Those of us who listen to public radio are familiar with Diane Rehm, the raspy-voiced hostess of a respected public affairs program. Recently–in the wake of her husband’s terminal illness–Rehm has become a spokesperson for an individual’s right to decide how and when he will die.
Rehm said she decided to write the book because she was frustrated by the way her husband died.
“People need to talk about this issue,” she said. “Doctors need to be taught about this issue. The whole idea of doctors being taught about helping to keep people alive, but not being taught how to listen to those who are ready to die — that seems to me sad and misguided.”
One doctor who has come to agree with Rehm is my cousin, Morton Tavel, a cardiologist whom I often quote on this blog. He recently analyzed the issue thusly:
As a physician, I originally supported the dictum that death should be prevented at all costs. But more recently, I have come to realize that perhaps we should also consider suffering as well as dying.
These thoughts have directed my attention to the so-called “aid in dying” laws that are in force in the U.S. states of Oregon, Washington, Montana, Vermont, and California. They are sometimes referred to as “Physician-Assisted Suicide”. These examples often require that a patient’s death be expected within six months, and they compassionately offer a voluntary, self administered end to suffering at an individual’s own preferred time. Since 2014, aid-in-dying bills have been introduced in Washington, D.C. and several states. Canada is also considering such a bill. Other countries, including Switzerland and Belgium, allow aid in dying for people who are not even terminally ill. All these laws provide freedom for a physician to prescribe a lethal drug to a patient for self administration. At present, such a practice is unlawful in 46 states, including Indiana..
In the example of Oregon, which has had such a law in effect since 1997, subsequent study has uncovered no abuses, and, interestingly, about a third of patients who receive medication to end their lives never actually use it, meaning that many are likely reassured by the simple knowledge that they will be able to end their lives at any time of their choosing.
What people want, often, is knowledge that they can control their own lives and deaths.
Tavel recognizes the potential for abuse, and the need to ensure that people do not terminate their lives because they are depressed, or in pain that could be alleviated with proper medical intervention, but he insists that such issues can be addressed.
Laws addressing such issues should be clearly defined. First, I believe a specific time for life expectancy need not be spelled out, for misery without hope doesn’t necessarily conform to a distinct number of days or months. For instance, someone suffering from a severe progressive neurologic disease such as Lou Gehrig’s disease (ALS) can continue suffering for many months prior to death. On a personal level, I witnessed the suffering and death of a patient/friend of mine from a similar neurologic disorder called progressive supranuclear palsy (PSP), a disease that claimed the life of actor Dudley Moore, which is an uncommon progressive fatal brain disorder that affects movement, control of walking (gait), balance, speech, and many others.Given the choice, and if it were legal, he would have gladly opted to end his life by assisted suicide. Even various terminal cancers can behave for variable durations, but also cause prolonged pain and suffering.
In Oregon, for example,the attending physician and a consulting physician have to confirm the patient’s diagnosis and prognosis and determine whether the patient is capable of making and communicating health care decisions for him/herself. If either physician believes the patient’s judgment is impaired by a psychiatric or psychological disorder (such as depression), the patient must be referred for a psychological examination.
If this and the other safeguards of the Oregon law are satisfied, the prescription may be written.
In most cases, the drug used for this purpose belongs to a group of so-called “barbiturates”, commonly used in lower doses for the induction of normal sleep. In large doses, however, death is painless, peaceful, and will occur within a matter of minutes to hours.
A death in this fashion is usually far better than other, less desirable, alternatives. Thus I might conclude with a simple question: Isn’t it more humane to deal with one’s own species in a manner at least as appropriate as the smooth and painless exit we provide to our beloved animal pets?
What is the justification for over-riding individual autonomy, and insisting that a terminally-ill person suffer?