My usual reader (that's the commenter's handle)
asked me what I think of
Dan Savage's piece about Washington State Initiative 1000, which would allow physician-assisted suicide. I've been so busy I hadn't even known the initiative was on the ballot (and yes, I know I said I was going to be studying, but I already put in a good amount of study time today and I need to stretch my brain in other directions).
MUR says Savage's piece left hir shaken, and continues
What do you think about the issue? You are probably against it because of religious reasons, right? If you didn't believe, would your opinion be the same or not?
I'm not opposed to physician-assisted suicide. I would have voted for the Oregon statute. I haven't read the proposed Washington State law, but if it's the same model I would probably vote for it, too. My religious faith informs my values, and my values inform my practice of religion - and my practice of medicine - but I am a Reconstructionist Jew and don't consider myself bound by
halakhah, Jewish law. So I am not opposed to the idea. It's been my experience, though, that very few people actually make that choice - and that's what we've seen in Oregon and in the Netherlands. Most people who say they would choose assisted suicide are afraid of pain or other symptoms, and if they are sure their symptoms will be treated, they change their minds.
I was also shaken by Savage's article, mostly because his mother had lousy care. I don't see any mention that hospice or palliative care was offered to her at any point, although she clearly knew she had a fatal illness and was deteriorating. Even when they knew it was the end, her doctors did not adequately treat her anxiety or her shortness of breath, and they did not offer anything approaching appropriate support to her family. No wonder Dan Savage thinks she should have been able to choose suicide.
That said, I take issue with one statement in the article. Savage equates physician-assisted suicide with "end-of-life-pain-management". No. No. No. The medications used for suicide are not pain medications; they are sedatives. We can achieve adequate pain control for more than 90% of people at the end of their lives (see, I told you I've been studying). For those unfortunate enough to fall into the less than 10% who have pain we cannot control, or other symptoms we can't manage, we can offer palliative sedation, which means effectively rendering the patient unconscious with strong intravenous sedatives. This may well shorten life, but ending life isn't why we do it. We do it to relieve suffering.
If Savage was trying to say that assisted suicide can be merciful, I would agree, but I think he is speaking from the common - and mistaken - assumption that good pain control will shorten life, and is only offered as a means to death. Most people with pain and shortness of breath can benefit from treatment with narcotics. The medications do have side effects, but they don't cause respiratory suppression and can be safely used even in people with severely compromised lung function.
Initiative 1000, I presume, is the end result of Booth Gardner's campaign, which was described in a piece in the
New York Times Magazine last year. It's worth reading the article if you're at all interested in this subject. I found myself questioning my own stand when I read about the work of Susan Wolf, who opposes physician assisted suicide because she believes women will disproportionately choose this option.
If women are expected, above all, to care for others, for children, parents, husbands, she asked, aren’t they particularly likely to view their own lives as without value when they become so sick or disabled that they are the ones who must be cared for? Might they be especially likely, at that point, to see themselves as burdens and, if assisted suicide were legal, to request that their deaths come right away? And might this tendency be compounded by a cultural lineage exalting female suicide, a tradition going back, Wolf suggested, borrowing from the work of the French classicist Nicole Loraux, to Greek tragedy, where suicide is carried out almost exclusively by women?
Wolf cites Jack Kevorkian's record; approximately 70% of the suicides he assisted were women, and a number were not terminally ill. She makes a compelling argument. No one reading this will be surprised to hear that I believe we have a lot more work to do before we live in a society where women's lives are seen as having worth equal to the lives of men. But I can't convince myself that we should restrict everyone's liberty because of the patriarchy.
I don't think we'll ever know just how many physician-assisted suicides there are. The practice was illegal everywhere in 1991, when Tim Quill wrote about his patient
Diane in the New England Journal of Medicine.
Diane taught me about the range of help I can provide if I know people well and if I allow them to say what they really want. She taught me about life, death, and honesty and about taking charge and facing tragedy squarely when it strikes. She taught me that I can take small risks for people that I really know and care about. Although I did not assist in her suicide directly, I helped indirectly to make it possible, successful, and relatively painless. Although I know we have measures to help control pain and lessen suffering, to think that people do not suffer in the process of dying is an illusion. Prolonged dying can occasionally be peaceful, but more often the role of the physician and family is limited to lessening but not eliminating severe suffering.
Tim Quill acted as a healer when he helped Diane end her life. That is profoundly paradoxical, but true. Healing is the relief of suffering. I imagine that Diane's suffering in the last weeks of her life was eased by the knowledge that she retained control, and by the deep and meaningful relationship she clearly shared with her doctor, who was able to hear all her needs and do what he could to meet them. If only Dan Savage's mother had had a doctor like Timothy Quill.
