Reconciling justice, selfishness, and compassion when the only way to be free of pain is death
My father, a lifelong atheist, died at 91 in a Catholic hospice center. He received excellent, compassionate care from his nurses and from a doctor who willingly administered the morphine needed to ease his suffering -- although, she advised, it would hasten his death. Did she violate the doctrine of a church actively opposing a Death with Dignity proposal now on the ballot in Massachusetts?
The medical team was administering palliative care, not assisting in a suicide. According to a Church spokeswoman, "You can have whatever level of morphine you need to control the pain, even if that level of treatment hastens death." Palliative care is "legitimate," even when it risks "shortening life," Cardinal Sean O'Malley explains -- so long as "the intent is not to hasten death, but only to ease the pain of a dying patient."
The view of suicide as selfish, even when undertaken to avoid extreme pain and suffering, is central to the debate over it.
I guess God knows the intent of every physician who administers pain medication to terminal patients, but law enforcement officials can't be expected to know it. And sometimes, palliative care involves not just "the risk of shortening life" but the knowledge that it will shorten life. What if the only way to ease pain is to shorten life?
Put aside, for the moment, arguments about the right to die, and consider this: If Cardinal O'Malley's principle is the basis for secular law, if "legitimate" end-of-life care is distinguished from illegitimate "killing" on the basis of a district attorney's perception of intent, doctors risk prosecution when they administer palliative care, and patients risk gratuitous suffering. If my father's doctor had been subject to a law laid down by the Catholic bishops, she might have let him suffer harder and longer, gasping for air, in his last days.
According to the bishops, "a society that devalues some people's lives, by hastening and facilitating their deaths, will ultimately lose respect for their other rights and freedoms."
This makes little sense if you consider few freedoms more fundamental than the freedom to end your own life on your own terms, when confronting a terminal illness and inevitable pain and suffering you'd rather avoid. But this concept of freedom deeply offends the Church: Physician-assisted suicide "would create pressures to limit our freedom, because it could establish an expectation that certain people will be better served by being dead, a dubious premise indeed," Cardinal Sean O'Malley declares.
I don't begrudge the Cardinal his differing view of liberty or the belief that assisted suicide cheapens regard for life. I do begrudge him and other opponents of assisted suicide their slippery, inflammatory arguments against it.
"By rescinding legal protection for the lives of a category of people, the government sends a message that some people are better off dead," O'Malley preached last year.
Let's parse this rhetoric. First, the people must approve the Massachusetts Death with Dignity proposal at the ballot box. It will not be a directive laid down by "the government." Second, while O'Malley can fairly speculate that physician-assisted suicide is a step down a slippery slope toward euthanasia, he cannot honestly describe the Massachusetts proposal as a form of euthanasia that will "rescind" existing "legal protections" or the right to life enjoyed by any "category of people." Instead, as the Cardinal must know, the proposal formally extends new legal protections and a limited, heavily regulated right to die to a very small category of people who are terminally ill.
The Death with Dignity Act will allow doctors to prescribe lethal medications to adult patients, "medically determined" to be competent and capable of communicating their desires and medically diagnosed with terminal diseases expected to cause death within 6 months. Patients will be required to make two requests for medication, on two occasions, 15 days apart, and to sign standard request forms, in the presence of witnesses, "one of whom is not a relative, a beneficiary of the patient's estate, or an owner, operator, or employee of a health care facility where the patient receives treatment or lives."
My mother drifted in and out of consciousness, acutely aware of her circumstances, tracking her own death, apparently impatiently. "Why does it take so long?" she asked.
This process will be voluntary, not just for patients, but for health care providers. Doctors who do participate will be required to report every case in which they dispense lethal medication to the Department of Health. Still, opponents of physician-assisted suicide claim that, despite regulatory safeguards, it leads to the murder of people considered expendable or burdensome by their relatives, insurance companies, or society in general.