Debate Forum: 02/03

Forum Center: The death debate

By Sarah Sidlow

Illustration: Jed Helmers

You’ve just been told you have six months to live. Because your brain tumor is so large, doctors prescribe full brain radiation – a procedure that will result not only in the loss of your hair, but first-degree burns on your scalp. At 29 years old, you know your body will outlast your mind, and the medication you are on will likely lead to morphine-resistant pain, personality changes and verbal cognitive and motor loss. There is no known conventional treatment that will save your life.

You are walking in Brittany Maynard’s shoes.

Maynard was living with her husband in California when she was diagnosed with brain cancer. She had begun the process of dying.

Feeling that she wanted to die in the same self-determined way in which she lived, Maynard sought other end-of-life options. She found one in Oregon, one of three states where “death with dignity” is authorized. Death with dignity, an option for mentally competent, terminally ill patients with a prognosis of six months or fewer to live, is authorized by the Death with Dignity Act, which legalizes physician-assisted suicide in the form of self-administered medication. Under the act, qualifying Oregon residents may self-ingest a prescribed medication that would end the dying process. The act prohibits euthanasia, where a physician or other person directly administers the medication to end another’s life.

In California, as in Ohio, physician-assisted suicide is illegal.

So, Maynard uprooted. She found new physicians, established residency in Portland, secured a new home, a new driver’s license and changed her voter registration. Her husband, Dan, took a leave of absence from work.

When she felt it was time, just a few months ago in November, 2014, she ended her life.

In her last year, Maynard became an advocate and a spokesperson for the legalization of aid in dying.

Her story sparked discussions around the country as to whether or not Maynard’s choice should be available in all states.

As with many challenging ideological discussions, opinions are informed by a number of complicated human factors – philosophy, religion and semantics among them.

The terminology itself – from the connotation of “suicide” to the definition of “dignity” – is argued frequently.

Many oppose the practice on religious grounds. Pope Francis, in the days that followed Maynard’s highly publicized death, called it a “false sense of compassion” to consider euthanasia as an act of dignity when in fact it’s a sin against God and creation. Life, he argues, is to be celebrated in all its forms – in its health and happiness as well as in its suffering.

Opponents in the medical profession extol the availability of hospice care, which, they claim, provides relief, assistance and closure for both patients and their families.

But supporters of the death with dignity movement claim it’s all about having the option.

“Who has the right to tell me that I don’t deserve this choice?” Maynard wrote in an opinion column for CNN. “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?”

Debate Forum Question of the Week:

Should Ohio approve a Death With Dignity Act, similar to that in Oregon?

Debate Left: Life-less

Response By Ben Tomkins

I don’t like the phrase “assisted suicide.” I never have. History has shown time and time again that it is impossible to have an honest, sober, measured conversation about the nature of the end of life and the comparative value that choice has for an individual, in the context of a word that is so emotionally radioactive.

Suicide is an act that occurs in isolation. Bodies are found with a rope around their neck or a bullet in their head, and even when the individual leaves a note there is never any peace in it. For their family and friends all that remains is an infinite fractal of “what if.” No matter how deeply one peers through a microscope the picture yields the same answerless, meaningless repetition.

Because of the nature of it, it’s almost impossible to judge whether or not someone was in a state of mind that would allow the act to be viewed as somehow reasonable or rational. It may not even be possible to draw the line between killing oneself in the depths of a temporary depression episode and an individual who is suffering mentally consciously exercising their right to choose the time they wish to go.

After all, if the desire to end one’s life is by definition a disease of the mind, suicide cannot be a sane decision.

Therein lies the problem when we talk about end of life issues and dying with dignity. To treat the idea of ending one’s life as a semantic tautology is to create a perpetual excuse to avoid dealing with a topic that has very worthy grounds for deep reflection. The willingness to address the question of whether ending one’s life may have morally and ethically sustainable conclusions takes as much courage as facing the terminal illness of your loved one.

To choose to suffer through a terminal illness may be seen as an act of great fortitude or defiance in the face of death, and a personal statement of the joy and value of life. Perhaps a person has even done so for the sake of their loved ones despite their desire for the pain to end. There’s a lot to be said for that, and the examples of people who have endured that kind of suffering and maintained a positive attitude to the end revitalize the optimism of those of us who continue on.

However, we have no right to demand that of someone. Terminal physical suffering does not imply that someone is mentally compromised. They may be mentally exhausted from the ordeal, but their capacity to talk openly about their condition is precisely the difference between suicide and a desire to die with dignity.

Brittany Maynard is a perfect example. How can we say she is mentally compromised if she is engaging those people around her in the discussion of the end of her life? It is said that suicide is a selfish act, but the word selfish is misleading because of its negative overtones. It would perhaps be more accurate to say that suicide is the most singularly self-oriented act. A depressed or otherwise mentally broken person commits suicide when nobody else is home. It is characterized by mental and physical isolation. We find the lifeless body in a car on the side of the road, floating in a river or in a bathtub because the person does not want to be talked out of it.

Brittany Maynard engaged her husband in the conversation and the process every step of the way. There was no question, baring a miracle, what her outcome would be and what that process would look like. It was going to be difficult on her husband and her friends and family, and they would have to suffer by watching her suffer. She neither intentionally isolated herself, nor did she act as though she was waiting for the right moment to slip into Oregon at 4 a.m. so she could do it before anyone else could stop her.

Many, many voices were a part of that process, and modern medical science gave her a full review of her condition and prognosis. It’s one thing to question whether or not she should have done it, but it is too far afield to suggest that she was unquestionably exhibiting signs of delusion that might warrant an intervention.

The bottom line is that no one can take away your right to die. My grandmother recently passed away, and after spending a month in the hospital with a broken hip and tubes sticking out of her, she told us she was ready to be done. That hurt. Tremendously. None of us wanted to have to deal with a world without her in it, but at the same time, we also realized that she was 98 and suffering. She was at peace with her life and the reality of her condition, and as much as we love her I don’t think anyone wanted her to go on suffering against her will.

I think that the death with dignity laws as they are in place in several states are reasonable and humane. They take into account that it is a process, and many qualified people are involved to ensure the person is truly making a choice. It takes more courage for people to assist that process than it does to require them to suffer.

Ben Tomkins is a violinist, teacher, journalist and critically acclaimed composer currently living in Denver, Colorado. He hates stupidity and generally believes that the volume of one’s voice is inversely proportional to one’s knowledge of an issue. Reach Ben Tomkins at
BenTomkins@DaytonCityPaper.com.

Debate Right: Proper legal planning gives dignity to death

Response By Rob Scott

Death with dignity, or physician-assisted suicide, during the past few months has reached the headlines again with recent terminally ill advocates utilizing states that make it legal. There are only three states that have legal death with dignity: New Mexico, Oregon, Vermont and Washington.

It is well known many terminally ill patients wanting to terminate their life change their residences to these three states in order to utilize the state’s law. Many of those terminally ill and supporters of death with dignity laws argue if someone is in pain, then they should be able to make the choice to end their life – similar to that choice given to pet owners. Additionally, there are several organizations whose goal is to pass death with dignity laws throughout the U.S. and even possibly a federal law.

In Oregon, since the law was passed in 1997, a total of 1,173 people have had DWDA (Death With Dignity Act) prescriptions written and 752 patients have died from ingesting medications prescribed under the DWDA. According to the Oregon Public Health Report In 2013, there were approximately 22 assisted suicides per 10,000 total deaths in Oregon.

However, there are many legal ramifications, as well as public policy and moral issues with physician-assisted suicide.

First, death with dignity is at odds with the medical community. Many believe it would violate doctors’ Hippocratic oath. Upon receiving a medical degree, each doctor is required to take a Hippocratic oath, which says among other things, “First, do no harm.” Assisting in suicides would be a violation of that oath, and it would lead to a weakening of doctor-patient trust. The oath was created in part so patients could be reassured that doctors only wanted to help them, not hurt them. A weakening of that oath may cause patients to wonder.

Second, it could morally demean the value of human life. The thing that elevates Western society above others, generally speaking, is the value we put on each and every life. To stomp out a life because it’s not convenient or it’s expensive demeans that value. Human life is much more than just a cluster of biological cells.

Many religions prohibit suicide and the intentional killing of others. The most basic commandment is “Thou shall not kill.” Most religions have a moral cannons against killing. 

Third, allowing death with dignity may lead to a slippery slope. Floodgates could open to non-critical patient suicides and other abuses. Any loosening of the assisted-suicide laws could eventually lead to abuses of the privilege. For example, patients who want to die for psychological or emotional reasons could convince doctors to help them end their lives. Attitudes would loosen to the point where certain states may decide that any person can commit suicide at any time. 

Fourth, doctors, families and the patient may be prompted to give up on recovery much too early. If a patient is told that they have, for example, six months left to live with progressively worse pain, he may decide to end things before things start to get worse. This denies the slim chance of a recovery or the possibility of discovering a doctor error.

Fifth, and most practically, government and insurance companies may put undue pressure on doctors to avoid heroic measures or recommend the assisted-suicide procedure. Health insurance providers are under tremendous pressure to keep premiums down. To do this, they must cut costs at every turn and make tough decisions. Many doctors are already prevented from giving patients certain tests or performing certain operations despite what the doctor believes is truly necessary. Legalizing assisted suicide would likely invite another set of procedures directing when life-sustaining measures should be undertaken. If death with dignity were allowed, the regulatory process would be a nightmare and a doctor could face severe criminal penalties if they abused the power.

Sixth, with proper legal planning, making most of the death with dignity decisions is already available. With healthcare advanced directives, the decision to end one’s life is available with the necessary legal protections. Within advanced directives is “health care power of attorney,” which allows you to designate a person to make important health care decisions when you cannot. Additionally, a living will is available, giving you the legal power in your written instructions regarding your health care decisions. These legal tools would give you the ability to not be supported by life-sustaining measures, thus carrying out your decision to end your life if conditions reach a certain point. Ohio has such provisions and provides the advanced directive forms for free through the Ohio Secretary of State’s website, most county probate courts and most hospitals.

Finally, and most importantly, miracle cures or recoveries can occur. You can never underestimate the power of the human spirit. A cheerful, never-give-up attitude can often overcome the longest of odds and the worst of illnesses. You also have to consider the constant medical and pharmaceutical advances that may lead to a miracle recovery. We should never get to a point where we spend more time looking for a way out of life than for a way to sustain life.

Rob Scott is a general practice attorney at Oldham & Deitering, LLC. Scott is a Kettering City Councilman, founder of the Dayton Tea Party, member of the Dayton Masonic Lodge and Kettering Rotary. He can be contacted at rob@oldhamdeitering.com or  gemcitylaw.com.

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

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