A Gentle Death

Once you get born it eventually becomes clear that there is only one way out, and it’s called dying. As the police sometimes say, when they arrest a violent criminal, “You can do this the hard way or the easy way.” When it comes to getting dead, we often don’t have much choice. There are thousands of horrible ways to die, and the chances of having a gentle death are actually pretty small. Even old age, while not a disease, brings infirmities and miseries of its own, most of which are not terminal.

Dying of old age can’t be a lot of fun, but it’s probably much better than unexpected and abrupt departures caused by war, accident, or murder.

As a culture, we could help many more people avoid the agonies of protracted dying with assisted suicide, an option that seems to be gaining in acceptability.

The State of Oregon passed, by popular vote, a physician assisted suicide law in 1998. (See: http://www.oregon.gov/DHS/ph/pas/). By the end of 2007, 341 terminally ill patients had used the right to end their lives and their suffering by taking a lethal amount of prescribed drugs. The Catholic Church and some health care groups spent millions to defeat this law, and the state was eventually forced to put it back on the ballot where it was again approved by a majority of voters in Oregon. To date there have been no reported abuses of the law by relatives, practitioners, or organizations.

“Right to Die” or “Death with Dignity” laws are vigorously opposed by the Catholic Church as well as by other health care groups. Why? I suspect it is all about the money. Many years ago, using the huge force of cheap labor provided by various religious orders, the church moved into the health care business by developing hospitals and care facilities. No doubt many sisters who worked in health care did so from noble motives, from concern for the comfort of the sick and dying. Church leaders, however, saw this as a huge source of income.

Those who profit from caring for the terminally ill probably don’t care where the money comes from. be it insurance companies, family savings, or the government. They have to cover the payroll and have some left for profit.

A terminal illness can cost many thousands of dollars and cause protracted misery both for the patient and for his/her family. The savings of a lifetime can vanish in mere weeks as various treatments and tests follow one after the other. Even the simplest daily care in a nursing home is extremely expensive.

The two main objections to assisted suicide seem to be the religious idea that life is sacred and the fear that unscrupulous people will use the law for evil purposes. So, the question is: should terminally ill people be denied the right to a peaceful and painless death because some people have religion-based opinions or because there is the chance that the law will be abused? We already have many laws that permit behaviors (gambling, drinking, abortion, etc.) that are not approved of by various religions, and many good laws are violated by criminals. The possibility of criminal violation of a law should not prevent its establishment if the law benefits and is favored by the majority of voters.

Unbearable pain, life in a coma or semi-coma, and all the expenses of prolonging life with no hope of recovery—these set the stage for a rational decision in favor of an early departure.

In Oregon, the great majority of the 341 approved assisted suicides resulted from advancing cancer of various types.

Washington State put an assisted suicide measure on the ballot in 2008 and it was approved by a substantial majority. (See: http://wei.secstate.wa.gov/osos/en/Documents/I1000-Text%20for%20web.pdf)

Oregon and Washington in the United States joined Switzerland, Belgium, and The Netherlands in making assisted suicide legal according to Derek Humphry who founded the Hemlock Society in 1980 and more recently the Euthanasia Research & Guidance Organization. He is the author of the book Final Exit (www.assistedsuicide.org). Many other countries are either ambiguous about or tolerant of assisted suicide without making it a matter of actual law.

The usual rule is that two physicians must certify that the patient asking for assisted suicide has six months or less to live. This has caused some controversy in the medical profession which, of course, has the primary obligation to save and improve life, not to help end it.

There is even now an emerging profession called Thanatology that has the potential for solving many ethical concerns. There is a certification program based on required studies and on an examination process offered by Association for Death Education and Counseling (http://www.adec.org/certification/FT_info.cfm).

No physician should ever be required to prescribe a lethal dose of drugs in the assisted suicide situation. Many will never do so. On the other hand, death is more of a social problem than a medical matter once it has become certain. Suicide was decriminalized some time ago in most of the modern world. Regulated assisted suicide may not be far behind.

Although the cooperation of medical doctors in determining the life expectancy of a dying patient is vital, trained and qualified thanatologists from any discipline should be available as case managers. There is so much to do beyond attending to the medial needs of the patient, areas in which physicians are not generally trained or interested. These areas include counseling the dying patient, family therapy, financial counseling, and legal matters such as final directives, wills, post death memorial services, and so forth. A qualified thanatologist might come from other professions such as social work, psychology, pastoral counseling, or law. In any case, it would be most efficient if the thanatologist, with proper certification or license, had direct access to the drugs needed to end the life. This would relieve the physicians’ ethical concerns about having to end a life.

(Julian I. Taber, Ph.D. is author of Addictions Anonymous: Outgrowing Addiction with a Universal, Secular Program of Self-Development: ISBN 978-1-60145-647-2)

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