Saturday, 21 January 2006

Death With Dignity - Relief & Concern

This week the Supreme Court turned aside the old Ashcroft challenge to Oregon's voters' initiative to allow doctors to prescribe lethal doses of medication to their patients who want to keep their options open for controlling their own deaths. I wrote with some concern about this in October when Miers was Bush's nominee to replace O'Connor. As I hoped at that time, Kennedy sided with Oregon which eliminated any temptation to defer the decision until O'Connor's replacement, since a 6-3 decision would not be affected by a change of one justice.

My relief of course stems from the decision, my concern from Roberts' siding with the dissenting opinion in this case.

Aside from my gross lack of legal qualifications, I could never be on the SCOTUS. I would always want to rule in favor of the most aggrieved party, precedent or Constitution be damned. I understand the importance of moving cautiously when precedent IS being set, but the Court does have an important function in setting boundaries based on common decency as well. I heard Breyer explain it very well one evening when describing what the job of the court really is. The legislative branch is charged with defining the particulars of law, and the Supreme Court must only set the parameters within which those laws should operate. If public opinion has overwhelmingly moved to find certain restrictions or lack thereof repugnant, then it is not outside the purview of the Court to limit what lawmakers can do, but they are still obliged to find some Constitutional basis for it.

Personally I find it repugnant that some folks believe that other suffering people should not be given a dignified manner of ending their own life - in ANY state. I may or may not be in the majority, but I'm certainly not in the overwhelming majority in that regard. The SCOTUS cannot properly mandate that states create Death with Dignity provisions, though the current court can see that Ashcroft was overreaching in claiming that the Oregon law violated Federal drug laws. If Congress writes a more specific law outlawing doctor assisted suicide, however, we may be forced to take a step back from compassion. I must remind myself though, that in the long arc we as a society have been moving toward compassion more than away from it, and with an engaged citizenry I must believe that such a general trend will continue in the long run.


rev. billy bob gisher ©2005 said...

laws based on morality only are never going to work, and will be circumvented. thank god for that.

-epm said...

First of all, I think the three dissenting judges have exhibited a textbook example of judicial activism: turning aside congressional intent and the text of a law/act and inserting their own personal judgement.

Secondly, progressives need to find find a better sound bite that "doctor assisted suicide." I know that's a media/right-wing term and not the progressives term, but nonetheless... Personally, I'm a little uncomfortable with the term "suicide," doctor assisted or not. To a lesser extent I'm not thrilled about the term "death with dignity."

To me this is simply medically appropriate, compassionate, and civilized terminal care management. This should be contrasted with the barbarism of forcing a person -- and their family -- to suffer needless pain, both physical and emotional, in their final days.

Gerald said...

Great article. I think its a very thin line to walk on, and I think the courts will lean more conservative and ban it altogether.

But hopefully I'm wrong.

PS: Can you read and add my blog to your site? It's always hard starting out. Thanks!

Worried said...

In over 40 years of nursing and working in the medical field, I have attended many of my sisters and brothers of the human family as their lives came to a close. I have observed people dying in many different ways.

There was a time in my younger years when I would have objected strenuously and in horror to assisted death. Our duty was to preserve life, not take it.

But years of experience caused me to change my mind. The real horror is watching a fellow human suffer prolonged agony, complete loss of dignity, and marginally exist in fear, despair,helplessness and the deepest depression one can imagine. I have seen my patients welcome death, beg for death. I came to believe that they had a right to be spared the long, drawn out degrading and dehumanizing experience if they so desired. They had a right to die in dignity and peace. Medical science is marvelous and even miraculous, but it is limited, and sometimes we cannot give some patients the peaceful passing that they deserve, that they DESERVE, except by utilizing that medical science to assist them. The key words are IF THEY MAKE THAT CHOICE.
The toll on the families that must watch their loved one suffer adds even more to their grief and pain and personal suffering.

So many people fear death and want it delayed as long as possible. I have seen death come as an enemy and I have fought with every bit of skill and knowledge that I possessed to try to drive it away, raging in despair, wishing it was a physical entity that I could seize with my hands and beat it away. But I have also seen death come as a friend, freeing my patient and easing his existence.

One of the best experiences I had with a dying patient came about 3A.M. when an elderly lady coded and the usual emergency protocol was instituted. We would get her pumped up, then she die off again, over and over. One last time we managed to get her vital signs reinstated and we stood around her, watching her intently in case she coded again. We assumed she was in a coma, unaware of her condition. To our vast astonishment she suddenly opened her eyes, glared at the young attending physician and sternly admonished him, "Young man, why don't you leave me alone and let me die in peace!!" She then coded again but that time we were unable to revive her. She had escaped our well meaning ministrations and died as she wished. To her, death came as a friend.

Sonya said...

I have very strong feelings about this subject. When I was 22, I became involved with a man who was amazing and turned my world upside down. 8 months after our first date, he had tongue cancer. A year later, neck cancer. Another year and it was lung cancer and things went downhill from there.

He was terrified about it getting "too bad" for him to be able to handle it. We talked to doctors about his fears and nothing would relieve him of his anxiety.

We read the book "Final Exit" and with a little help, he put together a little kit that lived on the bookshelf by his bed. It was a little shaving kit, but inside were the tools he needed to end it all when it was time. I had problems with it at first, but he really made it clear to me that it was important to him. To be able to see every day that he had the option to end it on his own terms was very empowering to him. I was devastated that I couldn't be there when he did it to legally protect myself, but I understood why.

We had that little kit on the shelf for months. I saw it every morning and so did he. Sometimes I'd catch him looking inside of it, checking expiration dates or maybe just thinking.

He died in the hospital, without ever using his kit. But just having it there was such a huge comfort to him. He needed to know that he was in control of his own fate. It was amazing what it did for him psychologically. As long as he had an exit strategy, he could withstand anything.

The fact he never used the kit said a lot to me. I hate the argument against the law that it's just a way for HMO's to get rid of expensive patients. The reality is that anyone who has watched a loved one suffer at the end of life can understand the desire to have the power to end it when the suffering becomes unbearable. I hope that when my time comes I have similar options available to me. Anyone in Olympia listening?

Walker said...

Let me extend a grateful thank you to all of my commenters. Worried American & Sonya, you have provided powerful testimonials to the compassion which drives this important movement to offer a reasoned option to those who suffer with a terminal, painful illness.

Eric, you define it correctly as "simply medically appropriate, compassionate, and civilized terminal care management."

I would step even further and suggest that this option should be provided to anyone with a terminal OR painful illness. Why should the state control such a personal decision?

I remember a television profile of a young man who suffered from a constant agonizing headache for YEARS! The condition was not terminal, but the young man took his life in his twenties after having suffered from his mid-teens. In my own life I have known a woman who fought psychological demons for two decades when she decided she had fought enough. Who am I to judge such decisions?

These cases are substantively different that the tragic cases of teenage and other early life suicides where appropriate counseling could have redeemed lives which rashness otherwise cut short. I appreciate the earnest belief that redemption might always still be possible, but I condemn the insistence that there is no line beyond which we need to allow the choice to be in the hands of the individual whose life is at stake.

Walker said...

P.S. to Sonya: Please contact me directly if you are reading here and are willing to do so.