11 September, 2011

The assisted suicide dilemma - The Globe and Mail

This is an interview with chair of the Royal Society’s committee on end-of-life decision-making in Canada. Please note that the first issue addressed in the interview deals with the costs involved of caring for the elderly under our Canadian health care system. I offer it as evidence to those who have over the years accused me of exaggeration when I said that dollars would eventually settle the euthanasia debate.

When the chair of such an important committee does not respond with an affirmation of the value of human life but offers a litany of economic reasons why the aging baby-boomers are going to stress the health system to the breaking point, we boomers have good reason to be concerned. It will be very difficult to resist the imposition of euthanasia as a mandatory health care option once we start down this road. The fact that every major lobby group representing the handicapped community oppose its introduction because they see it as a legitimate threat to them. They claim that they already suffer the prejudice of the able bodied community who perceive the lives of the handicapped as being less worth living than theirs. Imagine how it sounds to someone who's handicapped when they hear others say that 'they'd rather die' than live with a similar handicap. Yet when a survey of the entire community (able bodied and handicapped) is asked to rate the quality of their own life, they offer the same rating!

I have been present when doctors have tried to convince a guardian to euthanize a loved one (Dianne) who suffered from advanced MS... even when that person was still perfectly cogent and able to communicate their desire to live... AND WAS DOING SO throughout the entire interview. When the physicians suggestion was refused, the patient was immediately discharged from the hospital for 'refusing to accept' a doctor's 'treatment recommendations'. She did indeed die soon after, but it did not come that day because of the strength of her husband and family who cared for her through her final days at home.

What would have happened if such a situation were to befall you? Would your spouse/children/family be able to do for you what Dianne's husband was able to do for her? He did not need to work so he was able to care for her 24/7, 365 days a year. His wealth came from his brother's, sister and father who all contributed to his needs from their family logging business. Would you be able to afford to have someone care for you if the government health care system refused to do so? I wish I were wrong, but I fear it will be a question many of we boomers are going to have to face in the not too distant future.

Fr. Tim

8 comments:

  1. Hi Tim,

    I am going to go way out on a limb here and make a statement that may seem to be provocative: Costs must always be one factor in our decision making - even in quality of life/end of life decisions.

    Now before anyone blows a gasket and tells me that godless atheists hate life, and that they have no compassion for the sick and the suffering - let me remind such gentle folks that our financial resources as a society are not unlimited. More specifically, our medical resources (hospitals, equipment, beds, ICU, CCU, specialty doctors, nurses etc…) are not unlimited. In fact, all of our resources are scarce, and if consumed unchecked, a situation can be created leading to unintended human suffering and loss of life. How so? By unnecessarily prolonging the death of one individual, we may be consuming resources needed to save the life of another individual who requires the same resources to be effectively treated. We can of course keep allocating resources to our medical system to avoid such unpleasant tradeoffs, but then we begin to deplete the resources available for other social endeavours: e.g. education, welfare, housing, roads, infrastructure etc… By underfunding these other areas we at some point risk new human suffering, new social suffering, and even loss of life (think about untreated water or sewage as a salient example).

    So – can we at least agree that at some point the unchecked consumption of healthcare is unsustainable?

    If we can get past this point, then yes –we as a society are going to have to make tough decisions about how much healthcare is enough, and how it is going to be allocated. We can let the “free market” decide such allocation questions, however, I think the US clearly demonstrates that this approach is far from satisfactory.

    We should not let the difficult question of “costs” scare us away from an adult conversation about how we ought to make such quality of life/end of life decisions. We are going to need to make cost decisions about everything in healthcare, and end of life decisions are just one area that needs careful thought and consensus.

    I am all for putting safeguards in place to protect the vulnerable, but it is entirely legitimate for some folks to decide that their personal quality of life warrants an early exit. Some folks may even legitimately and selflessly decide that the healthcare resources needed to sustain their personally unsatisfactory life are better allocated to someone else who has a better chance of survival. There is nothing wrong with allowing such altruism – as long as it is not coerced.

    I invite comments/thoughts?...

    Cheers…Martin

    ReplyDelete
  2. Martin: I have no problem with your first premise. Medical procedures that prolong the process of death are not ethically or morally mandatory. Death is a natural process and will eventually claim everyone. As a friend says, 'despite the advances of modern medicine, the death rate remains the same as it always was... one of each person.'

    The only point of contention I have with your position is the possibility of implementing safeguards. We're both old enough to remember the promises in similar cases in the past. Abortion was to be legal only to save the life of the mother or to preserve her health. Safeguards were put in place to ensure this was so. 20 years later (as predicted by Paul VI) every safeguard had been wiped away. As a priest I lived through the experience in Quebec of witnessing the government guarantee confessional schools as part of a linguistic re-organization of school boards only to see these guarantees disappear within 10 years.

    Legislative safeguards are woefully inadequate to keep life or faith commitments whenever we start to tamper with our societal conventions on major moral questions. I don't see why it would be different should we open the door to active euthanasia.

    Tim

    ReplyDelete
  3. Martin: Let me develop the abortion example a bit further. The reason that we initially put restrictions upon the right to an abortion was that we measured the rights of the nascent life of the child against its threats to the health and welfare of the mother. We implicitly were accepting that each party had some rights in this decision. The safeguards were in place to protect the minority rights of the unborn child. Alas the legislative safeguards were insufficient to protect the pre-born from the reach of our courts which allowed the majority interest of the mother to trump the minority rights of the child in every case... even past the point of viability for the child.

    No, laws alone cannot protect the elderly, infirm or handicapped from the state menacing their existence against their will. Future citizens will simply redefine the value of what is worthy of public support and 'voila'... the majority interest will trump the minority right of those deemed unworthy of living.

    Compassion should not blind us to repeat the failures of the past, especially when the cost will be born by those least able to protect their own survival.

    Tim

    ReplyDelete
  4. Hi Tim,

    Thank you for thoughtful posts.

    I am glad to see that we are agreed that no one is morally or ethically required to undergo a medical treatment. Some of your fellow travellers insist that even hydration and tube feeding must be imposed on those who do not wish it (as expressed in living wills) but are in a persistent vegetative state. They also insist that it never be withdrawn - even when it is futile to continue do so (refer to Shaivo case).

    I am, however, not only arguing that medical treatment can be refused (this is an existing right which competent individuals already possess), but that one may also legally seek and obtain the assistance of a doctor to end one's own life.

    Your abortion reference is what I would classify as a "slippery slope argument". While there is usually a valid case for "concern" with such arguments, I am not persuaded that such concern justifies an outright ban. Such arguments were also used to argue for a ban against equal marriage rights for LGBT persons - yet no catastrophic results have come to pass as a result of equal marriage. Straight marriages are no more in peril today than they were 6 years ago.

    Again - I think public discourse and an adult and informed debate about what the rules ought to be around euthanasia are in order. To simply ignore the question is to invite a court ruling that simply declares the law unconstitutional and leaves the field wide open for abuse.

    So in the spirit of debate I propose the following modest rules:

    1. Must be restricted to cases of terminal illness.
    2. Requires patient consent. Patient must be legally competent at the time of the request, the request must be peristent, and patient must reconfirm their desire in front of a panel of 2 doctors.
    3. Must be approved by the 2 doctor panel as a competent, persistent, free and reasonable request.
    4. Must be carried out by a qualified and registered practitioner and limited to specific methods that are lethal and painfree.
    5. Patient may withdraw their request at any time without prejudice.
    6. Must be reported to the coroner and there must be an autopsy to confirm the cause of death.

    Are there other safeguards or mechanisms?

    Cheers...Martin

    ReplyDelete
  5. "I have been present when doctors have tried to convince a guardian to euthanize a loved one (Dianne) who suffered from advanced MS... even when that person was still perfectly cogent and able to communicate their desire to live... AND WAS DOING SO throughout the entire interview."

    Tim, THAT was not assisted suicide. That was attempted murder. Everyone not only needs to know the difference, but acknowledge that the difference is of extreme importance. And stop making out that it is what it is not.

    ReplyDelete
  6. Lady Janus: Yet that was what it was described as by the administration of the hospital and beyond. I have witnessed the same crisis face more than one person. Usually their express wishes are respected. If they say that they've had enough, their treatment switches into palliative care mode. No one is arguing against passive euthanasia in which the only concern is keeping the person comfortable, cogent, as pain free as is possible to facilitate a merciful death. All you need do is witness as many acts of people willing themselves to life or death as I have seen to know that the personal wish of a dying person to have some control over when they 'check out' is present in all of us.

    But make no mistake. What I described in my initial comment accurately describes what is practiced as euthanasia is today's hospitals in both Ontario and Quebec.

    Fr. Tim

    ReplyDelete
  7. Martin: Food and hydration must be continued until a person enters a palliative state. It would only prolong the period of suffering. However, if a person requested that it not be removed until death, that wish must be respected. In questions of doubt... the benefit falls to treat the patient until s/he indicates otherwise.

    Aside from this concern, I still have my initial conviction that legislative safeguards will not suffice to protect from abuses. I see this issue exactly the same way I view capital punishment. Since we cannot be certain not to kill an innocent man, we should refrain from killing any. Since we cannot guarantee that people will not be victimized if we grant the state the right to terminate the weak and aged, we should refrain from killing any. When the costs are counted in lives, the stakes are too high. Life should be respected wherever it exists.

    (NOTE: This is different from permitting death to occur if a person expressly wished that outcome. An individual always has the right to refuse treatment even if it means their death. Self-autonomy should be respected as far as possible. We still have the right to free will.)

    Tim

    ReplyDelete
  8. "Yet that was what it was described as by the administration of the hospital and beyond."

    Then stop listening to how others describe it and start insisting that they use correct terminology. When you accept someone else's wrong usage of language, you aid and abet their intentions. You have a brain -- time to use it, yes?

    " No one is arguing against passive euthanasia..."

    You can't argue against what does not exist, Euthanasia is active, not passive. Assisted suicide is even more so. And no, euthanasia is NOT the same as assisted suicide!

    ReplyDelete

Followers of this blog:

Blog Archive

Google Analytics