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.
Their fears, or fear mongering, are refuted by facts about the effects of similar Death with Dignity laws in Oregon and Washington. The numbers of people who use these laws are small; the numbers who use the lethal medications they receive are even smaller.
In Oregon, where the law has been in effect for 14 years, a total of "935 prescriptions have been written and 596 individuals have ingested medication." Last year, of the 114 patients who received lethal medication, 71 patients ingested them. In Washington, 103 patients received medication in 2011, and 70 people ingested them.
Of course, some people may have obtained or been administered medications in violation of the law, but that is no argument for repeal. Abolishing the right to physician-assisted suicide would not decrease the number of questionable suicides anymore than abolishing abortion rights would decrease the number of back-room abortions.
But opponents of assisted suicide are not persuaded by the Oregon and Washington experiences, either because they assume that the slide toward euthanasia remains inevitable, or because they categorically condemn assisted suicide, even when it's the voluntary act of terminally ill, competent adults.
It represents "the absolutization of autonomy," Cardinal O'Malley laments. "(A)ll expressions of personal freedom must be judged by their social implications." Your decision to end your life, on your terms, violates "our communal commitments and values."
This view of suicide as selfish, even when undertaken to avoid extreme pain and suffering, is central to the debate over it. Even if physician-assisted suicide laws are not abused -- even if they don't lead to euthanasia or the devaluing of sick, poor, and disabled people -- they are anathema to people who believe we are socially and spiritually obliged to cling to life, just as others are obliged to care for us as we do.
Does selfishness lie in the desire to end your unwanted life or in the refusal of other people to allow you to do so? It's a moral or ideological question, not an empirical one, and it's at the heart of a unbridgeable divide between people who strongly oppose and support physician-assisted suicide.
My understanding of selfishness, compassion, and justice differs fundamentally from that of the Cardinal. I cared for my mother and father at the end of their long lives and tried to help them fulfill their needs and desires, not my own. Both were mentally competent and their approaches to death were entirely consistent with their characters, and their approaches to life. My father wanted to fight, against all odds, and his doctor gave him every chance -- increasing his morphine only at the end, when his suffering was pronounced. If I had urged her not to ease his pain, so that I might spend more time with him -- that would have been supremely selfish.
MORE ON PALLIATIVE CARE
- The Evolving State of Physician-Assisted Suicide
- A Doctor's Deathbed: The Burden of Knowledge
- The Woman Who Went to Every Country
My mother had been ill longer and while she enjoyed life despite some disability imposed by heart disease, at the end, when she crashed, she was more accepting of death. A very practical woman, she declined invasive procedures that could have prolonged her life. "What's the point," she said to her doctor a few days before she died. "I'd only have to go through this again."
She wanted to be medicated into unconsciousness in her final days; she wanted doctors to "hasten" her death. They declined to do so. I'd promised her I'd help her die, and purposefully made a scene in the hospital corridor, demanding that doctors increase her morphine. They obliged, but 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.
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