Wednesday, January 9, 2013

Right to Die: "No authentic picture of public opinion"

The moral/ethical tug-of-war between autonomous choice and respect for human life is being vigorously and divisively engaged. That’s hardly breaking news. But aspects of the life-versus-choice debate are playing out loudly on multiple fronts.
In the United Kingdom, the Liverpool Care Pathway for the Dying Patient, a hospice-inspired strategy for appropriate medical care, is getting the “death panel” treatment, portrayed in some media as callously hastening patient deaths for economic and other reasons. In Canada, the Supreme Court will rule this spring on the authority of medical carers to decide when to remove a patient from life support. And in Rome, in words directed in part to legislators in Ireland, where a woman recently died from pregnancy complications after being denied an abortion at a Galway hospital, the pope has noted “with dismay that, in various countries, even those of Christian tradition, efforts are being made to introduce or expand legislation which decriminalises abortion.”

In the shadow of these evolving stories, and just two months removed from the narrow decision by Massachusetts voters not to make it legal for a physician to write a lethal prescription for a terminally ill patient, I came upon an instructive new study in the journal Palliative Medicine. The title: “Why do we want the right to die? A systematic review of the international literature on the views of patients, carers and the public on assisted dying.”

This study, led by Maggie Hendry and Diana Pasterfield of the North Wales Centre for Primary Care Research, is an impressive effort to get a sense of the range of values regarding assisted dying, in the form of physician-assisted suicide, euthanasia, or “accompanied suicide,” as practiced in Switzerland by Dignitas.

Some form of assisted dying is legally practiced in four European countries (The Netherlands, Belgium and Luxembourg, in addition to Switzerland), and three US states (Oregon, Washington and Montana).

Some proponents of legalizing physician-assisted suicide elsewhere in the United States anticipated Massachusetts as a bellwether, and the last-minute swing in support provided an interesting look at the pliability of attitudes. Polls just weeks before the November vote showed the measure supported by a significant majority. Was the reversal to a narrow defeat on Election Day indicative of how soft support or opposition can be on a question that puts life and choice into conflict?

The study of “right to die” attitudes found four themes in reasoning for and against: "concerns about poor quality of life,” “desire for a good quality of death,” “concerns about abuse if assisted dying were legalised,” and “importance of individual stance related to assisted dying.”

On the last theme, the authors wrote, “Some felt that only God should decide time of death. Others believed such decisions are morally wrong and could be equated with murder or interpreted the desire to hasten death as a sign of moral weakness. Some people saw death as part of a natural process that should not be interfered with, whereas others argued assisted dying could be morally justified to relieve suffering.”

According to the study, “The heated exchange about legalisation or de-criminalisation shows no sign of diminishing. There is a dearth of high-quality, unbiased evidence about the collective views of people that such a change in law might affect, and no authentic picture of public opinion is available.”

The study underlines both the need for clear policy on assisted dying, and the challenge in achieving that. “Importantly," say the authors, "the dichotomy between the views of doctors and the general public needs to be urgently explored.”


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