Not exactly musings on Physical Assisted Suicide... (but close)

[johnpalmer]

In thinking about, and debating, phsyician assisted suicide, I had an interesting revelation, one that I think is very important.

I'm not exactly in favor of physician assisted suicide. Is anyone actually "in favor" of it? I reckon some people consider it better than the alternative, but it's a bit mean spirited to make it sound like they approve!

Okay, but my feelings on suicide are complicated. I've seen such strong moralizing about suicide in general, where people who commit suicide are loathed and reviled, that my initial feeling was that the only opposition to physician assisted suicide was this same kind of moralizing. Oh, sure, there are other arguments made, but lots of times people make arguments that they think will sell, when their real motivation is completely different. I just assumed that, deep down, they were hateful of suicidal people, or too unwilling to let go and admit that people die, and I didn't have respect for either viewpoint.

I have a friend who helped me realize that this was not the case. I won't try to make her argument, but I hope I can attempt a rough paraphrase. It goes like this:

At any stage of life, if a person feels suicidal, we consider that a medical emergency, and seek to preserve their life, and return them to a state in which they are no longer suicidal. It doesn't matter why they feel that way, or what intractable-seeming problems they're having, we always fight to protect their lives, and help them to find answers to continue to live out their alloted time. Why would we change that, simply because that alloted time is smaller than it is for most?

As for the problems with end of life, if they are in pain, we provide better pain control. If they are despairing, we provide counseling and other supportive measures. If their symptoms are otherwise horrible, we try to find ways to relieve or ameliorate them. And we do this because this is what we do for living people, even if they are not going to continue living for long. (Note that this does not include forcing life-extending treatments on a person who does not wish them. This is all about letting a person die in their own time, in as much comfort as we can provide.)

That argument is compelling for me; I agree with it completely. At the same time, I see some exceptions. We may not be able to relieve their physical suffering, be it pain, or something else. And there's also just a sense I have that, if I knew I was dying in the next week or so, I might find some empowerment in deciding that I've lived as long as I need, and Saturday night would be a fine night to check out.

And that's where the more important revelation came in.

Who is pushing for the greatest help for those who are dying? The person who says "if we can't control the pain, we need better pain control methods!" or the person who says "it's intractable pain; but we can provide a lethal dose of drugs."

Who is more compassionate? The person who wants to help people break through a natural stage of end-of-life grief, or the person who agrees they might want to die in the same situation, so why not help the patient do so?

Who will push us to find other methods of treating suffering? The person who insists we must figure out how to help people die naturally and without suffering, or the person who might think it's impossible, and besides, there's assisted suicide if the suffering is too much?

We need people who push back. Even if there's some way in which I am "right" about whether some people should be given help in dying near the end of their lives, we need people to push back against that notion so we continue to test our compassion and stretch our understanding so we make it less and less necessary.

More importantly, we need such people to be totally committed, to be angry and unreasonable. If I were ever in a position where I had to make a call regarding assisted suicide (and I don't imagine I'll ever be, unless it's for myself), I'd need to feel that I was letting this friend down. Because otherwise, I might let my own feelings, about how I can understand why a person might want to "check out early", cloud my judgment and not realize that there are other, better options in that specific case.

It's not easy to accept that good people can take all of our carefully constructed, well thought out, compassionately reasoned ideas, and say "you're wrong!" and attack our beliefs and struggle against us as if we were enemies. But it would be worse if we could see that they were coming from a place of wisdom and compassion, and nevertheless wish that they were silent, so we went unchallenged, even when wrong.

Comments

[dubhain]

Whereas I mostly agree with you on your other suicide-related post, I actually can't get on board with you on this one.

I voted in favor of physician-assisted suicide, in Oregon, when it was on the ballot. The reason I did had nothing to do with end-stage grief. It had to do with the fact that most individuals who would be likely to avail themselves of it would be either in intolerable, incurable pain, or losing their memory due to Alzheimer's or Dementia.

Personally, and I am not projecting anything onto you, I won't ask or insist that someone dealing with a terminal illness have to suffer the pain and the potentially horrific effects (such as losing their mind and memory, knowing it's happening, and being helpless to do anything about that) simply because I dislike the idea of suicide.

DubhGrandmother died of emphysema. She was determined that, if she was going to be helpless, bedridden, and drowning from her own fluid-filled lungs, that she would kill herself first. I told her that, although she could not expect me to help her, I supported her decision. She was grateful. As it happened, she didn't have to take her own life. She died the day DubhDad was supposed to begin looking for nursing homes for her to be transferred to.

If she had killed herself, though, I would've supported her decision. I can see no reason why she, or any other terminally ill person should have to suffer simply because we, as people who are not in their place are uncomfortable with death. If it were simply a matter of end-stage grief, I might well have a different opinion. But I will not ask someone to suffer simply because I don't like or am afraid of the idea of death or assisted suicide. If your opinion differs, I respect that, as I do with our difference in your other post regarding suicide. But yeah. I can't agree with you on this one, not that it likely matters very much.

Wishing you all the best, and hoping life treats you gently.

[johnpalmer]

I'm not sure we disagree - I also agree with physician assisted suicide. I'm just saying that there are people who are virulently opposed for very good reasons - and that those people are very important to the argument.

My feeling is that we should investigate everything - we should make sure all dying people have excellent hospice care and counseling and the best symptom management we can provide, and, in addition, the option to ask a doctor for a prescription to end their lives in a compassionate manner. And, as part of writing that prescription, the doctor should be ethically compelled to verify that hospice is working properly.

And then, well, people like my friend might still be furious with me if I were involved in that. And I get that. And I want to feel bad over that. Not crippled with guilt, but bad enough that I'd want to be absolutely sure that I'd investigated all productive avenues.

I want to feel bad because she's right - first and foremost, we should be trying to let people die comfortably, without suffering. And if there's absolutely no way to do that, okay, maybe there should be another option, but only for when we can do everything, and still be unable to make end-of-life bearable.

[dubhain]

Heh. Perhaps we do agree, after all.

Hope you're doing well.

[jhetley.livejournal.com]

I can't condemn suicide, either assisted or self-administered. My mother's last years were hell -- if you put a dog through that, you'd end up in jail for animal abuse, and yet a Do Not Resuscitate order vanished from her medical file. Wife's former boss took a one-way swim in our river, in preference to living with a degenerative brain condition that she had seen take her mother. In both cases, you are looking at women with world-class Phi Beta Kappa brains loosing memory, losing the ability to reason, losing speech and mobility and independence . . .

And even for someone with sound body, I'm not gonna reach inside their head and say "No. You have to live with that."

For most of the Church's teaching on suicide, I see it as tyranny -- "If you try to escape Hell, you will end up in Hell."