by Linda Ryan
Not long ago, the House of Lords in London undertook a consideration of physician-assisted death and whether or not it should be made legal in Britain. It has also been a topic here in the US, most recently about a young woman, newly married, who has an inoperable and incurable form of cancer and who has indicated she will pursue physician-assisted death (PAD). Death, however, is not a topic not discussed easily or often. It’s not usually a topic for dinner-table conversations, lessons at school or even mentioned at church. It is, though, a very important topic because it is something we all have in common: all of us will ultimately die, and avoiding the topic does not make it any less final.
The objective of physician-assisted death is to enable people to have some control over their lives when there is really not much anyone, including physicians, can do to either postpone the inevitable or mitigate its effects on both patient and family. We hear stories of people passing quietly in bed with little fuss and seemingly no pain and that’s the way I think most of us would like to go when our time comes. It doesn’t always work that way, though. Death can be very painful, prolonged and, unfortunately, messy. That in itself, as much as for the sake of everyone being aware of the wishes of their loved ones, is all the more reason we need to talk about it while it is still distant enough for us to be objective about it, or as objective as we can be about confronting our own mortality.
The older we get, the more we think about death, willingly or unwillingly. Young people may think they are invincible but they die too, mostly due to accident, murder or even suicide. Older folks, though, see family and friends pass, and their own declining health makes the specter of death more real, whether or not they want to consider it any more than a teenager would. We don’t like to think of being incapacitated, dealing with excruciating pain, being frozen in immobility, having to have people change diapers for us like we were infants, or losing the mental acuity that made us who we were. We are told that palliative care, care that allows us the greatest quality of life possible at the time through medications and sometimes machines, should be sufficient to get us through death’s door with as little loss of dignity as possible, but that isn’t always the case. Sometimes we just want to feel we still can make decisions for ourselves about how we want to live — and how we want to die.
In the US, several states have already given electoral approval to physician-assisted death, where it should be available, under what circumstances, and with what restrictions. Their laws are fairly clear: the person must have their full faculties but have been diagnosed as terminally ill with six months or less left to live, and having made a clear declaration of their desire to have control over when they feel their life is no longer bearable. A form stating the desire and intent has to be witnessed by two separate medical professionals who have no relationship, professional or otherwise, to each other or to the patient so there is no chance of ulterior motive in the death. The medications must be self-administered or administered on the direct orders of the patient. It sounds pretty straightforward, but nothing this side of heaven is totally straightforward it seems.
There was and still is a lot of controversy surrounding such a law or bill, mostly from those who claim religious beliefs and strong pro-life convictions. It is claimed that it is a slippery slope which, once passed, will allow others to euthanize relatives and others who they deem as unnecessary, too much of a burden or too expensive to care for. Statistics have shown that not all who are facing fairly immediate end-of-life issues have an interest in physician-assisted death and of those who are, even fewer request the service. Of those requesting, not all go through with it. Some die naturally without any intervention and others decide to opt out of it. So the actual number of such deaths is a few percentage points of total deaths, but it gives the terminally ill the choice they may want and feel they need.
It is compared, in a simplistic way, to taking a suffering cat to the veterinarian to be put to sleep when there seems to be little else to do other than watch the cat die in pain that could be alleviated by euthanasia. It is often said that we treat our sick and dying pets with more compassion than we do our fellow humans.
Religion-wise, those who object most to the bill are those with religious convictions they claim are firmly pro-life. They are very much against abortion, usually not approving of any form of birth control, and unwilling to allow women and their doctors to make decisions about the continuation of a pregnancy caused by (a) rape or incest, (b) a fetus with severe birth defects that will lead to a very short and painful life after birth, and (c) when the life of the mother (who may have other small children to consider) is at risk due to the pregnancy. Now they are also focused on how aged, infirm and/or terminally ill adults should live out their final days, whether or not they know the patient, the circumstances, the patient’s wishes or religious beliefs. It comes down to who gets to make the decisions about how that patient’s life should be lived — and how it ends.
In the case of the House of Lords’ consideration of the matter, what is somewhat surprising is the stance of two Archbishops of Canterbury. Lord George Carey, a former Archbishop of Canterbury, is quite conservative on most issues; however, he is firmly in favor of passage of the bill. At odds is the current Archbishop, Justin Welby, who is very much against it. A third archbishop, Desmond Tutu, formerly of South Africa, is equally firmly in the pro camp. I wonder if his battle with cancer gives him a clearer view of the ramifications as much as the prolonged treatment and death of his friend Nelson Mandela.
No doctor can say for certain when a person is going to die. They can guesstimate, based on symptoms, test results, and experience, but doctors are not omniscient. They tell a person that they have six months and that patient may die by week’s end or go on for years. It’s a crapshoot. PAS is intended to give the patient some control over when they feel their quality of life is compromised beyond any hope of redemption. It allows them to make a decision while they are still of sound of mental state, to say, “Here is my line in the sand; beyond this I do not want to go.”
There is a lot of concern that if a general physician-assisted dying law is passed, it would mean a wholesale slaughter of the mentally incompetent, the disabled, and others deemed unworthy of life, and that is a slippery slope nobody wants to go down. There are some families who, burdened by the care of an elderly, handicapped or terminally ill member, take the decision in their own hands. They usually end up in court for murder, no matter whether their intentions were in accordance with the patient’s wishes or not. There are also many doctors who believe their Hippocratic Oath holds them to preserving life at all costs, not ending it, even if their patient actively asks for it.
In the House of Lords, the outcome of the recent debate was a 65 to 63 vote in favor, not enough to make it law but enough to continue the discussion in another session. In the United States, PAS is legal in three states, Oregon being the first to pass the legitimization of Death with Dignity in 1994. So far people have not been beating down the doors in Oregon, Washington or Vermont (the other two states in which it is legal) to have either themselves, a loved one, friend, or even someone they barely know ushered gently out of this world and into the next. Quite a few people don’t seem to mind using physician-assisted death when it comes to executing criminals, but when it comes to the elderly, terminally ill, disabled, living in extreme pain, or even just lying there hooked up to machines without thought processes, it is a different story.
Where I think faith comes into this is in the realm of compassion. It is compassion that allows us to take our pet to the veterinarian for euthanasia. When it comes to human life, though, it is a different ball game. People take “Thou shalt not kill” seriously, and that becomes a place where the discussion dies. What place does compassion have when faced with this commandment although most are perfectly comfortable breaking or ignoring the other nine? When should a person be allowed to make their own choice? Should the religious beliefs of some take precedence over all, including those who have no religious beliefs on the subject at all? Who makes the decisions as to when life is worth living or is merely an existence? Would God really eternally punish someone who has been tried beyond their limits? Is that the kind of God we have?
What I think it comes down to is who has the right to make a decision about their own life? Who knows what the person is experiencing and how much they feel able to bear and for how long? Ultimately, the questions that have to be asked is, “What would God expect us to do? Whose life is it, anyway?”