against what opponents have derisively called “Obamacare”.

In their essays, the opponents of Death with Dignity legislation don’t pull out the “God” card that allows them to say, “only God can take a life”.  Religion’s role in this battle however is there, just below the surface.  The pervasive religious restrictions towards euthanasia imposed by the American Catholic Church as well as many Protestant fundamentalist sects are all too prevalent.  One 1998 study found “that the odds of the nonreligious approving physician-assisted suicide are three times greater than the religious … .”

In conjunction with this are attitudes many have towards the health care system in this country.  “Americans are more distrustful of their health care system — for good reason”, says Marcia Angell in her argument.  Ms. Angell is the former editor in chief of The New England Journal of Medicine

[Americans] are well aware that insurance companies increase their profits by stinting on medical services, and they suspect that the new health care law will also stint on services to rein in Medicare costs. So any practice that might save money raises the specter of rationing. In Europe and Canada, where there is universal, comprehensive and largely nonprofit health care, there is much less worry about abuse of right-to-die laws.     SOURCE 

Her second point is expanded on by Petra M. de Jong who notes that since 1960, health care in the Netherlands, where Ms. de Jong resides, “has developed enormously. People live longer and a wide range of treatments is possible.”

Euthanasia and assisted suicide can only be legalized in a country with optimum health care, including palliative care. But most of all, with citizens having access to good health care, regardless of their income.     SOURCE  

Patricia King, adjunct professor at Johns Hopkins University’s Bloomberg School of Public Health, agrees with Ms. de Jong about the Dutch as she discusses how social divisions, unlike those we have here in America, have been mediated by “a robust social welfare system, including universal health care”.

… many Americans — particularly the poor, the disabled, the elderly and members of racial and ethnic minorities — worry that if assisted suicide becomes widely available they will be viewed as “throwaway people.” They fear coercion, stigmatization and discrimination, understandably believing that the societal indifference prevalent throughout their lives will also infect their end-of-life care.

Assisted suicide should not be legalized in America before we have addressed our glaring inequalities in health care and other crucial social services in a way that assures marginalized groups that they too will be treated with respect and dignity at the end of their lives.   SOURCE 

Do legitimate concerns exists where the quality of life for some Americans will be viewed in “cost benefit analysis” terms within a system that allows physician-assisted suicide?

Americans are pretty much divided on the question of PAS.  One Gallup poll shows that only slightly more – 48% – find it morally wrong than the 45% who find it acceptable.  Underscoring the point about the elderly’s concern with the abuse of this medical treatment, fewer people who were 55 years or older – 43% – found it less acceptable than the age group between 18-34 at 46%.  But time tends to change the views of those polled on this subject.  Between the years of 2004 and 2009 there were majorities that found PAS acceptable.  One poll done by the professionals at Angus Reid in 2010 found that 42% of Americans supported legalizing euthanasia in the United States while 36 per cent opposed the notion.

The Gallup poll mentioned above shows that as a political group, Republicans oppose physician-assisted suicide in larger numbers than Democrats or Independents.  Isn’t it ironic that this same group also has larger numbers who vociferously oppose what they view as “socialized medicine” or what Ms. de Jong more civilly refers to as “a robust social welfare system, including universal health care”.

People who are in great pain with terminal illnesses and whose quality of life isn’t much beyond that of the caged factory farm animals that supplement most diets in this country, deserve to die as they see fit and with a measure of dignity.  The reluctance by many Americans to get on board with a legitimate, licensed system with strong, consistent oversight to allow such a medical procedure to be instituted in this country appears to be the result of sincere but misplaced religious views, fear that those who can least afford it will be too easily “put out to pasture” by an uncaring society, or a combination of both.

Oregon and Washington states, as well as those other Western countries that share aspects of our culture, have legalized physician-assisted suicide in some form and have yet to be shown that the worst fears of their opponents are becoming a reality.  The role of people like Marilyn Golden are important to see that their concerns do not materialize, but their views and the views of others should not be a barricade to prevent the choice an individual makes that serves their best interests to take that final step with life and end it on their terms.  To continue this practice is cruel and unusual punishment as that standard conveys.  People forced to deal with excruciating pain to satisfy another person’s moral qualms or some legalistic purview have a right to die with dignity.

Death is not the greatest of evils; it is worse to want to die, and not be able to.  – Sophocles

Is denying the terminally ill patient their right to die with dignity a form of torture?

Posted by lbwoodgate in Health Care Reform, seniors/aging Tags: Assisted suicide, Death with Dignity National Center, End-of-Life, end-of-life rights, Oregon's Death with Dignity law, physician-assisted suicide, terminal illnesses and diseases