Deciding to Die
Filed under: Ethics, Health Care — marc moore on February 12, 2008 @ 3:07 am CET
From the NY Times:
Modern medicine can keep people alive into their 9th and 10th decades, when in years past they would have succumbed to any number of conditions. Now a small but growing number of these people are asking why. What is the point of living so long if you can no longer enjoy living? What is the point of living until your mind turns to marshmallow and you are reduced to an existence that is less than human?
…
Why shouldn’t an emotionally sound, thoughtful person be able to call it quits when life has dragged on too long? When there is nothing to gain and much to lose from an ongoing existence?
Good question.
Gloria C. Phares:
“I was healthy until 90, and then Boom! Atrial fibrillation; deaf, can’t enjoy music or hear a voice unless 10 inches from my ear; fell, fractured my thigh and am now a cripple; had a slight stroke the day after my beloved husband died after 61 years of marriage.
“I’ve lived a happy life, but from here on out it’s all downhill. Is there any point in my living any longer? I’m not living — just existing. I very much want to die, but our society doesn’t let me. Oh for a pill to ease myself out and end my pain, pain, pain.”
Cases like this are so sad. Should Mrs. Phares be forced to live out an existence that is a painful burden to her?
I have to admit that I’ve never understood why people answer "Yes" to that question. It makes no sense to me, particularly when coming from Christians, that a person’s life must be prolonged past the point that the pain and infirmity can be tolerated.
Yes, Paul wrote about suffering for the Lord as a virtue, But there is a difference, I think, between the pain of a young or middle-aged man hard at work pursuing a great and mighty goal and that of an elderly person confined to a death bed, artificially held there for months or years by the forces of social custom and modern medicine.
That difference is elusive, but seems to be largely made up of hope for the future and the capacity for choice. Paul could have given up his burden at any time, had he so desired. The people whose stories grace this article do not have that luxury.
More from the article:
My high school biology teacher was 94 when I visited him at an assisted-living center. Though physically independent and medically well, he was not happy. Gesturing toward a dining room of people in various stages of physical and mental debility, he said: “I feel like my mind is going, and I don’t want to end up like them. While I still can, I want to be able to check myself out. Will you help me?”
And more:
Ida was a loving, funny, delightful human being. She was also a no-nonsense, take-charge person. So when Ida’s life had become a series of debilitating medical crises — “Every day is bad,” she said — she asked her daughter to help her end it.
“Mother,” Ms. Rollin responded, “is that really what you want — to die?”
“Of course I want to die,” Ida said. “Next to the happiness of my children, I want to die more than anything in the world.”
And still more:
I thought about my mother, who died at 49, a year after learning she had advanced ovarian cancer. When it was clear that no therapy could save her, when her life had been reduced to pointless treatments and prolonged hospital stays, she twice tried to end it, first by slitting her wrists and later by drinking rubbing alcohol.
Twice, to my 16-year-old thinking, her life was saved. But when I grew up, I asked myself, saved for what? More misery, an increasingly bleak future with no hope for recovery? If I were in a similar position, would I want to be rescued?
I think not. Several years ago a good friend’s father had a stroke and his mental capacity was virtually completely extinguished. During his father’s prolonged physical decline, he and I agreed that we would want help out of a similar situation if we were ever to be in his father’s place. After over five years of watching his father waste away, how can anyone dispute my friend’s right make to that decision for himself?
1 amba
February 12, 2008 @ 3:35 am CETThe fact is that people — family, friends, doctors — do help people in that situation. The legal risk they undergo is real, but can be minimized by care and planning. Also, people who really want to end it sometimes find a way on their own (although that depends on their level of physical ability). I have known of people with advanced cancer who chose to stop eating and drinking.
The trouble with making euthanasia legal is that people who want to live, but are an inconvenience to their relatives, will be pressured into using it.
It’s a terrible comparison, but euthanasia is one of those things, like torture, that are occasionally called for but are best done off the books.
2 C Stanley
February 12, 2008 @ 3:49 am CETI completely agree, amba. I think the coercion you spoke of is quite real but so subtle that it’s insidious; it’s simply a pervasive feeling that society doesn’t value those who are no longer productive, so that the elderly and infirmed begin feeling that they ought to step aside to make room for the young and healthy. This is conveyed through legalization of euthanasia and through discussions of healthcare costs and shortage of resources; not a word needs to be uttered to the person by his/her loved ones- it’s simply understood and unspoken.
3 kranky kritter
February 12, 2008 @ 5:12 am CETYup, me too. I have even thought of the same analogy. I had a discussion months back about torture and a few of us reached the same conclusion that it was a necessary thing that also was necessary to keep outside the margins, as it were.It pays to think ahead and be resolved if you are certain, from personal experience, that you want to go out before your last shreds of savor and dignity have been withdrawn.
4 Nihat
February 12, 2008 @ 5:36 am CETI agree with Marc. Long live Dr. Kevorkian, my favorite Armenian.
5 Wild Bill
February 12, 2008 @ 6:18 am CETMarc Long is right on the money. Fears that vulnerable people will be pressured into ending their own lives are largely unfounded. Oregon has had a form of assisted suicide for several years. Very few people in that state have taken advantage of this option. Some have, of course. A carefully written law, such as the one being proposed in my state of Washington, has plenty of checks to assure people don’t go around callously killing off sick family members. Euthanasia is a horrid specter to religious people; God frowns on self-destruction. Why, suicide is a mortal sin, don’t you know? It’s high time those of us living without the threat of "hell-fire and damnation" are allowed to pursue an alternative to ending our lives in abject pain.
6 Claudia
February 12, 2008 @ 3:07 pm CETThough of course there are fears of coercion, it makes little sense to me to prohibit a practice entirely because some people might be pressured into it. There are a multitude of practices in the world that people can be pushed into by moral blackmail, and yet they are not prohibited. Take the way Christian Scientists will pressure members into not seeking treatment, or Scientologists into not looking for much needed psychiatric care, or the way unscrupulous and unloving men push their girlfriends/wives into plastic surgery they do not need.
There must certainly be safeguards in place to make sure that the decision is a real one, not a spur of the moment and not in response to pressure from the outside. This already happens in many abortion clinics. You may think the act itself is still wrong, but there are mechanisms in place to make sure that at least it only happens when the woman really wants it to.
I’ve yet to meet a person that has said "keep me alive no matter what". Everyone I know has heard of cases of the very elderly or terminally sick or severely paralysed and are usually very clear that they would rather someone help them end it than keep on existing that way. Biological life is not always the most merciful of answers.
7 Rudi666
February 12, 2008 @ 4:18 pm CETthe torture analogy is weak. Everyone mentions the subtle (and not so subtle) immoral persuasion of family members to kill a loved one, but never even show anecdotal evidence. In the NYT’s piece these people are saying, "I wanna die" and not the phony Schiavo "I wanna live". Ida makes the choice to die, in torture there is no choice by the detainee.
8 kranky kritter
February 12, 2008 @ 7:36 pm CETNo, I think the torture analogy is quite strong if you take the time to go through both issues at length and in depth over time, over a period of years. And let me be clear, the analogy is not that euthanasia is like torture. The connection is that both work best if we quietly accept in private that there may instances where either torture or euthanasia might in fact be necessary. But that even so, we don’t insist that this acknowledgement be forced upon the entire culture and given a legal green light. In other words, out of a personal acceptance of human nature and the way our culture works, we make the personal executive decision that its wiser to "ask forgiveness rather than permission."Further, I’d like to suggest that only those folks who have actually had to go through the process of watching someone they deeply love slowly slip away are capable of having a truly informed opinion. Only such a person is morally worthy of giving the sort of "help" we’re talking about here. And any such person who does give such help and doesn’t feel some need to ask for forgiveness from whatever they hold good or holy is missing a piece.
9 Rudi666
February 12, 2008 @ 7:56 pm CETKK - Amba comment dealt only with the issue at a personal family level(micro). In comments 2 and 3, CS and yourself take it to a broader level(macro) and then include torture. But consensual suicide is different from forced suicide or torture. Oregon "Death with Dignity" has no examples of "coerced suicide". A Google search of "Oregon coerced suicide" turns up nothing on the news front.
http://www.google.com/search?hl=en&client=firefox-a&rls=org.mozilla%3Aen-US%3Aofficial&hs=BsK&q=oregon+%22coerced+suicide%22&btnG=Search
I wonder how many people die from liposuction…
10 kranky kritter
February 13, 2008 @ 6:46 am CETRudi, I have no interest here in speaking to the notion of coerced suicide, only to the connection we note above between torture and euthanasia, which I believe you are misunderstanding. I thought I was pretty clear when I said the following: let me be clear, the analogy is not that euthanasia is like torture. The connection is that both work best if we quietly accept in private that there may instances where either torture or euthanasia might in fact be necessary. But that even so, we don’t insist that this acknowledgement be forced upon the entire culture and given a legal green light. Get it? They’re not the same and we don’t think they are. We’re just saying that they are both instances of something that may be culturally necessary on some occasions, but you run into all sorts of problems getting the culture to give them official approval. You start by trying to erase a well-drawn bright line and re-draw it in a slightly different place. And then it turns out that it’s nearly impossible to draw an equally bright line in any place other than the spot where it was. In all the other spots, you can only draw dim and crooked lines.Feel free to disagree with me for the time being. I only ask that instead of rejecting what I am saying, you keep it in mind and re-evaluate it over the course of time.
11 C Stanley
February 13, 2008 @ 1:14 pm CETAnd Rudi: I won’t presume to speak for amba, but I inferred that she was going beyond the private and into the public sphere when she made the analogy to torture (I don’t think she was saying we should turn a blind eye to family members torturing one another.)
Anyway- the bright line that kranky kritter speaks of is a good point as well. Although it’s a frivolous comparison, it’s a bit like highway speed limits being set at 55 mph when we all know that means you can legally drive somewhere around 60 without getting a ticket. But if the posted signs said 60, then everyone would drive 65…