Category Archives: Health Care Reform

Columnists Ross Douthat and Ezra Klein engage in a dialogue that raises the conventional concerns about physician-assisted suicide as they continue to overlook the deeper basis of this social issue – human connections deprecated by self-interests.

Many people have feelings that oppose a person’s right to die based on a sense of morality that either comes from their religious upbringing – “Only God has the right to end a life” – or from secular people who simply feel that life is too precious to give up without a fight.  Whatever pain we endure, physically or emotionally, there is always reason and cause to continue our existence out of respect for this one and only “gift” we have been given, some would argue.

In a couple of columns based on this subject that were spurred by Dr. Jack Kevorkian’s recent natural death, Ezra Klein with the Washington Post and Ross Douthat with the NY Times broached the subject with insights of a moral nature that suggest legalized physician-assisted suicide would hurt us more as a society than help us.   Let’s take a look at the points both writers make in their columns and see if there is something missing.  Douthat’s two columns, here and here, began the dialogue and ended with a follow-up after Klein responded to his original post.

Ross Douthat (RD): “[A]ssisted suicide seems to depend on human sympathy — on the impulse toward mercy, the desire to ease what seems like pointless pain and suffering. Why shouldn’t the terminally ill meet death on their own terms, rather than at the end of prolonged agonies? Why shouldn’t the dying depart this earth with dignity, instead of enduring the inexorable stripping away of their physical and mental faculties?”

But if such sentiments are understandable, they are morally perilous as well.  Even when death is inevitable and inevitably painful, it is not considered merciful to prescribe an overdose to a cancer victim against her will, or to gently smother a sleeping Alzheimer’s patient.

The difference, of course, is that Kevorkian’s clients asked for it. That free choice is what separates assisted suicide from murder, his defenders would insist.  But this means that the moral case for assisted suicide depends much more on our respect for people’s own desire to die than on our sympathy for their devastating medical conditions.  If participating in a suicide is legally and ethically acceptable, in other words, it can’t just be because cancer is brutal and dementia is dehumanizing. It can only be because there’s a right to suicide.”

I would debate the sole contention Douthat makes that the public who have seriously studied this issue is more consumed with the notion of rights than sympathy for one who has to endure an incurable physical pain for the rest of their life.  But the next comment from Douthat is a leap that seems more like he’s grasping at air to defend his view that end-of-life decisions or against God or nature’s will and will serve to weaken our social character.

RD: “And once we allow that such a right exists, the arguments for confining it to the dying seem arbitrary at best. We are all dying, day by day: do the terminally ill really occupy a completely different moral category from the rest? A cancer patient’s suffering isn’t necessarily more unbearable than the more indefinite agony of someone living with multiple sclerosis or quadriplegia or manic depression. And not every unbearable agony is medical: if a man losing a battle with Parkinson’s disease can claim the relief of physician-assisted suicide, then why not a devastated widower, or a parent who has lost her only child?”

I really know of no one that would defend the right to end one’s life simply because “We are all dying, day by day.”  Nor have I heard any suggestion by those who promote right-to-life legislation or those physicians who carry out these acts that emotionally distraught people like “a devastated widower, or a parent who has lost her only child” are legitimate candidates for physician-assisted suicide.  Nor would I expect any to develop such a connection.

This is the “slippery slope” that Douthat assures us isn’t “hypothetical” based on the evidence from a Detroit Free Press investigation in 1997 that found … 60 percent of those [Kevorkian] assisted weren’t actually terminally ill. In several cases, autopsies revealed “no anatomical evidence of disease.”  This may be true but all did suffer from chronic pain from which their was no medical relief that was not costly, lasted indefinitely and self-medicated.

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The limitation, imposition, and interference that severe pain causes on it’s victims over long periods of time ultimately create the mental depression that eventually forces them to look toward ending their own life.  Unlike the distressed widower or parent who Douthat refers to, the patient who has reached a level of chronic pain cannot take their own life because their physical condition has left them dependent on others to help perform basic daily routines like bathing themselves or having a bowel movement.

The fear Douthat generates that emotionally distressed people will earn the right to die and succumb with the assistance of a licensed physician ignores the fact that in the few states that do allow this right, along with a  couple of other countries, none consider candidates who suffer emotional trauma alone.

In the Netherlands where “voluntary suicide” became legal in 2001 “euthanasia by doctors is only legal in cases of “hopeless and unbearable” suffering. In practice this means that it is limited to those suffering from serious medical conditions and in considerable pain. Helping somebody to commit suicide without meeting the qualifications of the current Dutch euthanasia law is illegal.”   In Switzerland the organization Dignitas (see my earlier article on this) assists only those with terminal illness and severe physical and mental illnesses.

Ezra Klein’s argument on this issue first suggests that physician-assisted suicide might actually decrease the rate of self-inflicted suicides but then opposes it based on the findings of Ezekiel Emanuel that suggests not all those who endure “unbearable physical agony” are motivated to seek end-of life options.  Some of these people go out of their way to make sure their doctor has never performed physician-assisted suicide or euthanasia.

EK: “You could even argue that the option of physician-assisted suicide might reduce suicides: The promise of a painless and safe death, one with no chance of failure and no grisly spectacle for loved ones, might be enough to persuade people who want to swallow a bottle of pills now to wait and begin working with a doctor instead. That creates time between the intention and the act, and that’s time in which the individual might reconsider, and time in which a professional caregiver is going to attempt to help them find treatments to ease their pain.

But for all that some of the arguments for physician-assisted suicide are convincing, this article by Ezekiel Emanuel continues to give me pause. Emanuel shows that unbearable physical agony is almost never the reason patients give for seeking euthanasia. “My own recent study of cancer patients, conducted in Boston, reveals that those with pain are more likely than others to oppose physician-assisted suicide and euthanasia,” he writes. “These patients are also more likely to say that they would ask to change doctors if their attending physician indicated that he or she had performed physician-assisted suicide or euthanasia. No study has ever shown that pain plays a major role in motivating patient requests for physician-assisted suicide or euthanasia.” Depression and other forms of mental distress — which are, of course, a sort of pain — are by far the more common motivator.

Emanuel also worries that the option of euthanasia will lead to worse care for the dying, and perhaps even subtle coercion on the part of loved ones and medical professionals who can no longer bear to see a patient suffer, or, more worryingly, can no longer afford to treat their suffering.

In the end, Emanuel says, the proper policy is to “affirm the status of physician-assisted suicide and euthanasia as illegal” while making it possible for doctors to prove that this or that case was extraordinary enough to be the exception. ‘Such a policy would recognize that ending a life by physician-assisted suicide or euthanasia is an extraordinary and grave event,’ which is probably as it should be.”

Both men make intelligent and articulate cases to portray right-to-life legislation as something that our society should avoid.  But neither put all their information together in a manner that other thoughtful people could support.

Clearly the insufferable long-term pain some people endure is not in of itself the sole reason all or even most elect to end their lives.  Their minds have to reach a point that tells them there is no hope for ending the pain and the quality of life they once knew will never return.  They are further depressed by the high costs of keeping them alive  and the imposition they pose on healthy family members and friends.

Slippery slope arguments are always part of the equation by people who can’t support with data what they believe will happen.  Worse scene scenarios are less likely to occur than they are to scare people into believing they may come true.  The fact of the matter is that life, as precious in concept for many as it is and is a reality for a lot of others, just doesn’t factor any realistically with terminally ill patients or those who may not be terminally ill but whose “quality of life” endures unbearable pain.

The fear that weak-minded people who are depressed will be allowed to legally take their own life under clinical conditions is a scenario that can only come true when society in general becomes so self-absorbed with individual needs and wants than with the larger communal life they share with others.  Once we allow ourselves the “right” to seek only our own self-gratification, our own self-interests, then we are subject to a moral failure that would permit easy exits from this life in the form of suicide.

Humans are by design social creatures and need and rely on each other for their well-being and healthy existence.  Independent lifestyles are limited within the context that we can choose material differences between us but the nature of our being revolves around being wanted by others and sharing our desire to be a part of other people’s lives.  People who are terminally ill or endure incurable physical pain may have some support systems within a small circle of friends and family but are aware that the larger society view them as irritants to their self-interests.

Feeling connected to the larger social structure is absent in most all cases but that has become a condition of a world where small clans are no longer the norm due to exponential population growth over time.  Where there is a sense of “community” within the life of those who endure great physical pain and are aware that they only have months to live, it may be likely that those people will eschew suicide in any form.

Perhaps this is what both Douthat and Klein are most concerned about without fully realizing it.  As they and others begin to look around and watch the political and social environment we find ourselves in today devolve into a morass of what’s in “MY best interests”, there may indeed be a legitimate concern to dread that legal suicide will take hold as the social context of life we evolved from disappears.  It’s not that right-to-die legislation will create a demoralized society but that as we break the bonds that unite us as humans, we generate the need to find legitimacy in suicide.

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Mercy Killing or Senseless Suicide 

Posted by lbwoodgate in Health Care Reform, Social Discourse, Society and Politics Tags: Assisted suicide, chronic physical pain, Euthanasia, Ezekiel Emanuel, Ezra Klein, Jack Kevorkian, quality of life, right-to-die issues, Ross Douthat, suicide