You can tell how divisive an issue is when even what you name it causes controversy. In my native state of Massachusetts, Question 2 on next week’s ballot is called the “Death with Dignity Act” by those who support it. Those who oppose it refer to it as a measure to legalize “physician-assisted suicide.” They sound very different, don’t they?
Many liberals and progressives with whom I agree on many questions support the Death with Dignity idea. They make two broad arguments. The first is an argument about liberty and autonomy: that the right to end one’s life at a time of one’s choosing is one of the most basic rights there is.Why should the government prohibit this? Why should it prevent terminally ill patients in great pain from seeking the assistance of their doctors when they know their life is nearing an end anyway? This leads to the second argument, from compassion.Why should a suffering, terminally-ill person be denied the right to end his or her own suffering? And why, given the costs of our health-care system, should a terminally-ill person be denied the right to end his or her life and thereby save both the medical system and family members from enormous, unnecessary medical costs?
I should begin by acknowledging that my opposition to physician-assisted suicide goes “all the way down,” as the philosophers like to say. Because I view life as a gift and our own lives as implicated in the lives of others, I do not believe there is a right to kill oneself. This could be described (and, by some, dismissed) as a religious view, although I believe it is defensible on non-religious grounds. Put another way, I don’t think we have any more right to kill ourselves than we do to kill other people.
I also know that most people probably disagree with me on this and might legitimately object to imposing this view of suicide through the force of law. And, in any event, my strongest objections to physician-assisted suicide do not rest on my philosophical inclinations, but on worries that many others, including liberals, might share: (1) the danger of muddling the role and the moral obligations of the doctor; (2) concern that pressure could be placed on terminally ill and disabled patients to kill themselves; and (3) a worry about how physician-assisted suicide would interact with the need to curb costs in our medical system.
The Death with Dignity movement has done enormous good by calling attention to problems in our medical system. It often did a poor job of pain management and so emphasized medical concerns, in the narrowest sense, that it dehumanized the final months of life for many terminally ill patients. Because of pressure from the Death with Dignity movement, there have been marked improvements on both fronts. And we need to continue moving forward.
On the issue of pain, I believe in the need to continue drawing a bright line between risking a patient’s death by prescribing heavy doses of pain medication, and killing a patient outright. Some might dismiss this distinction as forced, but it isn’t. In particular, making this distinction helps us avoid compromising the doctor’s role as a healer.
There have also been great advances in hospice care, and we need to build on them. One of the maddening aspects of the fight over the Affordable Care Act was the explosive and false claim that the bill included “death panels.” Of course it didn’t. But the original bill did contain measures to encourage terminally ill patients to discuss treatment options with doctors, and to make carefully thought-through decisions as to whether they wanted to continue with heroic measures to stay alive, or to seek hospice care or other alternatives. It is a shame this part of the bill was removed and that the discussion was cut off by demagoguery. We need much more honest discussion about end of life care and the choices faced by those near the end of life face.
We need to draw another bright line between removing artificial life support and death by physician assisted suicide. Here is where some conservatives who probably agree with my arguments went wrong on the Terri Schiavo case. In the case of removing support, we are acknowledging that medical advances have allowed us to trump nature and to keep someone alive long after they would otherwise have died. There is no moral obligation to keep a terminally ill patient alive through artificial, and particularly through heroic means. In the second case, we are taking active measures to kill. I am very uneasy about erasing this line, and it is why I hope Massachusetts voters will reject Question 2.
If I would urge liberals to have second thoughts about physician-assisted suicide, I would ask conservatives who agree with me on this issue to ponder what a commitment to life means in relation to the health-care system as a whole. Those lacking health insurance coverage too often cannot seek medical help until it is too late. Surely the proper moral unease they feel about physician-assisted suicide should extend to a concern for providing regular access to health care for all Americans. Emergency rooms are not the answer.
No one fought harder for universal coverage than the late Sen. Edward M. Kennedy, so I close by noting that one opponent of Question 2 is Victoria Reggie Kennedy, the Senator’s widow and a strong public voice in her own right. “When my husband was first diagnosed with cancer, he was told he had only two to four months to live, that he'd never get back to the United States Senate, that he should get his affairs in order, kiss his wife, love his family and get ready to die,” she wrote in the Cape Cod Times. “But that prognosis was wrong. Teddy lived 15 more productive months.”
She added: “When the end finally did come — natural death with dignity — my husband was home, attended by his doctor, surrounded by family and our priest.”
Vicky Kennedy argues that the alternative to physician-assisted suicide is to “expand palliative care, pain management, nursing care and hospice.” I think that is the right choice.