On ‘Death with Dignity’

By Cathy Keim

“The solution to suffering never is to eliminate the sufferer.” – Dr. William Toffler

I was writing a piece on the Death with Dignity Act but Michael beat me to it by posting on it last Wednesday, so I will address some of the issues that Michael touched on briefly.

I agree with Michael that this bill has a good chance at passing. My reason for thinking this is due to the emotional appeal that is being made by the proponents. None of us like to think about death in general and our own death in particular. Even less appealing is to consider oneself in extremely poor health with no chance of recovery; indeed, only a continued progression downward.

Many people jump from that grim thought to friends or loved ones that they have seen suffer and are ready to declare that they will not submit to such a fate. This is really a very American “I am captain of my ship” type of thinking. We are a free people. Why should we have to suffer a lingering illness and the indignities that accompany such a loss of mobility or mental capacity?

The more libertarian among us declare that the government has no right to keep us from our choice. Perhaps they should stop for a minute and realize that the more present fear is that the government will all too willingly let you have your wish and maybe help you along before you quite decide that is where you want to go.

Now that our healthcare has been taken over by the government and our Republican leaders show no progress in their faint attempts to stop it, people should realize that things are quickly moving to the government being able to refuse care. After all, it costs a lot of money to treat sick or handicapped people and we could save a lot if we helped some of them choose to leave a little sooner.

Insurance companies are already questioning charges on patients that have difficult prognoses and are refusing to cover futile care. I think you can see that this could get pretty scary pretty fast. Or let’s consider that now Maryland hospitals are given a set amount of money at the beginning of each year and they are not to go over budget. The safest way to not go over budget is to reduce the number of patients you see, particularly the really sick ones.

Now some of these measures may be good, but when you change your basic outlook from “we are here to help sick people” to “we are here to not bust our budget” then you can quickly see how this might not be to the patient’s benefit. This is why we must consider the principles involved before we go to the emotional appeal. Sadly, the emotional appeal is more attractive, which is why it is used over and over again to gain voter support for a myriad of causes.

But on to the less attractive principled approach. This comes down to do we want a culture of life or a culture of death? When you start addressing the big issues, then you have to come clean on your worldview. There are really only two worldviews: we are either created by God (you may choose which one, but America was founded on a Judeo-Christian construct) or we sprang from somewhere with no purpose and no place to go.

If you believe that the world and all that is in it, including men, were created with a purpose, then you will lean towards a culture of life. Since you cannot create life, then you should respect it and care for all men, even those that are not perfect no matter how they came to be that way, whether through accident, age, birth, or war.

You will show compassion to those that need help, starting with your own family and then spreading outward to your community and beyond.

This culture of life says that each life is of value whether they can contribute economically or not.

If, on the other hand, you do not believe that you owe allegiance to any Creator, then you will be quite right to think that you can decide whatever you wish. However, you must realize that Nietzsche dealt with all this and you are heading down a path to a very dark place.

In a very short time, you will go from being captain of your own ship to “might makes right.”

One small aside is that weakness and compassion may have lessons for us all that we will never learn unless we are exposed to situations where we must care for or be cared for by someone. This is not a particularly happy thought, especially to our can-do American spirit, but it is true. Suffering is not something that we seek, but it does bring strength that nothing else can.

Dr. William Toffler, a professor at Oregon Health and Science University, is also the National Director of Physicians for Compassionate Care Education Foundation. Since Oregon passed an assisted suicide law in 1997, Dr. Toffler has had plenty of time to observe the law in action. In a USA Today op-ed he wrote with Dr. Frank S. Rosenbloom, Toffler noted:

At the most fundamental level, the fatal flaw of assisted suicide is that it subverts the trust in the patient-physician relationship. Once a physician agrees to assist a patient with suicide, their relationship is altered.

(snip)

Clearly, the disconnection from the patient under the guise of compassion is contradictory to the long tradition of medical practice: ‘First, do no harm.’

In short, this legislation has not granted, but has actually stripped vulnerable individuals of their worth and dignity. In fact, it has diminished the dignity of us all.

Dr. Toffler’s last quote points us to another danger of the emotional appeal. Vulnerable individuals are not immune to the subtle push of the culture of death which whispers to them: you have no value, you are a burden to your family, you are costing everybody a lot of money and time, you should just take these pills as it would be better for everybody. Mothers carrying babies with handicaps are already told that it is for the best to abort the imperfect baby.

I told you that the principled approach would not be the easy way. Perhaps I have not convinced many to change their mind with such a short essay, but to those who understand I appeal to you to call your Delegate and State Senator and tell them that you do not support HB1021 or SB676.

To save the terminal

A few weeks ago the Maryland Right to Life group sounded the alarm about a proposed doctor-prescribed suicide bill intended for introduction to the Maryland General Assembly. Sure enough, on February 6 the Richard E. Israel and Roger “Pip” Moyer Death with Dignity Act was introduced in the Senate as SB676. The companion HB1021 was introduced a week later, and differs from the Senate bill in that it has modestly bipartisan support as two Republicans are among the co-sponsors.

In principle, MRTL should be against the bill as it interferes with the natural death process. But in reviewing the reasons MRTL gives for their specific opposition, they lean heavily on the experience the state of Oregon has had with a similar bill. Maryland’s version addresses some of these issues.

The bill is one of those which splits the Republican community, though. Libertarian-minded members see this as a “death with dignity” issue – one example is this piece from Joe Steffen at his Darkness Revisited website. It’s a piece where he asks that:

I’ve heard EVERY counter argument, like, a million times. So, please don’t throw any pro-life/anti-abortion stuff or “unintended consequences” type crap at me.

Hearing every counter-argument isn’t the same as refuting them, however. Truthfully, I can see both sides of this bill and while the MRTL may be going a little overboard with their reaction, I don’t think this bill is going to be the final answer.

First of all, the bill which is supposed to give more freedom to those who would like to end their suffering makes them jump through a number of hoops in order to get their relief. It’s a very complex process, and perhaps that’s by design given some of the alleged abuses detailed in other localities. In most cases, the biggest fear is that of an elderly family member being bullied into making the decision to end his or her life in order to provide personal gain to the heirs or other family members.

Or – even worse – they may be bullied into the decision by the state, such as in this example from Oregon.

But one big problem with Maryland’s proposed law is that it requires the cause of death to be listed as the underlying illness rather than noting the assisted suicide. While there are legitimate reasons for this, such as patient privacy, I think it’s also going to lead to significant underreporting of how many people actually use the procedure.

Regardless, this is a bill which has a reasonably good chance of passage. It’s worth noting that the House version of this bill went to two committees, which is often done if there’s reason to worry about getting through a particular committee. But assuming the bill makes it through second reading, there are enough Democrats in both houses to pass the bill. A handful of Republicans will likely vote yes as well while most vote against it. Governor Hogan, who avoided social issues like the plague during the campaign, will most likely bend to the will of the General Assembly and sign the bill into law.

I understand the emotional appeal to the bill, as most of us know someone who succumbed to a lengthy and painful terminal illness. But the potential for abuse from future amendments to the bill has to be considered as well so I’m not sure I can be on board with this one.