by Saul Friedman (bio)
The poet Dylan Thomas said it best for those of us of advanced age:
“Do not go gentle into that good night; rage, rage against the dying of
the light.” But what if there is no good alternative to quietly turning
out your light?
In Connecticut, the home state of insurance giants, a legal and moral
battle rages that may have national implications as two physicians have
sued the state for an action that could eventually allow patients to
choose a peaceful, drug-induced death to avoid the pain and terrors of a
terminal illness.
As CNN's Randy Kaye reported,
“While courts have addressed constitutional questions
connected with aid in dying, no court has directly considered whether a
mentally competent, terminally ill patient’s desire to bring about a
peaceful death should be considered a ‘suicide.’”
That’s vital, for a suicide is generally against the law and the
family of the person who dies may suffer spiritually and legally,
including the loss of insurance and other claims.
Thus, Connecticut physicians Dr. Gary Blick and Ron Levine are suing
the state, asking that the state’s laws restricting assisted suicides
should not include cases in which mentally competent, terminally ill
patients take their own lives to avoid pain and suffering.
The suit, which a superior court judge has dismissed on technical
grounds, was prompted in part by several cases in which people have been
punished for helping friends or relatives to die. Right to die advocacy
groups are expected to appeal.
In the most publicized case, in 2004, John Welles, who was dying of
cancer and suffering, pleaded with a friend, Hunt Williams, to give him a
pistol. Williams did as his friend asked. As Welles walked away in the
woods, Williams shouted “God bless” and heard the gunshot. Welles died
and Williams was convicted of “assisting a suicide,” a felony in the
state.
Blick’s suit was aimed, in part, to clear and free Williams and win
permission to end a dying patient’s suffering. Said Blick,
“We’re not talking about hooking up a potassium chloride
drip and have our patient’s heart stopped. We’re talking about
terminally ill patients who I’ve counseled over the years and that I
would like to give them prescriptions and help them die with dignity.”
Blick, the Medical and Research Director of CIRCLE Medical, is a
specialist in infectious diseases and HIV-AIDS, which raised for me a
question. Not a few years ago, AIDS was considered always fatal. Now
it’s not. How many AIDS patients took their lives, rather than wait for
the life-saving treatments now available?
Nevertheless, if Blick and Levine are successful in their campaign,
Connecticut could join a growing number of states that recognize the
right of a terminally ill patient to end his/her life with the help of a
physician.
The recent HBO film,
You Don’t Know Jack, was a sympathetic
portrait of Jack Kevorkian who was jailed for helping a number of people
die, most them not his patients. But he brought the issue to a life
that is growing. Recent polls indicate that 60 percent of whites (38
percent of blacks) favor allowing physicians to assist the terminally
ill to die.
By all accounts, Oregon’s pioneering “Death With Dignity” law has
been doing what was intended. The 1998 law (which has been copied in
Washington state) has survived legal challenges including protests by
members of Congress because of its safeguards. A physician must
determine that the patient has less than six months. and a second
opinion is required. The patient must make repeated requests, waiting at
least 15 days between requests.
If these procedures are followed, an Oregon physician can prescribe
the life-ending drugs, which may be taken with or without a doctor
present. In this way about 30 persons a year have gone through the
process and died, usually with close family members present. Most of the
patients were suffering from advanced cancer or ALS (Lou Gehrig’s
Disease).
Leading medical institutions, Harvard Medical School and
organizations such as the American Medical Women’s Association, the
American Medical Student Association and the American Public Health
Association support legislation permitting physicians to assist
terminally ill patients to take their lives with drugs.
The American Medical Association stands opposed. And the American
Academy of Hospice and
Palliative Medicine is neutral, possibly because
proper hospice care (in which I am now a participant) can avoid the need
to take one’s life and even put off death.
But in the end, hospice provides for pain free and comfortable last
days with the help of a hospice nurse to tend to the patient and a
hospice social worker to work with the family.
Much of the opposition to assisted death also comes from the severely
disabled and persons with serious chronic diseases. They fear, with
some justice, that they and people like them will be vulnerable if, for
example, their insurance companies balk at the cost of their care.
Remember former Colorado governor Richard Lamm telling such people to
“get out of the way” because they were costing Medicare too much money?
Other opposition comes from religious institutions and right-to-life
organizations who also oppose elective abortions. I disagree, of course,
but I believe that just as the state should stay out of a woman’s right
to choose, so the state should not need to come between a dying patient
and his/her right to choose the manner and time of his/her death.
Oregon’s statute, I admit, is a model of regulation for the safety of
the patient’s rights and to guard against abuse - say by relatives who
can no longer care for the patient. But the choice of hospice seems to
be minimized. That’s why I’m uncomfortable with such organizations like
Compassion and Choices, which seems to advocate an end-to-life as if it
were a walk in the park.
They may encourage people to seek the alleged comfort of death for no
good reason. A woman I know whose medical problems are serious but not
life threatening seems to have given up on life because she’s despondent
over the death of her husband.
End-of-life advocates seem to provide little encouragement to fight a
disease, as I am, and the reasons for their despondency, the better to
hang onto life and “rage against the dying of the light.”
As another, more gentle poet, Robert Frost. has written, “The woods
are lovely, dark and deep. But I have promises to keep and miles to go
before I sleep. Miles to go before I sleep.”
Write saulfriedman@comcast.net
http://www.timegoesby.net/weblog/2010/06/gray-matters-assisted-death.html
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