Feature :: Page 2 :: A Death of Her Choosing
Today, Oregon’s law is under attack from a powerful foe: the Bush administration. The debate begins with semantics.
Physician-assisted suicide is the term used by most of the public and the media. Death with Dignity is the official title of the law—which has in fact been affirmed twice by Oregon voters: the 1994 act was challenged in 1997 and was upheld by a 60/40 margin. Supporters call it compassionate, enlightened, and freeing. Few use the word “suicide.”
Barbara Coombs Lee, of the nonprofit organization Compassion in Dying and one of the original sponsors of Oregon’s law, writes: “Let’s make these distinctions clear: Suicide is a violent, desperate act the dying might resort to when they feel trapped and locked in the torture chamber of their illness. It isolates the patient and leaves survivors shattered by guilt and anguish. Physician assistance in dying is the direct opposite, a key to the door of that locked room and a way to keep family and loved ones close during a most intimate time. Providing the key can prevent violent and premature suicide, because it gives the suffering patient peace of mind about the final moments and the courage to go on living for a while longer.”
Opponents, on the other hand, call the practice medically illegitimate, a slippery slope, and even immoral. They have no trouble with the s-word.
“I refer to it as ‘doctor-ordered suicide.’ That’s a more realistic description of what it actually is,” says Dr. Kenneth R. Stevens, president of the group Physicians for Compassionate Care, leaders of the local medical opposition to Oregon’s law. “The act of writing a prescription is not a passive thing. It is a written order, a directive to the patient. By writing a prescription for a lethal dose of medication, you’re not pulling the trigger, but you’re giving the patient the loaded gun.”
“That is such an antiquated notion of the doctor-patient relationship,” Lee responds. “Patients today regard physicians as wise counsel and trust them to give their patients power to make their own decisions based upon the physician’s best recommendations. Oregon’s law allows, but does not require, physician participation. When numerous safeguards are met, a doctor is authorized—but absolutely not required—to prescribe life-ending medication that the patient may then self-administer at a time and place of his or her own choosing. The option should be fully integrated into compassionate end-of-life care.”
But Stevens argues that physician-assisted suicide does not serve a legitimate medical purpose. “The ethical and moral statements that are part of a physician’s training indicate that we are not to take the life of a patient,” he says.
“It is contrary to our ethics, and an assumption of power that physicians should not be given. Look, there is no law against committing suicide, but that’s not what this act is about. People say they want the right to die, but really what they’re saying is ‘I want someone to kill me.’ Everyone has the right to die, but trying to legitimize this by making it a medical practice is improper.”
The American Medical Association has been solidly against physician-assisted suicide from the beginning. Its position includes the assertion that the practice “would undermine the physician-patient relationship and the trust needed to sustain it, would alter the role of physicians in society, and would endanger the value our society places on life.”
It is clear that physician-assisted suicide, like abortion, places doctors on the exposed and shifting front line of a white-hot moral issue. But even beyond the proper or improper role of physicians, opponents fear that with assisted suicide in place, the aged or infirm could be “coerced” to die by family members, or that social pressures might evolve from the right to die to the duty to die. Others are afraid the practice invites abuses, especially in the case of mentally or economically challenged patients.
But many ethicists, even those personally opposed to physician-assisted suicide, are beginning to believe that these fears are unsupported.
One example is Daniel Lee (no relation to Barbara Coombs Lee), an author and ethics professor at Augustana College in Illinois. Lee has long been staunchly opposed to physician-assisted suicide. But in recent years, the reality of the Oregon law and its results have led him to ask what are, for him, difficult questions.
“Do those of us with deep reservations about the morality of physician-assisted suicide have any business using the coercive power of government to try to prevent those who disagree with us from doing what they believe is right?” he writes. “Are there any compelling arguments to justify placing legal roadblocks in the way of terminally ill individuals who wish to end their suffering by ending their lives, provided such decisions are made only after thoughtful, careful deliberation in an environment devoid of social pressure?”
Lee makes the point that Oregon’s law “specifies an elaborate procedure consistent with the most rigorous standards of voluntariness,” with provisions, including a 15-day waiting period and multiple opportunities to rescind the request, intended to make it very clear to those contemplating ending their lives that they are under no pressure to do so. When physician-assisted suicide is presented in this cautious, completely voluntary manner, it is, in Lee’s opinion, a matter of individual choice, not a decision forced or influenced by social pressure.
“There is another firewall—one that is also built into the Oregon law—that might be even more significant,” Lee adds. “This is the requirement that lethal drugs be self-administered, rather than administered by the prescribing physician or anyone else. If physicians, family members, and others are prohibited from administering lethal drugs to terminally ill patients, and that restriction is rigorously enforced, nonvoluntary euthanasia is precluded.”
Lee concludes that “the arguments in favor of continued prohibition of physician-assisted suicide are not particularly compelling. Those of us opposed to it would do well to focus our efforts on helping others discover the meaning and hope that are possible in life. If we were to do a better job of responding to suffering individuals in a loving, caring manner, physician-assisted suicide would in all likelihood be an option rarely, if ever, chosen.”
And that is the one place in which supporters, opponents, and the reality of Oregon’s law itself find agreement: very few people want to die.