"Jesus, I trust in you!"

Friday, February 16, 2007

The Cult of Death

Roman Catholic Blog has a report on the renewed efforts to pass a law through the California Assembly allowing euthanasia.

I wrote an essay on the subject in 2005, the first time they tried this. I'm posting it below. Perhaps some of my arguments and research may aid you.

A Compassionate Choice

Does the “right to life” guaranteed by the Bill of Rights imply a right to die? The California Legislature is currently debating that issue. The “Compassionate Choices Act” or AB 651(formerly AB 654) proposes legalizing physician-assisted suicide, following similar laws in Oregon and Holland. Proponents argue that “mentally competent patients have the right to make the decision to die, and this bill enables doctors to respect their wishes” (“ACLU”). It is death with dignity.

Supported by the ACLU and the National Organization for Women, AB 651 relieves suffering and allows patients to die with dignity at the end of their lives. Proponents argue that safeguards are in place to prevent abuse. Two physicians must agree that the patient has less than six months to live; the patient must be mentally capable of making an informed decision; the patient must make two oral requests and one written request; the patient must self-administer the prescription, no one can assist; and physicians may refuse to write a prescription (“Californians for Aid in Dying”).

However, can a rational person choose to die? According to the DSM-IV, the official diagnostic handbook of the American Psychiatric Association (APA), a desire to commit suicide is a sign of a major depressive episode (169). Medical professionals are obliged, under state and Federal law to recommend a minimum 24-hour hospitalization to anyone who shows signs of wanting to take their own life. Older adults, especially the terminally ill, have the greatest risk for depression and frequently go undiagnosed. According to a 2001 study published in the Journal of the American Geriatrics Society, “Depression was found to be highly associated with acceptance of PAS [physician-assisted suicide] and euthanasia in most hypothetically clinical scenarios in addition to patients' current condition” (153). Another study published in Arch Intern Med, a medical journal, showed that those patients who desired physician-assisted suicide at the time of interview “differed from all others on ratings of loss of interest or pleasure in activities, hopelessness, and the desire to die [, and]…had a higher prevalence of depressive disorders [although] …they did not differ on ratings of pain severity” (Wilson, 2454). In other words, the state of a patient’s mental health directly influences their desire to end their lives, not the amount of their physical suffering. Old age is a trying period of life. Erikson’s stages, which describe life development as a series of crises, classifies old age as a time of “integrity versus despair.” As Vimala Pillari states in Human Behavior in the Social Environment, “Integrity refers to the ability to accept the facts of one’s life and face death without too many regrets or fear”(315) whereas a person in despair may seek “death as a way of ending a miserable existence”(Pillari, 316). Modern care philosophy seeks to address the patient as a whole person. Palliative (hospice) care today addresses not only pain relief, but mental heath as well, through medication and environment enrichment.

In this debate, one must distinguish between the choice to end life and the choice not to prolong it. In Physician-Assisted Suicide, the life-ending medication is the direct cause of death. Patients also sometimes forego care, allowing death to occur by an existing illness. The President’s Commission for the Study of Ethical in Medicine and Biomedical Research describes it thus: “[M]any dying patients decide to forego further life-prolonging treatment when its benefits no longer seem to them worth the burdens it creates [and] cessation of treatment leads rapidly to end of life and, with that, to a release from their suffering”(62). However, the decision of “allowing to die” is focused not on control, dignity, or ending suffering, but on the patient’s happiness and fulfillment at the end of life. Such decisions stem from acceptance that death is inevitable—one should not use every means to prolong life at the expense of mental well-being. A realistic example of this is a patient with metastasized (advanced) cancer. Current treatment has no hope of curing such a patient. Rather than enduring the painful and debilitating effects of chemotherapy, some choose to spend their remaining time with their families and engaged in some meaningful activity, although this action may shorten their lives by some months. Similarly, palliative (hospice) care routinely uses medications that relieve pain but may shorten life. Another common case is that of a patient in irreversible coma. My grandfather was such a patient. Suffering from multiple organ failure, he slipped into a semiconscious state in his last hours, heartbeat and breathing maintained solely by a respirator. The family gathered at his bedside, and a doctor informed us that while life-support could sustain him for months, there was little chance of his waking. After saying our goodbyes, we made the collective decision to turn off life support. He died two hours later.

One must also question whether physician-assisted suicide truly protects a person’s dignity. One must distinguish between palliative care (which focuses on pain relief) and euthanasia, which terminates life prematurely. A fundamental principle of human rights is that the value of a person is intrinsic. Rev. Gerald D. Coleman, S.S., states this eloquently in “Dying with Dignity”:
Persons always die with dignity. They are sacred….Everyone’s dignity is indelible. Our worth is inherent. Our humanity is permanent. The real concern is not death, but dying. Physician-assisted suicide manipulates this fear (13).
Often those who choose to die, do so because of the high cost of health care. Others do so because of social isolation or the feeling that they are a burden on their families. (Smith, Manning, 77). Often, they are receiving insufficient care to relieve their physical pain (Smith). This does not constitute an informed, rational decision, as the ACLU claims, nor does it support patient welfare.

One of the most pervasive arguments in the Right-to-Die Movement is that of individual rights. However, legalized euthanasia often opens up the door to abuses. Michael Manning, M.D., author of Euthanasia and Physician-Assisted Suicide gives such an example from a Dutch medical journal:
A wife who was no longer willing to care for her ailing husband…issued an ultimatum: euthanasia or admission to a nursing home. The man, afraid of being left at the mercy of strangers in an unfamiliar setting, chose to be killed. The doctor, even though he was aware of the coercion, ended the man’s life (76).
Dutch government studies show that such abuses in patient’s rights occur over a thousand times a year (Manning, 74). Similar incidents have been occurred in Oregon as recently as 2000, in the case of Michael P. Freeland, who received life-ending medication despite having been legally declared to be mentally incompetent. He later sought psychiatric treatment and died two years later surrounded by family and friends, although the doctor who prescribed the “medication” gave him the required six months as mentioned in the law (Smith). It is worth noting that in its online campaign ACLU claims that “Oregon's ‘Death with Dignity’ law has worked flawlessly for the past seven years” (“ACLU”).

Physician Assisted Suicide implies that the patient is literally better off dead, that they are a burden on themselves and their families, and ignores their mental and spiritual well-being. Incidents in Holland and Oregon show that the current safeguards are inadequate to prevent abuse. Is this compassionate? Rather, honor and value the ill, treating their upcoming death as a loss. This would be treating death with dignity. In conclusion, the proposed law is neither dignified nor compassionate.

Works Cited:

American Civil Liberties Union of California. “Californians Deserve Compassionate Choices!.” Take Action!. 25 Mar. 2005. Get Active. 28 June 2005 .

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th Ed, Text Revision. Washington, DC: American Psychiatric Association, 2000.

Blank, Karen, et al. “Life-Sustaining Treatment and Assisted Death Choices in Depressed Older Patients.” (2001). Journal of the American Geriatrics Society 49(2): 153-161.

Californians for Aid in Dying. “About AB 651.” 13 June 2005. End of Life Choices California. 28 June 2005. .

Coleman, Gerald D. “Dying With Dignity.” Orange County Catholic May 2005: 13.

Manning, Michael, M.D. Euthanasia and Physician-Assisted Suicide: Killing or Caring?. New York: Paulist Press, 1998

Pillari. Vimala. Human Behavior in the Social Environment: The Developing Person, 2nd Ed. Pacific Grove, CA: Brooks/Cole, 1998

Smith, Wesley J. “The Creepy Underside of Legal Assisted Suicide” The Oregon Tall Tale.8 May 2004(Reproduced with Permission) Lifeissues.net . 9 July 2005 .

The President’s Commission for the Study of Ethical in Medicine and Biomedical Research. Deciding to Forego Life-Sustaining Treatment. New York: GPO, Mar. 1983.

Wilson, Keith G, et al. “Attitudes of Terminally Ill Patients Toward Euthanasia and Physician Assisted Suicide.” Arch Intern Med 2000(160): 2454–60.

Sunday, February 11, 2007

St. Blog's Parish