Advocacy groups and the merits and dangers of legal endorsement of physician assisted suicide.
This piece first appeared in The Vermont Standard.
Nancy Niedzielski has told her compelling story many times. Her husband, diagnosed with brain cancer in 2000, fought the disease with radiation, she says, as well as with three types of chemotherapy. In spite of treatment, his cancer metastasized to his nervous system. He couldn’t control his arms or legs and had to endure their painful contortions; his eyes so protruded from the pressure of tumors that he couldn’t close them. Eventually, he wanted to die, and in 2006, he did. His suffering in the last weeks of his life so affected his widow that she vowed to him she would fight for the right of patients to control their deaths. Niedzielski first campaigned for the 2008 passage of her home state of Washington’s Death With Dignity Act, which legalized physician-assisted suicide there, in particular circumstances. She visited Vermont a few weeks ago and in interviews and personal appearances pushed for similar legislation here.
As gut-wrenching as Niedzielski’s chronicle is, it’s insufficient to win over opponents of Patient Choice and Control at End of Life, a measure modeled on Washington and Oregon laws that was introduced in Vermont’s General Assembly last winter. Legislators have considered versions of the bill in each of the last five biennium sessions. In the decade-long attendant debate, the measure’s opponents and backers have both relied heavily on poignant examples to bolster their viewpoints.
The plight of Oregonian Barbara Wagner, for example, illustrates a component of the vulnerability inherent in condoning physician-assisted suicide, according to some of its opponents.
In a report that appeared on Portland television station KATU in 2008, Wagner explained that her doctor had suggested a new treatment for her lung cancer, a drug with a small but not insignificant chance to extend her life. Wagner’s insurer, the Oregon public health plan, thrice declined to approve the $4,000 a month chemotherapy, and in their letter notifying Wagner, offered up instead substantially less expensive physician-assisted suicide, along with hospice and other like alternatives.
“I told them, who do you guys think you are?” she said, as she sat at her kitchen table and wiped away tears, “You know, to say that you’ll pay for my dying but you won’t pay to help me live longer?” In an opinion piece published in the Oregonian after Wagner’s death a few months later, Barbara Coombs Lee, president of the activist organization Compassion and Choices, criticized Wagner, her physician, and their decision to pursue treatment. “What do patients like Wagner really understand about the ‘last hope’ treatments their doctors offer?” Lee wrote, noting that Wagner was a long-time smoker and died even though she eventually received the new drug as a donation from its manufacturer. “The burning health policy question is whether we inadvertently encourage patients to …chase an unattainable dream of a cure, and foreclose the path of acceptance,” Lee concluded. Some see Oregon’s treatment of Wagner as evidence of an inevitable temptation for insurers, including public insurers, to press the cost-minimizing path of ending life rather than extending treatment, and Lee’s opinion piece as evidence of an underlying desire of proponents of physician-assisted suicide to institutionalize that kind of expense-reducing thinking.
The proposed measure now before the Vermont Legislature, H.274 in the House of Representatives and S.103 in the Senate, as it is currently written, allows an “attending physician” to prescribe or dispense self-administered medication to “hasten” the death of a terminally ill Vermont adult who has voluntarily requested it. To “qualify,” a patient’s diagnosis of “an incurable and irreversible disease which would, within reasonable medical judgment, result in death within six months,” must be confirmed by a second, “consulting physician.” A patient must make three separate appeals for the medication, including a written request that is verified by two disinterested witnesses. All patients must explore palliative care options, and those thought to be suffering from judgment-impairing mental illness or depression must be referred for counseling.
The stories of Niedzielski and Wagner are just two of the many anecdotes that anyone wishing to examine the issues around physician-assisted suicide can find on the internet, or in the abundant literature on the subject.
Visitors to the Patient Choices Vermont website, for instance, can view video clips of fellow Vermonters explaining their support for the state’s proposed legislation. On the other hand, the Patient’s Rights Council website has links to articles laden with contrary examples.
For some, though, the heart of the matter is not the perhaps apples-to-oranges tally of end-of-life sufferings versus the dangers of thwarted treatment or misdiagnoses, or potential for abuses. Instead, an overarching ideology guides their thinking.
Woodstock’s Father Thomas Mosher sees the descriptor ‘death with dignity’ as unfitting, when applied as euphemism for ‘physician-assisted suicide.’ “We believe in the sanctity of all human life, and it is that sanctity that gives us a sense of dignity,” says the pastor of Our Lady of the Snows Catholic Church, “rather than trying to do away with pain by doing away with the patient, we choose to enter into a compassionate presence, whether that be through palliative care or through [other sometimes] difficult things.” There is “innate danger,” he adds, in empowering humans to help others end their lives.
The United States Conference of Catholic Bishops reaffirmed the Church’s long standing position of respecting life until natural death this past June when it adopted To Live Each Day with Dignity: A Statement on Physician-Assisted Suicide. The document implies that the “assisted suicide campaign” of the last couple of decades has been fueled, at least in part, by a pervasive fear of the dying process, with its sometimes accompanying anguish or pain, loss of control and independence, and artificial extension of life.
The answer to the difficulties of end of life, the Bishops write, entails neither prolonging life through unwanted treatment nor necessarily embracing suffering; they instead advocate an “unconditional respect for human dignity” that translates to providing the terminally ill with “love, support, and companionship,” and “the assistance needed to ease their physical, emotional, and spiritual suffering.”
In addition, they argue that adopting physician-assisted suicide as policy creates a societal norm that inherently and, as time passes, increasingly, promulgates an “expectation that certain people, unlike others, will be served by being helped to choose death.” The initially narrowly defined breadth of that population, the Bishops warn, can creep dangerously to include the disabled, the chronically ill, the mentally ill, and others who begin to see themselves as burdensome.
People grappling with the painful situations that often come near end of their lives should have as much freedom as possible to make choices for themselves, says the Reverend Daniel Jantos, minister of the North Universalist Chapel Society in Woodstock. “The medical communities, the local communities, the spiritual communities ought to be dealing with these questions,” he says. The members of Jantos’ congregation hale from a number of structured religions, but atheists and agnostics are welcome and active as well. “We don’t consider this a Christian organization,” he explains, “it is more an organization that is keenly interested in spiritual and religious questions, but doesn’t take a position favoring one view over another.” The church is among 1,000 or so independent, self-governing congregations that exist with the help of the umbrella Unitarian Universalist Association (UUA).
The annual General Assembly of the UUA addressed physician-assisted suicide in 1988, with its resolution The Right to Die with Dignity. “Unitarian Universalists advocate the right to self-determination in dying,” it says, and advocates no penalties for those who “under proper safeguards, act to honor the right of terminally ill patients to select the time of their own deaths.”
Jantos says that although there have been some conversations in his congregation, there has been no consensus, nor endeavors to reach consensus, regarding the Patient Choice and Control at End of Life bills that have come before the Vermont State Legislature. And while he himself feels there is no “magic” answer for difficult end of life situations, “I would invite legislators to not limit people’s choices around such personal and emotional subjects,“ he says, “I’d love to see the legislation pass. I think passing [it] gets the Legislature out of the equation, out of this issue.”