To pop the poison pill or not - that is the question. Life sometimes sucks under the best of circumstances, but what if you spend your days in a hospital bed slowly suffocating to death as cancer eats away at your lungs? You're frightened, your quality of life is zilch, and maybe you just don't see any point in delaying the inevitable. Like the English Patient, you want a little help to end your suffering. Should it be legal for a physician to provide you with such help? As always, we take you along both sides of a seemingly unbridgeable divide - and bring you out alive. (Or dead, if that's your preference.)
1. LEARN SOME BACKGROUND ON THE ISSUE
There have been times and places in history when taking your own life was considered honorable, but the practice of suicide has been generally opposed in America. One should pity Kurt Cobain and encourage him to seek treatment - of course - rather than help him to load the shotgun. Many insist that the desire to commit suicide is an indication of mental illness. Others believe that to take your own life is a violation of God's law. Suicide is wrong. Period.
But there have been dissenting voices who say that there are times when the prolongation of your own life is absurd and unethical, and that the individual, sovereign over his own body, ought to be allowed to make the determination for himself. Hemingway, for example, sincerely considered that splattering his brains all over the house was the brave and moral thing for him to do, even though his wife had to clean up the mess.
Suicide is not illegal in the United States. Law-abiding citizens who want off the merry-go-round of life will suffer no crises of conscience here. What if, however, it strikes you as somewhat unnecessarily barbaric to shoot yourself, or hang yourself? Or maybe you're not exactly certain as to the correct dosage of Drano. Surely a considerate doctor, a man or woman of the world, would be willing to help you find a more humane solution. Well, no. To do so would make the physician a murderer in every state except Oregon, even if you were a terminally ill patient, suffering terribly, with no hope of recovery. Advocates of physician-assisted suicide are hoping, and opponents are dreading, that Oregon represents the thin end of the wedge.
In 1994 Oregonians approved Measure 16, the Death with Dignity Act by a margin of 51% to 49%, which allows terminally ill patients to obtain a lethal prescription. In the years following the passage of this measure there were repeated legal attempts to prevent it from becoming law; legislators even went to the extraordinary length of asking the voters to repeal the Act. Measure 51, as the motion to repeal was called, was defeated. Voters chose to retain the Act by a margin of 60% to 40% and in 1997 the Act finally went into effect. In 1998 there were 15 physician-assisted suicides in Oregon, and in 1999 there were 27.
Similar measures have been proposed and scrapped in California and Washington. Oregon is currently the only state where physician-assisted suicide (PAS) is legal. But is it only a matter of time before other states follow Oregon's example?
In 1999 the poster-boy of PAS, Dr. Kevorkian, was finally convicted of second-degree murder for assisting in the death of Thomas Youk (notoriously broadcast on 60 Minutes) after a decade of flouting the laws against doctor-assisted suicide and winning over sympathetic juries. Kevorkian lost what Oregon won.
It would seem the conflict is far from over. In fact, the two sides may just be getting warmed up.
(For a full chronology go to http://web.lwc.edu/administrative/library/death.htm)
2. HEAR SOME ARGUMENTS IN FAVOR OF PHYSICIAN-ASSISTED SUICIDE
"A person should be free to choose to die when life ceases to be worth living."
The Argument: Each of us has the right to determine whether we want to live or die. In 1976 the New Jersey Supreme Court ruled that the parents of Karen Ann Quinlan, who had lapsed into a "persistent vegetative state", could remove her from the respirator. This signal victory of the right-to-die movement affirmed that death is sometimes an acceptable alternative to continued medical treatment. Under certain extraordinary conditions a suffering patient may be justified in wanting to end his life, and there is no sensible reason why he should not be able to seek the aid of a physician.
The Response: The practice of suicide is contrary to the values of most Americans. Our lives are sacred, and we do not have the right to dispense with them as we please. Withholding unnecessary and unhelpful medical treatment from a patient in a coma is a far different scenario from asking a doctor to prescribe poison for someone under his care. The analogy is a false one, and we must be on our guard against "slippery slope" arguments that might some day lead to the killing of the weak and the infirm.
"Sometimes it is not in a patient's interests to be kept alive."
The Argument: Prolonging life under extreme conditions is cruel and unnecessary. The Hippocratic Oath enjoins physicians to act solely for the good of the sick. In certain rare cases modern medical care is not able to ease the physical and mental suffering of a terminally ill patient and the doctor may be doing more harm by keeping the patient alive against his wishes than by helping him to die.
The Response: You can quibble all you like, but when doctors take the Hippocratic Oath they are promising not to do harm, plain and simple. Prescribing poisonous pills which will certainly kill the patient in a short time is obviously "doing harm" by any definition you care to offer. It is important for the future of medical care in this country not to blur the lines between medicine and poison. There is too much danger of abuse (particularly if you consider every such "treatment" to be abuse).
"The option of physician-assisted suicide would give patients and their families peace of mind."
The Argument: Having the option of a dignified death prevents suicide and homicide. There are cases when, out of fear that he will be incapable of acting later on account of his deteriorating physical condition, a patient takes his own life far sooner than is necessary, or asks someone other than a doctor to help him end his life. There would be fewer suicides if patients could be reassured that they will have the option of physician-assisted suicide, should it become necessary.
The Response: There is not enough evidence to prove that the availability of PAS has any effect on the occurrence of suicide or homicide. More likely, PAS will cause suicide rates to increase, as the state and the medical authorities actually encourage people to kill themselves, instead of encouraging them to seek proper treatment.
3. HEAR SOME ARGUMENTS AGAINST PHYSICIAN-ASSISTED SUICIDE
"Physician-assisted suicide is not a suitable replacement for proper medical care."
The Argument: Patient suffering is unnecessary given the sophistication of modern drugs. Physician-assisted suicide is really just a cheap and easy way of getting around the real problem, which is that many patients receive poor medical care and support. A competent, caring doctor is always able to relieve the pain associated with terminal disease, so there is really no need for any kind of suicide. Our attention should be focused on ensuring that everyone receives high-quality treatment rather than on legalizing the killing of suffering patients.
The Response: Suffering is not just a matter of pain. Even if it were true that doctors are always able to relieve pain - which is arguable - there remains the mental anguish and loss of quality of life. Patients who took advantage of Oregon's Death with Dignity Act most commonly reported that they were concerned about loss of autonomy and loss of ability to participate in activities that make life enjoyable. These are legitimate, rational concerns under the circumstances and not indications of mental illness. There are also gray areas between physical and mental pain, such as difficulty in swallowing and in breathing. It should not be the place of anyone other than the patient himself to determine what constitutes intolerable suffering.
"Suicide is morally wrong, and certainly should not be facilitated. Those who aid in such conduct (i.e., murderers) should be brought to justice, rather than encouraged."
The Argument: Suicide is a violation of divine law. America is a Christian nation and almost all Christian churches (as well as other faiths) forbid the practice of suicide as fundamentally immoral. Your life is not your own, but a gift given to you in trust by God. You have no right to take your own life before your natural time. And as for taking someone else's life, do the words "Thou shall not kill" ring a bell, by any chance?
The Response:There is a separation of Church and State in America, and no citizen has the right to impose his religious moral values on any other citizen. If you believe it's wrong to commit suicide or to assist in a suicide, even in the case of terminally ill patients, you can choose not to participate in PAS, but you cannot make that choice for anyone else.
"Physician-assisted suicide discriminates against the disabled."
The Argument: A national organization of people with disabilities called "Not Yet Dead" was involved in the Supreme Court case, Quill v. Vacco (1997),which upheld the constitutional right of states to ban assisted suicide. This group argued that people with significant health problems are singled out and denied "equal protection of laws and medical practice standards automatically applied to healthy persons who are suicidal". Terminally ill patients wanting to die should be treated just as a suicidal teenager would be treated. Helping them to die just because they are infirm is discriminatory.
The Response: The desire to end your life when you're suffering terribly, and have every reason to believe that you will continue to suffer up until the moment of your inevitable death, cannot be compared to the suicidal tendencies of people in less critical circumstances. We're not talking about getting rid of the disabled. We are talking about giving terminally ill patients, who are suffering and have no chance of recovery, and who want to die, the option of taking control over what will happen to them in a humane and dignified manner. Alarmists claimed that Oregon would become the Suicide State, but in fact only 15 people in 1998, and 27 people in 1999, availed themselves of PAS out of a total of 29,000 deaths each year. This supports the view that PAS is not a general threat to the community, but a rare and extraordinary event justified by extreme circumstances.
List of PAS Links: http://www.lwc.edu/administrative/library/suic.htm
National Public Radio Debate (RealPlayer) http://justicetalking.org/media/jtsuicide.ram
