Thursday night, HBO aired How to Die in Oregon, the winner of this year’s Grand Jury Prize in the documentary category at Sundance. The film, though emotionally powerful, is intellectually flabby, repeatedly shirking weighty questions surrounding the end of life.
The documentary’s springboard is Oregon’s 1994 “Death with Dignity Act” permitting assisted suicide for the terminally ill. Glaringly, however, the legislation, while replete with qualifiers and conditions, nowhere states exactly what it means by dignity. Instead, it simply takes the term as virtually self-evident and thus universally shared.
But what, precisely, does “dignity” mean in terms of someone’s dying? From the perspective of many of the documentary’s subjects, dying with dignity is synonymous with having the individual choice of the time, place, and manner of one’s death. But what, then, do we make of those who don’t – or can’t – exercise choice in the way they die? Does someone who dies suddenly on the battlefield lack dignity? Does a good per-son who unexpectedly dies of a heart attack lose her dignity at that moment? And, perhaps most relevant to the documentary and its rhetoric, what do we say about terminal patients who choose not to avail themselves of physician-assisted suicide: are their deaths shameful?
Not surprisingly, as the film reduces dignity to a matter of individual choice, it spotlights the advocacy group, “Compassion and Choices.” But in so doing, the documentary comes to bandy about “compassion” with all the analytical abandon with which it characterizes “dignity.” If the root meaning of “compassion” is “to suffer with,” how seriously does that apply to Compassion and Choices, whose volunteers drop by to drop off counsel and assistance vis-à-vis the fatal dose? More genuine compassion may well be found among those relatives or friends who spend months or years as long-suffering companions or caregivers at the bedsides of the sick and dying over the course of their chronic, debilitating, painful illnesses.
A belief in someone’s innate “right to die” – a term nowhere to be found in the Oregon statute – as an exercise of one’s autonomous choice has no more empirical basis than a tale about a man, a woman, and a talking serpent in a garden. As the oxymoron “physician-assisted suicide” attests, the choices afforded individual Oregonians are manifestly not choices merely up to them alone; other agents’ choices are involved besides. Not only must an Oregon physician first decide whether to write a prescription for a lethal dosage of some drug, an Oregon pharmacist must then decide whether to fill it, and an Oregon health insurance company representative must decide afterwards whether to reimburse it. And, of course, the Oregon electorate had to decide whether to legalize all of it in the first place.
Strikingly, How to Die in Oregon fails to explore another option at the end of life: hospice. Researchers such as Dr. Linda Ganzini at the Oregon Health and Science University have surmised that one reason for the low number of suicides since the law’s inception is the quality of care afforded terminal patients by Oregon’s fifty-two licensed hospices. Unfortunately, hospice tends to market itself far less effectively than do “death-with-dignity” supporters, relying not on high-profile documentaries, but instead (naively) on word-of-mouth and such circumlocutions as “palliative” - hardly a term of common parlance, which the film mentions in passing but never explains.
Although this essay obviously appears in the “On Faith” section of The Post, not one of its points rests on some religious ground – a claim death-with-dignity proponents frequently level against any criticism of their position. Revealingly, perhaps, How to Die in Oregon, in failing even to address the questions raised here, much less answer them, seems as dogmatic as any fundamentalist tract.
Michael Goldberg, PhD, lives in the San Francisco Bay Area and is the author of several books, including, most recently, Raising Spirits: Stories of Suffering and Comfort.
Matt Goldberg lives in Atlanta and is managing editor of Collider.com.