All Individuals Have the Right to Die with Dignity
By Matthew Hayes
For the last years of her life, my grandmother did not want to live. She suffered from advanced heart disease and renal failure. After battling a bacteria infection acquired during surgery, she was left weak and confused — a shell of the woman she had been.
She couldn’t take care of herself. Leaving the house became dangerous. Hosting Sunday dinners, a tradition she held for nearly 50 years, became too much. All the things that made life enjoyable were quickly being taken away from her. And she did not want to live.
We talked often about her desire to die. Life was not worth living, she told me, without autonomy. She wanted to die happy and with some dignity left. But we lived in New York State, where physician-assisted suicide is not an option. She could not end her life on her own terms, so instead she suffered: a crippling stroke; massive blood loss after an angiogram; dialysis; constant hospitalization; and mistreatment by staff. Month after month, she sank further into despair.
On the morning of May 21, 2011, we received a call from the hospital: the end was near. When we arrived, she laid in a hospital bed, unconscious, face clenched up in pain. She was surrounded by family and friends, but could not say her goodbyes. Death took her slowly, agonizingly, until finally she let out her last breath. After nearly two years, her suffering was finally over.
This story is not unique. It’s the story of countless terminally ill patients who want to end their lives with dignity. Why should we force people to endure such physical and emotional pain? Is there a better way?
In 1997, Oregon passed the Death with Dignity Act, allowing terminally ill patients the right to end their lives through the use of physician-prescribed lethal medications. Once received, individuals may choose when, if ever, to take them.
Since then, 1,173 patients have elected to participate in the program. Of them, 65 percent have chosen to die. Today, assisted suicide is legal in four US states and three countries. While this is a great start, it is not enough. Doctors everywhere should be free to offer euthanasia for terminal illnesses.
This is not to say aid-in-death should be left unchecked. Laws should be narrow and specific. Regulatory systems should be in place to thwart involuntary euthanasia and assess for psychiatric illnesses. Practices and medications should be routinely updated to reflect new information.
Despite these efforts, we must remember that no system is infallible, and there will always be unintended consequences. These risks alone do not warrant inaction, however. If they did, we would have no governments, no legal systems, and no health care of any kind. It is not the existence of risk but how we respond to it that determines our outcomes. By acknowledging the risk involved, and letting it guide our policymaking, we can better protect patients, families, and physicians.
US Supreme Court Justice William Brennan said, “An ignoble end steeped in decay is abhorrent. A quiet, proud death, bodily integrity still intact, is a matter of extreme confidence.” In a perfect world, end-of-life care would involve no suffering. Individuals would live to the end of their days happy and satisfied.
But that is not the world we live in. Individuals, like my grandmother, suffer terrible fates, to the anguish of their families and themselves. While we should strive for this standard of care, no one should be categorically denied the right to a quiet, proud death.
Matthew Hayes is a public policy researcher in Portland, Oregon. Follow him on Twitter: @mattayes.
Assisted Suicide Laws Empower Doctors to Prescribe Death
By Derek Miedema
Brittany Maynard’s choice to kill herself thrust assisted suicide into headlines around North America. It’s horribly tragic for a beautiful, engaging, and active 29-year-old woman to face a painful death. Her husband, suddenly a widower, is grieving both her illness and death.
Maynard’s choice was presented through videos which used music and photos to convey her decision as freeing and dignified. While we can empathize with the difficult situation, behind the poignant advocacy for assisted suicide lie deeper questions: Can we declare that someone is better off dead? If so, who determines when a person reaches that point?
No one likes to think about living life at a reduced capacity. But suggesting a certain quality of life is not worth living infringes on those who may experience such a life.
People with disabilities hear others proclaim the “better off dead” opinion regularly. “I’d rather be dead than be in a wheelchair,” or “I’d rather die than have someone wipe my bum.” Maybe even: “I’d rather be dead than need a respirator to help me breathe.”
It’s a shame when someone thinks of themselves this way. It’s even scarier when individuals declare another person “better off dead” on the basis of their situation. Assisted suicide requires a doctor to agree, “you’re better off dead.” Consider the Belgian doctor who killed a transgendered person who couldn’t live with the outcome of a botched sex change operation, or the deaf twin brothers who couldn’t bear the diagnosis that they were also going blind.
The Dutch now kill seriously ill infants with parental consent. Alzheimer’s patients who are no longer capable of making the decision have been euthanized in that country.
This belief that some humans are better off dead is part of the reason why, once the option to kill (euthanasia) or help commit suicide (assisted suicide) is legal, there is always pressure to expand the criteria for who qualifies.
In the Netherlands, the expansion of euthanasia is striking. Mobile euthanasia units were initiated in 2012, so doctors could do home visits to kill patients whose own doctors wouldn’t kill them. The Dutch recently killed a woman who was “suffering unbearably” because she was going blind.
The Belgian Parliament has made it legal for a child to choose euthanasia if their parents agree, and a psychologist has verified that the child knew what he or she was doing.
The Maynard case presents the choice as the patient’s alone, but these decisions are not immune from outside influence. In Washington State, where assisted suicide is legal and euthanasia not, letter writers responded to a newspaper article’s discussion on paying for care in old age by suggesting that euthanasia could be a solution. Could such a suggestion be made in a place without a history of legal assisted suicide?
It may seem a huge leap from Maynard’s videos to that attitude, but all that’s required is the acceptance that death is a compassionate and good solution to suffering.
It’s one thing for individuals like Brittany Maynard to accept this. It’s another for her doctor to do the same. Don’t forget that where assisted suicide is legal, doctors, not patients, have the final choice of who dies this way. This does not empower individual choice. It empowers doctors.
Imagine for a moment that you were diagnosed with cancer. How would you feel if your doctor suggested, as an option other than chemotherapy, that you might just kill yourself instead? He would be, intentionally or not, stating that you’d be better off dead because you’d avoid the suffering and save the health system lots of money.
Is this what we want for our grandparents or parents as they age? Do we want our children to grow up in a society that views people this way?
This isn’t, I’m sure, what Brittany Maynard wanted. It is, however, the truth behind the change she advocated. When society defines increasing numbers of people as better off dead, and these people themselves agree, giving doctors the right to help them commit suicide makes our society a toxic soup for the vulnerable among us.
Derek Miedema is a researcher at the Institute of Marriage and Family Canada.