Should terminal patients choose when to die?


Q: Should doctors be allowed to end a terminally ill patient’s life by painless means if the patient requests it?

By Sarah Sidlow

In America, there are rules. Rules about how you drive, rules about what food is available to you, and even rules about how you die.

In six U.S. states—Oregon, Vermont, Washington, California, Colorado and Montana—as well as the District of Columbia, physician-assisted death is a legal option. Earlier this month, Hawaii Governor David Ige signed into law the Our Care, Our Choice Act, which authorizes the practice of medical aid in dying in Hawaii.

Hawaii’s new law is similar to others of its kind: A terminally ill, mentally capable adult with six months or less to live can request a doctor’s prescription for medication that they can decide to take in order to die peacefully.

Death with Dignity
For patients and their families impacted by years of suffering, laws like Our Care, Our Choice are deemed compassionate and intriguing options. Since Oregon’s adoption of similar legislation in 1997, 1,749 people have been granted the prescription; 1,127 have died by legally ingesting those drugs.

The District of Columbia calls it “Death with Dignity,” a semantic argument that capable adults should be allowed to take their death into their own hands, potentially avoiding up to six months of pain and suffering, and protecting their families from the crippling emotional and financial burdens of long-term hospice or palliative care.

You may remember Brittany Maynard, a 29-year-old brain-cancer sufferer and right-to-die advocate who moved to Oregon to take advantage of the state’s medical
death policy.

“I would not tell anyone else that he or she should choose death with dignity,” she wrote in an op-ed for CNN. “My question is: Who has the right to tell me that I don’t deserve this choice? That I deserve to suffer for weeks or months in tremendous amounts of physical and emotional pain? Why should anyone have the right to make that choice
for me?”

Legalized Self-Murder
For others, the practice of providing patients with a “death pill” is tantamount to euthanasia. There is a reason, many argue, that this is not a more widespread priority in the United States. Legislation of this kind, many worry, could open the doors for unscrupulous family members to pressure the ill into an irreversible decision.

Others view physician-assisted suicide as a slippery slope to other forms of euthanasia. If people begin to view the practice as a benefit, a benevolent gift bestowed upon a patient by a doctor, then why limit it to those patients who are able to give consent?

For many religious groups, the idea of patients and doctors making choices about life and death is also uncomfortable. Many Catholics, for example, believe the gift of life is the most basic gift of a loving God—and not really something anyone else has the leeway to mess with.

And then there’s that “First, do no harm” part of the Hippocratic Oath—the doctor’s Pledge of Allegiance to uphold the sanctity of medicine, patient care and human life. Doctors literally swear devotion to the sanctity and power of life—is prescribing an end-of-life medicine a violation of that code?


Death be not proud. Nor prolonged.

Unwarranted suffering is not redemptive.
It’s inhumane.

By Marla Boone

Dying is worse than death.
The argument for physician-assisted suicide (PAS) is so compelling, so grounded, so merciful I barely know where to start or how to entertain an argument against life’s most profoundly personal and private decision. Our government has stuck its voyeuristic little nose into our sexual practices, our doctor’s offices, our churches, and our uteri. They still want to stick them into our deathbeds. Enough!

Let’s begin with some facts. According to a PBS Frontline report, seventy percent of Americans die in hospitals, nursing homes, or long-term care facilities. The exact number say they would prefer to die at home. Eighty percent of those with a chronic disease (and seventy percent of Americans die from a chronic disease) say they want to avoid hospitalization and intensive care when they are dying. Americans do not want long, drawn-out, lingering deaths that destroy both quality of life and personal finances. They want to die peacefully and painlessly. They want control of their final stage and their final days to be in their hands. No one else’s.

Anyone reading this can draw the same conclusion and that conclusion is supported by studies done by the Center for Disease Control. Eighty-six percent of Americans support PAS. Fifty-four percent of physicians support it. It’s only our elected officials who can’t seem to get the message. Or at least the vast majority of elected officials. There are seven states, plus the District of Columbia where PAS is legal. It’s nearly impossible to get a reliable figure for the number of terminally ill people in the United States. Over 1.3 million Americans are in the care of Hospice, which does amazing work with those people lucky enough and aware enough to seek it out. It is estimated that fifty-five percent of those who do not find palliative care will die in pain. This is unconscionable. It is 2018. We have put men on the moon and brought them back. We have developed pin-point bombing. We have technology so vast, so advanced, so all-encompassing, so integrated into everyday living we can choose our seats at the movies from the comfort of our own homes. But still we allow tens of thousands of our fellow citizens to die miserably, painfully, restively, and horribly. We treat our pets better than we treat those who have made the enormous mistake of getting seriously sick.

Death with dignity sounds like a…well, a soundbite. Don’t kid yourself. You would be an instant convert to death with even a modicum of dignity if you would witness a fellow human begin writhing, counting the minutes, the seconds, until they can get another dose of morphine to take the bitter edge off their relentless agony. Not wishing to be melodramatic here, but if you could look into that person’s eyes, those beseeching terrified eyes and not be moved by the raw humanity there, you are a stronger
person than I.

The laws in Oregon, Vermont, Washington, California, Colorado, Montana, Hawaii, and the District of Columbia are similar in content. A terminally ill patient who is a mentally capable adult with less than six months to live can request a physician’s prescription for drugs they can take to die peacefully. Even this is unnecessarily restrictive. Why does a patient have to be within six months of death? Why does a patient have to be terminal? Jack Kevorkian was a pioneer in the field of PAS. He should have been canonized for his efforts to spare people pain-wracked deaths but instead, he was prosecuted and jailed. In a 2010 interview with Sanjay Gupta, Dr. Kevorkian had this to say. “What difference does it make if someone is terminal? We are all terminal.” A basic tenet of the Hippocratic Oath is Primum non noncore—first to do no harm. Doctors providing PAS are not doing harm. They are doing the right thing for the right reasons to the
right demographic.

Puritans founded this country and that arrogant Puritanical streak still lives in some who endorse suffering (other people’s suffering, usually) above all else. Brittany Maynard, a 29-year-old brain-cancer sufferer who had a very vested interest in the issue said it best. “I would not tell anyone else that he or she should choose death with dignity,” she wrote. “My question is: Who has the right to tell me that I don’t deserve this choice? That I deserve to suffer for weeks or months in tremendous amounts of physical and emotional pain? Why should anyone have the right to make that choice for me?”

The potential for abuse is there, of course. It always is. And safeguards are in place. But do we allow the possibility of abuse to interfere with the humane treatment of those who already have been dealt a lousy hand? Martin Luther King, Jr. said unearned suffering is redemptive. We need less suffering and more redemption.


Life is special

Euthanasia is for dogs, not people

By Victor DeLaine

Doctors should neither kill people nor help people kill themselves.

To allow doctors to do so is to cross a threshold we should never cross, to enable the treatment of life itself as just another activity, a commodity that we may manipulate or dispose of with our own mortal hands. To allow assisted suicide is to pit our legal culture against the axiom that life is special, that matters of life and death on the one hand, and of mere comfort, convenience, and choice on the other, are not on the same moral plane and should not be on the same juridical one.

As civilization has advanced over the centuries, society has become fussier and fussier about extinguishing life. The more enlightened the society, the less inclined it is to sanction the deliberate inducement of death. Previous, less evolved cultures sent multitudes to gallows and gas chambers and stoically marched men off to die by the millions in war. Today, we rightly limit executions to the rarest of crimes and rightly cry for peace even when casualties number in mere hundreds. Assisted suicide breaks tectonically against this civilizing trend.

Once we make euthanasia legal, its very legality will force a question into the mind of every ailing grandparent and of everyone who has one: Why not just kill yourself? Whether asked or not, the question will loom in every hospital room, over every wheelchair. For those who think the subject too delicate to discuss openly, medical societies will print helpful tri-fold brochures with a photo of an attractive, silver-haired woman on a park bench, looking thoughtfully into the distance, weighing her answer to the great question. It will be what everyone is thinking without having to say. And every grandparent who isn’t brain-dead will know we’re all thinking it.

Why not just kill yourself? Until now, we heard that question only from pubescent girls who bully unpopular peers. Now it will be among every doctor’s standard disclosures and disclaimers. But don’t be surprised. Legalizing assisted suicide is the logical next step for an unfeeling, youth-worshipping society that warehouses its inconvenient elders in nursing homes. I spoke a paragraph ago about the moral progress accompanying the march of civilization, but one side-effect of that advance is an increased appetite for pleasure, and a corresponding disdain for anything that looks, sounds, or smells like a duty, which is what we owe, or used to see ourselves as owing, our ailing elders. And the socialization of healthcare costs gives us yet another crass incentive to facilitate death when maintenance costs for aging bodies drain too much cash from the public fisc. Whether we’re talking about decadent young people having too much fun to change Grandma’s Depends, or about grumpy, taxpaying suburbanites fretting over the effect Grandma’s expenses have on the national debt, the message to Grandma is the same. We tell her that we love her, honest we do. But we’re all glancing at our watches, waiting impatiently for the end. That’s the message legalized euthanasia sends, in boldface.

Don’t say it’s about the right to die with dignity. You don’t need suicide to die with dignity. Put me down in favor of a patient’s right to refuse treatment, in favor of his right to obtain care for pain and palliation even at the risk of hastening death. Let a fully informed patient and his family choose even to pull the life-support plug, by all means. But to withhold life-saving treatment is one thing. To affirmatively kill him is quite another. That he ends up dead in either case does not make them the same.

To see where this will lead, consider the Netherlands, which legalized euthanasia in 2001. Ghoulish consequences soon followed. In 2004, the Dutch adopted standards allowing the killing of children if doctors thought their suffering intolerable. By 2004, 21% of Dutch infant killings were done without the parents’ consent. And by 2011, according to Radio Netherlands, standards for determining whether suffering was intolerable were changed to inquire into a patient’s “financial resources, social network, and social skills,” so that one would now be eligible for death if he were poor, lonely, or shy. Practices that got Nazi doctors hanged at Nuremberg are now the Dutch state of the art. As Britain’s Telegraph reported in 2011, elderly Dutch patients “are so fearful of being killed by doctors that they carry cards saying they do not want euthanasia.” That’s the example we’re about to follow, the slope onto which we are about to take
our first step.

Let’s not go there. Let’s not put sick people to sleep the way we do with house pets, even if they profess to want it. The Hippocratic Oath says, “I will not give a deadly drug to anyone who asked for it, nor will I make a suggestion to that effect.” Many things are wrong with healthcare, but that oath is not one of them.

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Sarah Sidlow
Reach DCP editor Sarah Sidlow at SarahSidlow@DaytonCityPaper.com.

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