Monday, April 9, 2012

A Dignified End, or a Suicide?

I’ve surprised friends recently with the news that, at the same time they vote for president in November, they’ll also be asked to decide whether Massachusetts should adopt the Death With Dignity Initiative, and make it legal for physicians in the state to prescribe a lethal dose of medicine to terminally ill patients who have asked for it.

Their surprised reaction has in turn surprised me. I would have thought the initiative would be well known by now. Perhaps this is another indication that voters don’t really engage the issues or candidates till much closer to Election Day.
But perhaps it’s also an indication of what is unique about the Community Ethics Committee -- that we discuss and consider important questions that many people don’t even want to think about, especially as relates to medical care at the end of life.
Soon enough, all Massachusetts voters will need to think about the initiative, and how they decide will no doubt be reflected in what they choose to call it: Death With Dignity or Physician Assisted Suicide. Proponents of the initiative say using such an emotionally charged and judgmental term as suicide is misleading and does a disservice to the terminally ill patients who will benefit from the practice. Opponents say suicide is the clearest way to describe ending one’s life, and to do otherwise is euphemistic.
Massachusetts is hardly the first to engage these questions. Political efforts are underway to legalize euthanasia in Quebec and British Columbia. DWD/PAS is now legal in both Oregon and Washington state, by decision of voters.
As the Community Ethics Committee has studied and discussed DWD/PAS, and I’ve tried to sort out for myself whether Massachusetts would be wise to legalize it, two resources have risen to the top in helping me to decide. Each is fairly lopsided in its viewpoint. But each is also very well informed, with varied voices speaking directly to the essential questions.
“How to Die in Oregon.” a Sundance award-winning 2011 documentary film, clearly portrays the need for such a law, as perceived by DWD/PAS proponents. It is hard to watch but very real, compelling, and makes a convincing case for the compassion behind this movement. (Available here, but copies also are available within the Minuteman Library Network)

Less clear is whether that compassion is sufficient to overcome the harm feared by opponents when society gives physicians the moral, ethical and legal sanction to participate in killing. 
That side of the argument is well represented on the CBC Radio program “The Enright Files,” which devoted an hour to the subject. In it, host Michael Enright revisits conversations he has had with Balfour Mount, described as the founder and creator of term palliative care. Those conversations are followed by a panel of doctors, nurses, ethicists and advocates discussing what is meant by a good death and the right to die.
By the time Massachusetts voters really engage the subject, there is bound to be a lot of heat and not so much light from the two sides. Voters might do no better than these two resources for shedding light and making sense of the debate.
And those who take the time to watch and listen to both may be struck, as I was, by the similarity between two central characters: Cody Curtis, a patient who benefitted from Oregon’s DWD/PAS law, and Balfour Mount, who might question whether benefit is the right word. Each is extremely thoughtful and compassionate.

And listening to them requires patience. Each speaks at times in sentences and phrases interrupted by the gasps for breath that cancer causes without regard for what side you’re on.

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