The New York Times, in a web-only column, features a deconstruction of arguments for doctor-assisted suicide (“myths,” the author calls them), the legality of which is on the ballot in Massachusetts next week. Of particular interest is this statistic, which ought to tamp down the recurring appeals to pathos on the part of euthanasia advocates:
Only 22 percent of patients who died between 1998 and 2009 by assisted suicide in Oregon— one of three states, along with Washington and Montana, where it is legal — were in pain or afraid of being in pain, according to their doctors. Among the seven patients who received euthanasia in Australia in the brief time it was legal in the ’90s, three reported no pain, and the pain of the other four was adequately controlled by medications.
Patients themselves say that the primary motive is not to escape physical pain but psychological distress; the main drivers are depression, hopelessness and fear of loss of autonomy and control.
This is surely a problem, but one of quite a different character than the common invocation of vast numbers of sufferers would suggest. It’s also clearly distinct from cases where medical life-extension is indeed less dignified and more excessive than natural death, though those cases do exist. In fact, I wonder if legitimating this procedure legally and medically wouldn’t actually help fuel this sense of despair. At the very least, it’d be an implicit message from the broader society that those notions of worthlessness are in some way legitimate.
On a related note, Dr. Ezekial J. Emanuel (who is, funnily enough, a sibling of Rahm Emanuel) posits an intriguing thesis on what may be behind this (and many previous) efforts at legalizing medical suicide. It’s not simply the inexorable growth of technology: “If interest in legalizing euthanasia is tied to any trend in history, it is the rise of individualistic strains of thought that glorify personal choice.”
Read the full piece here.
October 30th, 2012 | 12:35 pm
From the linked article:
This does raise the question of how much of a problem it really is.
Perhaps I “glorify personal choice” too much, but I have seen what’s at the end of something like Alzheimer’s and I wouldn’t want what’s left of me kept around just because the empty body was still viable and not in any particular pain.
October 30th, 2012 | 5:45 pm
Ray, I understand your point, but in that case couldn’t you just ask a son or daughter to end your life at that point beforehand? While Catholics do consider suicide to be a grave sin, the medical ethic question is (I think) not so much suicide as such, but primarily the possibility for abuse and for the corruption of the field of medicine once it becomes an accepted procedure.
October 31st, 2012 | 10:33 am
Patrick –
Well, sure. But not legally.
Definitely a concern… but I quoted Dr. Emanuel as noting that it doesn’t seem to be a widespread phenomenon even where it is legal. In practice, that fear doesn’t seem to have borne out.
October 31st, 2012 | 4:05 pm
Dr. Ezekiel J. Emanuel articulately and rightly notes that “If interest in legalizing euthanasia is tied to any trend in history, it is the rise of individualistic strains of thought that glorify personal choice.” He also ought to recognize that this is exactly the mentality that led to interest in and eventually acceptance of legalized abortion on-demand. Such a voluntarist mentality, even if Dr. Emanuel doesn’t use that term, elevates autonomous choice by holding one’s capacity to exercise autonomous choice as the criterion for determining a human person’s worth. In turn, this voluntarist moralism creates a utilitarian anthropology that provides the ontological seeds for what John Paul II called a “tyranny of the strong over the weak.” Those in the silent givenness of their earliest, latest, and most vulnerable stages of life are the ruled in such a regime.
Dr. Emanuel, who has shown an uncomfortable openness toward the possibility of medical-care rationing based on age and mental health, ought to recognize that it isn’t exclusively ultra-individualist who demand doctor-assisted-suicide. Those who believe the elderly and the mentally and physically handicapped wastes of resources also–in varying degrees–demand such procedures. Of course, vitalism is one thing–aggressively extending a life expectancy by minutes, days and months when death is imminent is as morally problematic as euthanasia. Likewise, medical providers and insurers ought to design, administer and proscribe medical treatments, insurance coverage policies, etc, tailored to meet patents’ actual medical-needs according to age, physiological make-up and medical history. Such measures, along with allocating resources according to patients’ income-needs (so that low-income patients receive viable treatment), are reasonable and necessary means for effectively directing medical and financial resources. There is a clear distinction between such discretionary allocation of resources and refusing to treat a patient or giving her the barest of bare-minimum treatment because she, in some minds, has lived long or enough, or she is severely mentally disabled and thus a drain on society and, who are we kidding, isn’t living a life anyone in their right mind wants to live. The issue is complex and in many specific cases the line between moral palliative care and euthanasia becomes difficult to easily distinguish.
Dr. Emanuel clearly takes the issue seriously and has certainly done great work toward improving end of life care. Yet, he has also shown an openness toward prioritizing care for those who are functioning, socialized and participating citizens. A lesser priority is given to those who are “irreversibly prevented from being or becoming participatory citizens”–care for them is neither necessary nor basic.
I intended to avoid demagoguery in this comment, but it really is the “strong”–in the sense of those who are more psychically, socially and politically advantaged–who will and often do decide whether care to a patient with dementia, for example, is a priority and therefore necessary. In order to avoid partisanship, one ought to note that many social-conservatives subscribe to the bourgeois ethos that links one’s worth closely with his or hers “success” in life. While Tom Friedman’s recent critique of the pro-life movement is a dishonest caricature, we ought to recognize that too many pro-lifers have easily accepted and assimilated into the bourgeois mentality that often bodes poorly for those with less potential for achievement. Unsurprisingly, pro-abortion and euthanasia advocates tend to be “progressives” of an upper-middle income and wealthy socioeconomic standing. Yet, less noted is the fact that many social-conservatives from such standings have comprised on marriage–giving less import to marital values of fidelity and procreation. The acceptance of divorce and contraception among many social-conservatives might have been once difficult to imagine. Likewise, although it might be difficult to imagine now, we ought to be little surprised if social-conservatories gradually cede ground on abortion and euthanasia. As in the case of marriage, little stands in the way if one prioritizes “choice” and “success” over life as given.
November 1st, 2012 | 3:07 pm
“But the fact is that, even in places where physician-assisted suicide is legal, very few people take advantage of it.
This does raise the question of how much of a problem it really is.” –Ingles
As a high school teacher, it has often become necessary to discuss the topic of suicide in class. Many of you probably know that one-sixth of all teens contemplate suicide.
Whenever that discussion takes place before the suicide of a classmate, I have students that will argue that no one has a right to tell someone they can’t take their own life. After a classmate has applied such a “right” in reality, that insidious argument never gets made.
If we open up the door to euthanasia, we open up the legal door to suicide at any age. If your spouse or child came to you and said, “I’m thinking of suicide,” what one of us would say, “Well honey, you have the right to do that if you wish…”
No. In reality I think we’d all say something to the effect of, “I love you, please don’t do that, you aren’t alone and this pain won’t last forever.”
Ideas have consequences. I guarantee you, if euthanasia becomes “acceptable”, it won’t take long for teen suicide rates to rise as a logical response.
“Ray, I understand your point, but in that case couldn’t you just ask a son or daughter to end your life at that point beforehand?” –Patrick
Does it not say something about how spineless and selfish our culture has become when this thinking is a common point of discussion?
If I am a parent, how selfish do I have to be to ask my son or daughter to do something that has a great likelihood of psychologically damaging and scarring them?! Mother of God preserve us from such cowardice.
And before someone accuses me of being heartless, I have a wheelchair bound grandfather who hasn’t known who I was for five years. Doesn’t keep me from visiting him, and I’ve seen how the visits of his children (whom he now also doesn’t recognize) have grown virtue and love in members of our family. Human suffering is not to be feared as so many think…
November 2nd, 2012 | 9:26 am
Artaban –
Well, there’s some evidence for that, but oddly enough I can’t find any stats after 2005. And there are other factors.
Um, I didn’t propose having my kids mercy-kill me. Patrick did. If physician-assisted suicide were legal, that wouldn’t be an option.
So people should be forced to go through it for their own good?
November 2nd, 2012 | 4:00 pm
“Human suffering is not to be feared as so many think…
So people should be forced to go through it for their own good?”
Does it not seem to you that the very nature of our world forces people to go through a degree of suffering? Is it not eminently evident that some of the best that humanity has to offer have become so under the tutelage of hardship?
What parent hasn’t allowed a child to “suffer” in some way, because it was necessary for their growth into a mature and good human being? It seems to me that the children most “protected” from want (i.e. those that get whatever they want) turn into pretty terrible human beings.
I have psoriatic arthritis. There have been periods of weeks when there is throbbing, constant pain in some of my joints. One of the things I’ve learned is that if I focus on something else (work, a task, etc.) I don’t notice the pain. As soon as I let my mind wander or focus my awareness on my own body, the pain is there. I’ve been asked why I don’t medicate the pain away (it is an option). Very rarely I will take something to lessen a particularly bad flare up, but not most of the time, for it would stunt my growth as a person and could lead to a drug addiction. My family has a few alcoholics in it.
I’d rather have the pain for myself and spare my family another addict.
Our culture fosters a narcissistic self-focus that amplifies suffering and stunts human development. Christianity fosters a love so great it sacrificed itself under one of the most brutal forms of execution ever devised by man, and urges us to “take up your Cross”, for “blessed are those who sow in tears, for they will reap rejoicing”.
November 3rd, 2012 | 9:40 am
Artaban –
The question I asked was of the “yes” or “no” variety – and yet neither of those words appeared in your response.
In reality, there weren’t that many theologians who objected to anesthesia in childbirth or to lightning-rods… but there were a few. They also appealed to the redemptive power of suffering along with God’s sovereign authority.
But it seems that most people have decided that at least some kinds of suffering can – and should – be palliated.
Ah, but the question I asked you was – “So people should be forced to go through [suffering] for their own good?” (Emphasis added.)
Exactly what period of flagellation should be legally compelled?
(To help give focus to my question – if any is needed – may I point out the difference between ‘encouraging’ and ‘requiring’?)
November 6th, 2012 | 12:48 pm
“But it seems that most people have decided that at least some kinds of suffering can – and should – be palliated…
Ah, but the question I asked you was – “So people should be forced to go through [suffering] for their own good?” (Emphasis added.)
Exactly what period of flagellation should be legally compelled?”
I’m not exactly sure how or why flagellation is entering into this discussion. I fail to see where anyone is talking about legally compelling a practice that the Church has condemned and that is in defiance of Old Testament law. It has roots more in paganism and shamanism than Christianity, and those saints who engaged in it voluntarily still tend to have that part of their lives frowned upon.
Certainly some forms of pain can and should be palliated–especially considering the intention and reason for such. On the other hand, it’s ironic that a minority of the human population (America) consumes the vast majority of painkillers (80% according to some sources). It’s also significant that the CDC estimates 15,000 deaths a year in the USA are caused by painkiller overdoses.
We have a significant number of people unintentionally killing themselves in efforts to avoid pain.
To your original question, though, sometimes people should be forced to endure certain types of pain, and this is understand by secular society and practiced at almost every age and in every profession. The pain of incarceration is meted out to over a million people a year. The pain of medical care and physical therapy is endured by millions. The pain of detention is given to schoolchildren. The pain of docked pay and taxes is delivered to workers….Yet most of us understand at some level that pain is not the end-all and be-all.
Heck, Buddhism’s first Noble Truth is that life is pain.
Judeo-Christianity’s “first noble truth” (found in Genesis) is that “it/the world/life is good (in spite of pain).
November 7th, 2012 | 9:09 am
Artaban –
True. Is a blanket ban of painkillers the correct solution?
Hopefully fewer in upcoming years, though.
Without their consent, though? Only in cases of mental illness.
The main point here, though, is that you’re ignoring the point. Detention and incarceration are punishment, ideally intended to discourage bad behavior. What does keeping someone alive to suffer pain or indignity discourage? Falling ill? Are you one of those who consider that a sign of moral failing?
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