I remember a few months ago that, when Brittany Maynard made the decision to move to Oregon to end her life rather than suffer from the pain and indignity of her terminal cancer, she decided to go public to raise awareness of the issue. She has succeeded in doing that.
I can understand her thinking behind why she wanted to make the decision she did – but it’s something I could never do personally. Perhaps it is easy to say right now, when I’m young and relatively healthy, but I plan to fight until my dying breath when that day comes.
And, while I understand that some conditions have an air of inevitability, I have known too many people who were given only a few months to live and who are either still alive today or far exceeded that grim life expectancy. Experimental treatment, new technology, misdiagnosis, and, quite frankly, miracles occur.
And so, while I understand and support the need to alleviate suffering, I am uncomfortable with conceding to death.
Up until about 20 years ago, I was strongly in favor of assisted suicide. But a good friend of mine, who died prematurely over a decade ago, changed my mind. For him it came down to an issue of eugenics, the devaluing of life, and the possibility of society coercing “undesirables” into making decisions to end their life as a means of cost savings and resource allocation.
I think the legislation proposed here is well-crafted and good. Oregon has a good model to start with.
There are safeguards in place. For example, “The terminally ill patient is required to have two physicians confirm the patient’s prognosis of six months or less to live and that the patient has the mental competency to make health care decisions for him or herself.”
There is also the requirement of two oral requests to the physician, made 15 days apart, and a written request with two witnesses attesting to the request before the prescription can be written.
The doctors would be protected from civil or criminal liability and it would be voluntary on their part.
They do not specify the safeguards against coercion, but do establish felony penalties. And, of course, the patient has the right to rescind the request.
The law further specifies, “The attending physician of the terminally ill patient who wishes to engage in the End of Life Option Act is required to discuss feasible alternatives or additional treatment opportunities, including, but not limited to comfort care, hospice care, palliative care and pain control.”
There are several key elements to this legislation. The first is that it is limited to mentally competent patients and they have to make the choice themselves. That means that a family cannot make the decision for a loved one. It means that an individual cannot leave instructions in a will. And it means that it cannot be the decision of an insurance company or doctor due to financial reasons.
The 15-day requirement means that the decision is not made on whim, or in a moment of weakness or a fit of depression.
The legislation avoids the ethical dilemma of a doctor or facility being compelled to carry out a procedure that they do not want.
I want to stress this point – I think this is a really well-written legislation that articulates the concerns of many and attempts to address and safeguard against the worst fears.
The first point is that I think the notion that there is a slippery slope here is difficult to justify. It has taken far too long to even get small measures that would authorize assisted suicide to believe that suddenly we are going to slide from well-crafted legislation to anarchy.
That said, I cannot support this legislation.
First, as I mentioned, I think we cede to death too soon. Death is, of course, inevitable, but its timing is uncertain. We live our lives as though the limited time we are granted in this world has meaning and value. End of life can be hard, and I remember that my grandmother, mentally limited in her final years, would perk up and smile as we entered the room.
Even with two opinions, the doctors could be wrong; experimental treatments have worked in the past, and could buy enough time for new innovations to greatly prolong life.
Second, and I think more importantly, this really does open the door for the potential that the decisions could be made based on financial considerations rather than medical and humanitarian reasons. What if insurance companies started limiting their coverage for terminal patients in hopes that they could save money by convincing financially strapped families to make the fateful choice?
Third, I still fear the specter of eugenics and the value that we place on the lives of the sick, the disabled, the needy.
So, while I believe that this legislation attempts to address these issues, I fear that there is no sure way to do so.
Who becomes the guardian of the terminally ill? How difficult would it be for a cottage industry of doctors to spring up and sign off on assisted suicide for non-mentally competent individuals whose family simply decides that they are expendable?
Maybe this overstates the risk involved here, but, at the end of the day, I think it is going to be very hard to ensure that this stays as clean as the legislators intend. I would prefer us to spend our energy and resources to make sure that we research ways to increase comfort for those with terminal illnesses, and find ways to fund research to prolong life.
—David M. Greenwald reporting
I am not that familiar with the Oregon law to know how closely it matches the proposed CA one, you mention the CA one was based on Oregon’s. If so, what does the data show in Oregon? Are any of your concerns expressed in the article born out in the OR data?
We have a family friend, an elderly man, a resident of OR, who elected to use the OR law to end his life a couple of years ago. We were involved only through his stepson who was there and in talking to him before he died. Although not his family’s wish, he was very set in his desire to end his life for sound reasons to him, medically and quality of life. Who knows what each of us would do, given his or other’s condition? Even though we couldn’t necessarily ‘agree’ with his decision, we were proud that he could make it….and glad that the state he lived in allowed him to make it.
Not sure any of this post makes sense. I am finding it hard to express myself so will end.
Makes a lot of sense… if someone, is “very set in their desire to end (their) life”, they will probably find a way. They could acquire a gun and “eat it”; they could drive off a cliff; douse themselves in gasoline, and strike a match; hanging (Robin Williams found a ‘low-tech’ way of doing that). Many ways. But the sane ones don’t want their loved ones to be the ones to “discover” the remains in those situations. Do think it is selfish to eat a gun and have the loved ones dealing with the spatter of blood and brains on the walls of the family home, or example.
This is NOT a SIMPLE matter. I share many of David’s and others’ concerns. Biggest concern right now is what the bill will end up being by the time the legislature votes on it. Yet, there are many reasons why we, as a society need to have the conversation about these issues. If the bill, as currently proposed was on the ballot tomorrow, am not sure how I would vote. Until I have more questions answered, and am convinced that this is not a “camel’s nose in the tent” ploy, would probably vote against it.
I worked on a suicide prevention line for almost 2.5 years (~550 hours on the hot-line). Bay Area. High caller volume, particularly on Friday 7:00 P to Saturday 7:00 A, the shift I worked. Of the calls I deemed “moderate to high lethality” [probably over 100 calls in those categories](and yes, received excellent training plus refreshers to make that opinion), can’t think of ANY that would have met the criteria proposed in the bill.
The reason I haven’t worked on a crisis line for over 35 years is that on my last shift, before moving to Davis, I had a call that was very high lethality, where I sent the cops/paramedics. Never heard the outcome. Never knew if I made a difference. And these were people who supposedly were still ambivalent about life, as they called. The ones who have truly “committed” to suicide are not likely to call something called “Suicide Prevention of San Mateo County”.
SODA, the most recent report from Oregon shows that over the 14 years they have been collecting data, DWDA (Death With Dignity Act) deaths have accounted for only 0.2 percent of all deaths in the state. Most of the qualified patients are over 65, have a diagnosis of terminal cancer, and receive palliative care through hospice. An interesting part of this is that the number of DWDA prescriptions written are one-third higher than the number of DWDA deaths recorded, which suggests to me that there is little coercion involved and many people choose to let nature run its course.
I believe David’s concerns are valid, but are not borne out by the facts – at least in the 14 years of experience from Oregon.
Thx Robert!
robert: the test may not be when the first state does it, but when it becomes the general law of the land.
DP wrote:
> he test may not be when the first state does it, but when it
> becomes the general law of the land.
Keep in mind that “only” 0.2 percent of all deaths in America over 14 years is about 7,000 deaths (more than one a day)…
“it’s something I could never do personally.”
I think that the last word of this sentence is the key. Choosing when to end one’s already very limited life is a highly personal matter. The life in question belongs to the individual and individuals have very different philosophies of life.
While I understand every one of David’s concerns, and because of my profession have given these issues a great deal of thought over many years, I have come to the opposite conclusion.
I love life, my own, and in the general sense. However, I view death as a normal, natural part of life. I do not view it as something to be avoided at all costs. I will not “fight to the last breath” to avoid what I see as natural. I would ideally like to close my eyes, fall asleep and never wake up. But barring that, my preference would be to chose when the time is right for me to make a “graceful timely exit” from this stage of life.
What Oregon has done is to place this decision in the hands of the individual. The law with its provisions does not force anyone to do anything. What it does is to provide choice to individuals such as myself who will opt to end our lives when we feel that further intervention is futil ,unwarranted and undesired. This is something that I have discussed in detail with my family and all are in agreement so there is no issue of guilt or second guessing.
The law that we have now in California forces those who share my philosophy to leave our homes and go to another state in order to have the end of life experience of our preference. This imposes the terrible burden of leaving one’s own doctors, family members, friends and home in order to die in relative isolation amongst strangers. Is this really a more humane solution ?
I would have those who oppose this law consider that while they fear that their right to choose may be taken away, my right to choose is currently taken away by their preferences.
Sorry, Tia.. not buying your argument that not passing the law takes away your basic “right to choose”. Except in some nuances of “time, place, and method”, you can choose to end your life, probably without the assistance of others, and if you do, it is unlikely you will be convicted of a crime.
Particularly you, who have training in pharmecuticals (never could spell that word) and am assuming you have the right/power to prescribe/obtain what you would need to end your life on your terms, if it comes to that.
Just can’t buy: “I would have those who oppose this law consider that while they fear that their right to choose may be taken away, my right to choose is currently taken away by their preferences.” Just not true.
Pierce, your reply to Tia is very understandably personal, and uses her professional knowledge extensively. Let’s put your argument to the test by associating all the yous and yours in your response with me as an individual rather than Tia. I have no training in pharmaceuticals. I have no right/power to prescribe/obtain what I would need to end my life on my terms. So do you buy my argument when I say, “I would have those who oppose this law consider that while they fear that their right to choose may be taken away, my right to choose is currently taken away by their preferences” ?
Simply, if an author chooses to ask a question/issue a challenge using the “me” or “I” word, I’ll take it at face value. Had an author parsed it as “a person’s”, or “an individual’s”, or “somebody’s”, I would have responded in kind. If an author makes something ‘personal’ to make their ‘point’, I see no issue in responding in kind. The author in question makes it clear they have medical acumen, and that they are talking about their personal rights. Had the argument been stated “I would have those to oppose… others‘ rights to choose is currently taken away…”, I would not have made the generic, ‘personal’.
I am pleased that this legislation is being considered. As long as California follows Oregon’s assisted-suicide model and not the euthanasia/assisted-suicide model of the Netherlands, I can be supportive. I am uncomfortable with the euthanasia component of the Netherlands law which is the vast majority of their assisted deaths.
I look forward to reading the actual proposed California legislation.
Elizabeth
While I am quite familiar with the Oregon statute, I am not familiar with the actual details of the policy in the Netherlands, only the claims of certain American politicians that it has been used to “kill the elderly” which has been denied by officials of the Netherlands.
Can you tell me which provision of the law in the Netherlands that you specifically do not support ? You have cited “the euthanasia” component, but I am unclear how this works after reading the Wikipedia version.
From Wikipedia: “The law allows medical review board to suspend prosecution of doctors who performed euthanasia when each of the following conditions is fulfilled:
the patient’s suffering is unbearable with no prospect of improvement
the patient’s request for euthanasia must be voluntary and persist over time (the request cannot be granted when under the influence of others, psychological illness or drugs)
the patient must be fully aware of his/her condition, prospects and options
there must be consultation with at least one other independent doctor who needs to confirm the conditions mentioned above
the death must be carried out in a medically appropriate fashion by the doctor or patient, and the doctor must be present
the patient is at least 12 years old (patients between 12 and 16 years of age require the consent of their parents)
Practice[edit]
In 2003, in the Netherlands, 1626 cases were officially reported of euthanasia in the sense of a physician assisting the death (1.2% of all deaths). Usually thesedativesodium thiopentalisintravenouslyadministered to induce acoma. Once it is certain that the patient is in a deep coma, typically after some minutes,Pancuroniumis administered to stop thebreathingand cause death.
Officially reported were also 148 cases of physician assisted dying (0.14% of all deaths), usually by drinking a strong (10g)barbituratepotion. The doctor is required to be present for two reasons:
to make sure the potion is not taken by a different person, by accident (or, theoretically, for “unauthorized” suicide or perhaps even murder)
to monitor the process and be available to apply the combined procedure mentioned below, if necessary
In two cases the doctor was reprimanded for not being present while the patient drank the potion. They said they had not realized that this was required.[4]
Forty-one cases were reported to combine the two procedures: usually in these cases the patient drinks the potion, but this does not cause death. After a few hours, or earlier in the case ofvomiting, the muscle relaxant is administered to cause death.
By far, most reported cases concerned cancer patients. Also, in most cases the procedure was applied at home.
“
http://www.euthanasiecommissie.nl/
there is a lot of information on this site as well as their 2013 statistics (the most recent)
I am uncomfortable with the euthanasia component of the Dutch law. I’m not saying that I absolutely wouldn’t support it, but I would need to know a lot more about it and how it is being implemented before doing so. I don’t have a problem with the assisted-suicide component that is being considered here and that is available in Oregon.
Anon, as I read that wording, I couldn’t see any significant differences between what its parameters are (see below copied and pasted from your post above) and what the proposed parameters for California and existing parameters for Oregon are. Can you help me understand what you see as the differences?
Matt, in the Netherlands, the parameters for euthanasia do not differ significantly from the parameters for assisted suicide as you noted in your reply to Anon’s post. The difference between the two procedures, per the link I provided above, involves the patient’s participation in them. In assisted suicide, the physician provides the patient with the aid-in-dying medication which the patient then takes himself. In euthanasia, the physician also administers the aid-in-dying medication to the patient. My reading of CA SB128 is that it requires the patient to “self-administer” the aid-in-dying medication which conforms to the assisted-suicide arm of the Dutch program. My concerns are with the euthanasia arm of the Dutch program, in particular, the nature of the informed consent that is obtained from individuals who will not be self-administering the aid-in-dying medication, such as the mentally ill, mentally disabled, dementia patients etc.. I do not know enough about how the Dutch program is administered to know if this is problematic, but there are some worrisome reports in the media, especially the British and European media, about the Dutch euthanasia program. I am supportive, however, of the Oregon and proposed California assisted-suicide programs.
The more I think about the headline, the more I believe the author has a misunderstanding about the issue. This is really not an issue of suicide but rather of what some in the medical field call “hastened death.” The authors of a 2008 paper in Psychosomatics distinguish between suicide – a pathological and violent death – and hastened death, where an individual and their social network actively choose a course of action in the context of terminal illness and failing quality of life. The Oregon DWD deaths are not traumatic and painful in most cases, as are most suicides. The article in Psychosomatics, by Bostwick and Cohen, give examples from chronic kidney disease and the withdrawal of dialysis. They quote a study’s finding that: “Although death is inevitably sad, a prospective study of the qualitative aspects of dying after dialysis cessation has found that 85% of the deaths are judged to be good. Especially when medical and familial interests concur, many of these deaths are not only good, but “very good.” When symptoms are well-managed and where all participants collaborate and achieve agreement, death is often re- called as being merciful, compassionate, and even uplift- ing. Families and loved ones may find such deaths to be an epiphany and not a trauma.”
“Assisted Dying” would be a more appropriate title
Elizabeth wrote:
> “Assisted Dying” would be a more appropriate title
I wonder if the Death Penalty fans in CA would have better luck if they called it “Assisted Dying”?
I don’t have a problem with anyone making the decision to end their own life but I don’t like the idea of making it legal to kill (aka “assist”) someone else when they end their own life (whether it is a guy in San Quentin that admitted to killing three kids or a 99 year old that is in constant pain)…
“I can understand her thinking behind why she wanted to make the decision she did – but it’s something I could never do personally. Perhaps it is easy to say right now, when I’m young and relatively healthy, but I plan to fight until my dying breath when that day comes.”
Brittany Maynard did not end her life immediately after going to Oregon, as I understand it. She had a terrible brain seizure, which confirmed for her that she was making the right decision, and that is when she ended her life. I don’t think any of us could know what we would do in her situation, until we were actually faced with it. I suspect it also depends on one’s religious and/or moral convictions. I honestly am not sure how I feel about this legislation. On an intellectual level I perfectly understand it, but from a gut level it makes me queasy. I have had relatives die awful deaths from cancer, and I have put a pet down because of quality of life issues.
This may sound like a weird analogy, but I voted in favor of the medical marijuana law. Had I known the medical marijuana law was the first step in legalizing marijuana as a recreational drug and the legalization of all drugs, I never would have voted for it, and regret doing so. Had I to do it over again, I would have voted “no”. I don’t want to look back on this “right to die” law and regret having voted for it – the stakes are too high. I’m just not sure at this point in time.
interesting thoughts.
to hijack your subpoint, i don’t think medical marijuana was intended to be a step toward legalizing marijuana. i think the federal government turned it into that when it prevented california from being able to have marijuana within the medical mainstream. in short, i think that the way that this has been mainstreamed will preclude your concerns.
From: http://www.nj.com/times-opinion/index.ssf/2013/05/opinion_legalizing_marijuana_w.html
“Those numbers reflect a time when policy makers in New Jersey and several other states were debating medical marijuana. When then-Gov. Jon Corzine and the Democrat-controlled Legislature legalized marijuana for medicinal purposes, I predicted it was the first step toward legalizing dangerous drugs. ”
From: http://www.wtsp.com/story/news/health/2014/11/04/medical-marijuana-opponents-amendment-2-wilts-away/18461659/
“Many Bay area parents say right now they’re forced to travel to other states to purchase medicinal marijuana for their sick children or relatives. It’s said to provide relief from things like chronic pain, seizures, muscle spasms, eye pressure, nausea and loss of appetite.
Still, some think the amendment is just a a way to fast-track the use of recreational marijuana.”
From: http://www.nytimes.com/2014/07/27/opinion/sunday/high-time-let-states-decide-on-marijuana.html?_r=0
“Repealing it would allow the states to decide whether to permit marijuana use and under what conditions. Nearly three-fourths of them have already begun to do so, liberalizing their laws in defiance of the federal ban. Two have legalized recreational use outright, and if the federal government also recognized the growing public sentiment to legalize and regulate marijuana, that would almost certainly prompt more states to follow along.”
From: http://www.collegian.psu.edu/arts_and_entertainment/ps/article_5b50c388-9c53-11e4-a496-e7362bb17801.html
“In recent years, there has been a push toward full legalization of marijuana in states across the nation. So far, 23 states have either decriminalized or legalized marijuana for medicinal or recreational purposes. Now Pennsylvania is teetering on the edge of the legalization cliff.”
as i said, the biggest problem with the way the law is structured is that you are not getting the marijuana through normal prescription means – you get it with a 215 card from a normal drug dealer – that’s not a good way to have things structured if you want it to be used for the intended purpose and not bleed into broader issues.
DP wrote:
> i don’t think medical marijuana was intended to
> be a step toward legalizing marijuana
I worked on the Ed Clark for President campaign in 1979 and even back then most of the people in the Libertarian Party and NORML (lots of people in Northern CA were active in both groups) were hoping to use laws making “medical” marijuana legal as a step to make ALL marijuana legal. Sure there are some people that ONLY wanted marijuana legal for people with real (cancer glaucoma, etc) problems but my (unofficial) estimate is that 99% of the people pushing for “medical” marijuana wanted ALL marijuana legal.
Thank you for reinforcing my point!
“I honestly am not sure how I feel about this legislation. On an intellectual level I perfectly understand it, but from a gut level it makes me queasy. I have had relatives die awful deaths from cancer, and I have put a pet down because of quality of life issues.”
To clarify your thoughts about this issue, I would recommend exploring more fully just what exactly it is that made you feel “queasy”. There are a number of factors that could lead to this reaction.
It could make one queasy because :
1. You have fears about the “slippery slope”
2. The bill does not fit with your moral or religious beliefs about life and death. This one leads to further complexity because then you must decide about number three.
3. You don’t feel comfortable forcing your moral or religious beliefs on others and either feel that the current law forces people to live when they are in agony, or because you fear that they could be somehow “forced to choose death”.
4. You are simply not comfortable with confronting life and death decisions and issues.
I am doubtless missing many, many other possibilities for that “queasy” feeling but I picked up on that word immediately and just felt it is worth exploring further.
I think my queasiness is more the “slippery slope” issue, but I’m not even absolutely certain why I feel queasy about such legislation. I honestly think I have to let the idea of this legislation percolate in my mind for a while, mulling over the various issues and learn more about how the Oregon law works. I know I made a huge mistake from my perspective when I voted in favor of the medical marijuana law, and deeply regret it, despite the unlikelihood my vote would have made a difference in the outcome of the medical marijuana ballot measure. However, I feel very “betrayed” by those pushing for the legalization of medical marijuana, and their motives. So I have a deep-seated mistrust of ballot measures/legislation now, that demand radical change.
As I read David’s article I found myself thinking that his arguments fit into the model of “the quest for the perfect is the enemy of the good” The central tenets of the argument put forth are his uncertainty and uncomfortableness. Uncertainty about “experimental treatment, new technology, misdiagnosis, and, quite frankly, [that] miracles occur.” Uncomfortableness about “conceding to death.” As a result he is personally planning “to fight until my dying breath when that day comes.”
As I read those words, I couldn’t help but wonder whether David has only engaged uncertainty part way. Is his uncomfortableness with death the result of the uncertainty that we all feel about what happens to us the moment after we die? And further, is that uncertainty about death a purely personal feeling? As Sydney Carton approached the guillotine, his words would seem to indicate that he had no such uncertainty … or at least no uncomfortableness with his impending death. ““It is a far, far better thing that I do, than I have ever done; it is a far, far better rest that I go to than I have ever known.”
It isn’t hard to infer what the underlying beliefs are that caused Carton/Dickens to utter those words. Belief in an afterlife is a central theme of many of the world’s Religions.
I respect the intensely personal way in which each of us deal with uncertainty, but wonder whether David’s argument that he doesn’t want to support this idea because of the level of uncertainty and uncomfortableness it causes him personally isn’t indeed an individual quest for the perfect that is in reality an enemy of the greater good.
Or perhaps it is the difference of looking at the notion of dying as a younger person, versus someone who is much older. It does make a difference!
If the person in question is of sound mind and wants to make a considered decision to move on to the next phase of their existence, how does their age make any difference? Their decision is their decision. We are all external parties to that very personal decision on their part. Further, we will not be passing through the veil with them. They will be doing that alone … and of their own free will.
None of us knows with any certainty what happens after our existence on this plane comes to an end. Many scriptures in many different religious traditions tell us that we move on to the next plane of our existence. If that is true, a young person will enjoy the fruits of that “moving on” just as much as an older person will enjoy the fruits of that “moving on.” There appears to be no difference whatsoever, if those scriptures are to be believed.
I have two cents to add here. My husband suffers from the same thing Ms. Maynard was diagnosed with: glioblastoma multiforme. Instead of the one year estimate we originally received, Lenny is still living- although in quite compromised fashion- five years later. He is currently in hospice, although who knows if he’ll stay here. . . . As a result I’ve had a chance to consider many things associated with life, compromised life, dying, medical and non-medical, approved and non-approved treatment, and death; and legislation around those/some of those topics; as well as who makes these decisions when the dying person is compromised and even when s/he is not. It’s from that perspective that I’d like to offer the following: first, there is a wonderful book out there by Atwul Gawande, titled “Being Mortal” which treats this question- the end of life experience in the context of a western medical culture bent on extending life at all costs- among others, thoughtfully and quite fully. Second, although sometimes I want to scream and run wildly away from my own life as my husband’s caregiver, I have had an opportunity to watch this vital man be slowly changed as he moves towards his death, and I must say the experience teaches a lot that I couldn’t have known unless I experienced it: it’s like childbirth, I suppose. In particular, having watched my husband lose function, yet remain able to make some decisions about his life, I believe to my core that the choice- if one is compos mentis- to die, and how to die- should remain with the individual who is dying. If Lenny wanted to go to Oregon to die, I would honor that desire as I have honored his other wishes along this road; and I would do everything I could to support him.
Thanks very much, Nora, for providing this perspective. My own experience with hospice for my mother made it very clear to me that this is — should be — the individual’s choice.
Powerful. Thank you for sharing. No matter what may come for both of you, I will keep you, your husband, and family in my thoughts and prayers.
Nora, I appreciate your perspective, as someone who probably has better perspective than the average citizen on these issues. There are no easy answers in a situation like yours, as is often the case in life.
hpierce
I can see how you could “not buy it” since I chose to write in the personal form in order to not speak for others. That was an error which I realized only after I posted. Matt is correct that my intent was to point out that those without the knowledge and access that I have would not be able, in the system that we currently have to make this decision to end their life with medicines and thus would find their choice limited by our current laws. So with Matt’s example, not mine in mind, what are your thoughts ?
My thoughts are like many posted.
I have grave (pun intended) concerns about how this particular bill, as currently written, might morph during the legislative process. As the bill is written, I might be supportive, or at least neutral, if it meets my “thus far, but no further” criteria. On many issues, I have seen my making a compromise being followed by a demand for further concessions, later.
Personally, I have no problem knowing I have “a choice”, with or without a change in legislation. I still don’t understand fully why this legislation is needed, except for a CYA for physicians who already covertly aid accelerated death when death is imminent, and the only difference, at the end of the day, is “suffering” and timing.
I believe that there is a segment of activists supporting this who do see this as a thin, opening wedge, to lead towards a legal way to end the life of someone who has become an emotional or financial burden.
I am “pro-life”, and my interpretation is that abortion (please understand that I use that word in its FULL meaning) can be “pro-life”. I am an only child, and Mom experienced two abortions… her body naturally ended those two pregnancies (one happened before she had realized she was pregnant), apparently because something went awry with the development of the fetus, and the pregnancy was not viable. My interpretation also includes a case where a pregnant woman, in her child-bearing years, faces a pregnancy where the child has little chance to live, AND continuing the pregnancy is likely to result in either the death or infertility of the mother. In that case, using my moral compass, ending the pregnancy can well be “pro-life”.
As for end-of-life (other than abortion), I am also “pro-life”, but based on the concept that when the body might still be made to function, the spirit, elan, essence of the person is no longer present, and so “death” has already occurred. There are examples of a brain-dead woman, kept alive by artificial means, have delivered a healthy child. That is pro-life. There are many cases (through a child who works neo-natal intensive care) where a child is born, internal organs outside the body, no prospect of living to be two EVEN WITH ‘heroic measures’, but the parents can’t “let go”, and possibly torture the child by preventing what maybe should have happened in the womb. Such extraordinary measures, to me, are not “pro-life”.
I am very concerned that the proposed legislation will “logically” morph, over time, beyond assisted dying, to assisted suicide, to euthanasia, to eugenics. Witness the evolution of the laws regarding abortion, from prohibition, to medical necessity, to “convenience”/on demand. And even then the proposed laws sought to take a fetus, even ‘viable’, ‘partially’ out of the womb and end its existence. Why would the same progression not happen with ‘end-of-life legislation’?
As I have written before, a dear relative was dying of pancreatic cancer, which much more often than not, is exceedingly painful. They were identified as “hospice”, and even in the hospital, a morphine drip was available at the patient’s choice if and how much they wanted/needed. 12 years ago, California. My relative was lucky… a couple aspirin, a couple of times sufficed. They did not “suffer”. Morphine wasn’t used. Had my relative chosen the morphine, or had they overdosed on purpose, I would have loved them no less.
Don’t know if that responds to your query, but that is as far as I care to go as to “my thoughts”.
hpierce, you expressed my reservations elequently. This paragraph you wrote particular struck me:
“I am very concerned that the proposed legislation will “logically” morph, over time, beyond assisted dying, to assisted suicide, to euthanasia, to eugenics. Witness the evolution of the laws regarding abortion, from prohibition, to medical necessity, to “convenience”/on demand. And even then the proposed laws sought to take a fetus, even ‘viable’, ‘partially’ out of the womb and end its existence. Why would the same progression not happen with ‘end-of-life legislation’?”
hpierce
I appreciate your sharing. There are many ways to express a pro life position as I learned when I was the resident participating in the care of the patient I believe that you are referencing who was brain dead and being kept alive long enough to deliver a viable baby. This was the first, but not that last time that I have been involved in complicated end of life decisions either for the fetus in the case of the brain dead mother, or the termination of the life of a non viable baby in order to save the life of the mother. These are never easy decisions. However, as a doctor I will always follow the path of individual autonomy. This is true at the beginning of a new life, just as at the end of a fully lived life.
Not meant as a challenge, but as inquiry… in the case of the brain-dead mother (some would say ‘incubator’) and the viable fetus, how does “individual autonomy” factor in? Certainly not either of the two most ‘involved’ stakeholders. Did you default to the autonomy of spouse/family? Had the mother given directives prior to her loss of autonomy? None of this stuff is simple, but am not understanding how your “metric” would play out in that type of case. Am looking to extrapolate on how that might play out in an accelerated death situation. [I agree with others that the term “assisted suicide” is not truly helpful to the discussion]
My relative had executed a “do not resuscitate” directive, previously discussed with me, and ‘just in case’ there was a problem with the signed directive, they also gave me medical power of attorney. Knowing that I would ensure that I would honor their request.
One hypothetical situation might be if a terminally ill, suffering, patient made it clear that they wished to end the suffering, and accelerate their passing, but had not run the gamut of the protocols called for in the law. And their condition deteriorated, during the process, where they were no longer ‘compis mentis’. Could a relative with a medical power of attorney consent to/order the accelerated death to proceed? Failing a valid power of attorney, could a close relative proceed? Not questions to you, Tia, but it goes to how the proposed law might be ‘finalized’, and how slick and steep the slippery slope might be.
“However, as a doctor I will always follow the path of individual autonomy. This is true at the beginning of a new life, just as at the end of a fully lived life.”
Perhaps this is where you and I differ. Do you support late term abortions, when the baby is viable and purposely has its life ended for the convenience of the mother? I do not.
‘Viable’ is not a clear condition in many cases. I urge you to read this thread about the women who choose late-term abortions for a better understanding of how difficult that decision can be.
http://dish.andrewsullivan.com/threads/its-so-personal/
Returning to topic, looking at end-of-life decisions for adults, my main take-away from your citation and your comment asking folks to have a “… better understanding of how difficult that decision can be.” is relevant to the topic. And in deciding how to approach the proposed bill, I suggest should read your citation, and imagine rephrasing the stories to fit the end-of-life discussions. Anyone who thinks the merits/problems of the bill, much less what it may morph into, is black/white, cut/dried (pick your metaphor), is NOT thinking.
hpierce, I think that is true if you are giving third parties (family members, friends, etc.) a voice in the patient’s decision. However, if you exclude those outside voices from the patient-doctor dialogue, then the situation is much more black/white, cut/dried (pick your metaphor).
Matt… we have not seen how the bill will morph as it goes thru the legislative process. I stand by my concern that someone who is competent when the process starts may not be so when it has run its course. What then?
I have said I have concerns… I have NOT said I am opposed (nor, in support), NOR have I tried to say others are “wrong” [although I may question their logic,infromatiom/facts and/or motivations]. I need more information to address my concerns. It appears you don’t. At this point, I still assert that someone who has decided that this bill, however it may morph, is one they support (or, oppose) has ‘stopped thinking’. Am not convinced that the legislation will “exclude those outside voices”. If you are, fine. Your inalienable right. I’m not. I am not convinced. Hope you can respect that. If not, as the kids say, “whatever”.
Breton, in today’s Bee, captures (in general) my angst. We’re not talking steel skin of buildings vs. rich architectural features. We’re talking about life. Without that, we can’t express opinions, particularly in this forum.
Pierce, my comments had little to do with the specific legislation. Rather they focused on the individual personal right to choose.
If they are competent when they give the go ahead to complete the process, what would cause them to lose that competence in the relatively short timeframe of the process’s duration?
EDIT: I just read Breton’s article and I agree it captures the issues well. Some are straightforward. It is pretty clear his father’s personal choice was to live … regardless of the pain. The issue with the disabled is a bit more complex, but if the focus of the process is on their individual personal desires then the external influence concern should be mitigated. The real issue appears to be how to disenfranchise external influences like family.
Anon
“Do you support late term abortions, when the baby is viable and purposely has its life ended for the convenience of the mother? I do not.”
In thirty years of practice, I have never seen this happen. I have seen advanced pregnancy in which the fetus had no reasonable chance at life terminated in order to preserve the health of the mother. In women who are poor operative risks and in whom the fetus cannot be delivered without decompression of a hydrocephalus, I have seen the abnormal brain fluid collection reduced in order to allow for a vaginal delivery in what would be classified by those without an understanding of the clinical situation as a “late -term” abortion. This is not for the “convenience” of the woman but to preserve their health. I believe that those who use the argument against ‘late term abortions” as an argument against all abortion play upon the emotions of those who do not understand the complexity of the medical situations involved in the choice to perform a “late term abortion”.
“The intellectual arguments are often quite logical. It’s the practical reality that breaks one’s heart – and that’s where the parents should be supported for the decisions that they make, for their situation. Their God, their doctor, their family, and their finances. Not mine, not yours, and not every other person who thinks they know what’s good for them but don’t have to walk in their shoes.”
I think that this quote from all of the testimonies in Don’s posted article comes the closest to my position.
You are dodging the question, and so is Don. Do you support, in all circumstances, the mother’s right to choose, in the case of all types of late term abortions? I am not trying to be combative or difficult here. But when laws are made, they often have unintended consequences, as abortion law has. That is why the federal gov’t had to come back and do a correction by enacting the Partial-Birth Abortion Ban Act. And look at the statistical reasons why mothers have late-term abortions.
From Wikipedia:
“The Partial-Birth Abortion Ban Act of 2003 (Pub.L. 108–105, 117 Stat. 1201, enacted November 5, 2003, 18 U.S.C. § 1531,[1] PBA Ban) is a United States law prohibiting a form of late-term abortion that the Act calls “partial-birth abortion“, referred to in medical literature as intact dilation and extraction.”
Also from Wikipedia:
“In 1987, the Alan Guttmacher Institute collected questionnaires from 1,900 women in the United States who came to clinics to have abortions. Of the 1,900 questioned, 420 had been pregnant for 16 or more weeks. These 420 women were asked to choose among a list of reasons they had not obtained the abortions earlier in their pregnancies. The results were as follows:[2]
71% Woman didn’t recognize she was pregnant or misjudged gestation
48% Woman found it hard to make arrangements for abortion
33% Woman was afraid to tell her partner or parents
24% Woman took time to decide to have an abortion
8% Woman waited for her relationship to change
8% Someone pressured woman not to have abortion
6% Something changed after woman became pregnant
6% Woman didn’t know timing is important
5% Woman didn’t know she could get an abortion
2% A fetal problem was diagnosed late in pregnancy
11% Other
A new study in 2013 shows that most women seeking late term abortion “fit at least one of five profiles: They were raising children alone, were depressed or using illicit substances, were in conflict with a male partner or experiencing domestic violence, had trouble deciding and then had access problems, or were young and nulliparous.“”
I don’t recall being asked a question, but I’ll answer this one. I know of no way to assess the mother’s reasons. So short of setting up abortion review panels, my answer would be that the mother does have that ultimate right.
The Wikipedia article you cite shows the problem. That asked about abortions after 16 weeks. The current GOP proposal is to ban all abortions after 20 weeks. Those are, in fact, arbitrary deadlines for abortion, and have no biological basis. And they don’t allow for those many possible reasons that come up later in pregnancy.
Very few doctors do late-term abortions. They are rare. If you take the decision away from the woman and her doctor, who do you propose giving that decision-making power to?
I’m assuming what you are saying, and correct me if I am wrong, that the mother should be able to make the decision to have late term abortions no matter what. Yet you seem to forget why the Partial Birth Abortion Ban was put into place. A doctor was literally killing viable babies even in the ninth month, and I won’t even describe how.