February 19, 2015

Physician-Assisted Suicide: Yea? Nay?

Is legal physician-assisted suicide inevitable in all 50 states? In the argument for assisted suicide, which outweighs the other -- pros or cons? Does it make sense for a government to support suicide prevention and legal assisted suicide at the same time?

These are questions raised in an article published on February 13, 2015 by True Dignity Vermont (TDV), a grassroots, independent, citizen-led initiative in opposition to assisted suicide in Vermont. The headline: “A Deep and Tragic Irony: In Vermont, Lawmakers Praise Suicide Prevention While Legally Enabling Suicide.”

The topic of assisted suicide – the right of terminally ill people to choose the time and manner of their own deaths – has been more and more in the news. Full disclosure here: I am not neutral on the subject. I have frequently written about assisted suicide, and have said I’d definitely consider the option under certain circumstances. I feel that way today, and it is highly unlikely I’ll change my position.

Nonetheless, the story raises a few interesting issue for debate.

Are All Suicides Created Equal?
According to the TDV article, pain – or the fear of pain – is rarely cited by terminally ill patients who want to die. Instead, the author writes that in Oregon – apparently the only state for which data is now available -- the top three reasons terminally ill patients want to die… the reasons they give their doctors when asking for assistance with suicide -- are:
  • loss of autonomy,
  • loss of ability to engage in enjoyable activities,
  • loss of dignity

At the same time, as the article points out, suicide.org (“Suicide Prevention, Awareness, and Support”) begins its catalogue of suicide causes this way: “Over 90% of people who die by suicide have a mental illness at the time of their death. And the most common mental illness is depression.”

Under its lengthy list of the causes of depression are:
  •  “Feeling that things will never ‘get better,’”
  • “Feeling hopeless,”
  •  “Inability to deal with a perceived ‘humiliating situation.’”

The TDV article asks: Are the two lists really all that different? Is it reasonable – even conscionable -- to use these reasons to support assisted suicide for the first group, and the same reasons to support suicide prevention for the second?

The author writes: "Today’s resolution [from the state government praising suicide prevention] shows that the legislators in our state view the terminally ill differently than people with problems that are almost identical to theirs. Some people get suicide prevention, while others get aid in suicide."

Does Any Kind of Suicide Encourage Other Suicides?
The article raises the issue of contagion, and suggests that stories about suicide – of any variety – lead to increased suicides. The author mentions how the “Vermont Suicide Prevention Platform” -- published in 2005 by the state’s Department of Mental Health – even offers guidelines to the media:
The Vermont Suicide Prevention Platform has a whole section entitled, “Suicide Contagion is Real”.  Among the measures it recommends for preventing suicide contagion are avoiding”…inadvertently romanticizing suicide or idealizing those who take their own lives by portraying suicide as a heroic or romantic act…”, reporting suicide methods or the locations of suicides, and placing suicide reports “…on the front page or at the beginning of a broadcast…”

The author argues that the state’s assisted suicide program creates news about suicide. It suggests that a person’s suicide, in fact, is even more likely to make headlines if it is a result of the state’s program that enables terminally ill people to secure a physician’s help to end their lives.

The TDV author writes: “The Vermont legislature is as responsible as the media for the glamorization of one kind of suicide, despite the knowledge that it can lead to other kinds.”

Does Assisted Suicide Open Litigation Floodgates?
According to the article, people who are not terminally ill will sue the government for preventing them from obtaining the same services legally provided to others with nearly identical problems. Overseas, there are already cases where otherwise healthy people have been given assistance in ending their lives. According to TDV, some of those cases are certainly odd, like a pair of twins who asked for and were granted euthanasia because they were going deaf, as was a person unhappy with the results of a sex change operation.

Such cases create news -- and precedents -- and therefore encourage others with similar conditions to seek legal redress.

There’s a litigation flipside, too: people will sue governments that enabled suicides. The article cites the case of a man “who is challenging the Netherlands’ assisted suicide/euthanasia laws after receiving the traumatic news only the day after his depressed but otherwise healthy mother’s death by euthanasia."

And so the debate goes on. 

My guess is that public opinion will evolve, with increasing support for a terminally ill person’s right to choose. I doubt the tide will swing as quickly, say, as it has for same-gender marriage. But public acceptance of the option is surely moving forward.

Your thoughts?


Mommajo said...

My husband was also diagnosed with Parkinson's in 2009. It is very rapidly progressing, and probably has some elements of PSP involved. My gregarious, talkative, socializer can no longer speak and be understood, write and be deciphered, or move much of anywhere unassisted. He has almost no control of his bladder, and his eyes close involuntarily (blepharospasms). Needless to say, he is one very depressed 65 year old. In the 34 years we have been together, he has always stated that he didn't want to live this way. BUT....funny thing is, in the last couple of years, he's not mentioned the concept of suicide even once. I find it interesting that the intellectual stances we think are etched in granite sometimes soften those sharp edges when faced in reality.

I have not discussed this subject with him recently...and in all fairness, I don't want to. I have no desire to hasten the inevitable loss, although I grieve for the guy I used to know. That being said, I would understand...no matter what.

John Schappi said...

Mommajo's comment below is very interesting and moving. It accords with the experience in jurisdictions with assisted suicide laws. Surprisingly few people actually make use of them. In the hopes of stimulating further discussion, here's my own comment on my own blog post: The three things I fear most in these my final years are: 1. Being kept alive when I no longer have the ability to communicate with others. 2. Having my nearest and dearest subjected to the agony of keeping me alive when I'm little more than a vegetable. 3. Having my financial nest egg, which I've worked hard to develop, depleted by payments to doctors, hospitals, and drug companies in order to keep me alive when that's not what I want. Instead, I want my financial resources to be spent helping my nearest and dearest get through these much more difficult times. As for the contention that assisted suicide laws will generate lots of litigation, I find no evidence of that happening in the jurisdictions that have these laws. on Physician-Assisted Suicide: Yea? Nay?

Anna said...

My husband passed away suddenly in 2014 at age 77, about 12 years after PD diagnosis (which I was starting to suspect was actually multisystem atrophy). He, too, had been an intelligent (engineer), articulate and gregarious fun-loving man. Unlike myself, I never, ever knew him to be depressed. As the disease robbed him of his brilliant cognitive abilities, I started to wonder if this had changed, because he would sit for hours and seem to have no interest in anything. He, too, eventually became completely incontinent. I finally realized, perhaps too late, that it was impossible to know how he was feeling emotionally, because he had lost the ability to communicate with his brain anything that might have been going on in his mind. So he might have been deeply depressed and wished to end it all, or he might have been having a ball. I suspect the former. It occurs to me now that although he was not able to express original thoughts, I think this was largely due to his loss of memory of his previously vast and colorful vocabulary. He did seem to be able to confidently respond to yes and no questions. I will always wonder, had I asked him point-blank, if he would like to leave his body now, would he have said yes. And if he had, what would I have done?

These are important things for every one of us the think about. Thank you, John, for writing so transparently and courageously.