The D.C. Death With Dignity Act of 2015 is patterned after a 1997 law in Oregon, and, buoyed by the recent passage of a similar measure in California, the bill’s proponents are confident that it will pass.
The proposed legislation, which enjoyed the endorsement of The Washington Post’s editorial board, is slated to go to committee vote Wednesday. If the legislation is approved by a majority committee vote, the council is expected to vote on it as a whole in the weeks ahead.
As a doctor and as a theologian, the ethical dimensions of this bill must be considered in light of medical practice, as well as more foundational beliefs about the nature and value of human dignity.
The most vocal proponents of the bill include the patients’ rights advocacy group Compassion and Choices. The group has called for a formal structuring of an aid-in-dying practice guideline as part of a program they see as nationally desirable and inevitable, despite the medical establishment’s long-standing opposition to the practice.
The group’s agenda centers on the patient’s right of autonomy as the sole determinant of action and on the assumption that dying patients have inadequate choices available to them as they prepare for death.
But the proposed legislation is fundamentally flawed and out of touch with normative ethical medical and public-policy decisions.
Advocates suggest that dying patients don’t really have a “choice,” an idea that is simply uninformed. In fact, programs already exist for the terminally ill in the form of hospice, palliative care and intensive care — all of which provide excellent care, and prevention and alleviation of suffering.
The programs provide for active dialogue, where autonomy is valued and dignity — however defined by a patient — is maintained. And patients’ next-of-kin and powers-of-attorney are integral members of the decision-making process. We believe end-of-life care would be improved by focusing on refining these existing programs.
We should not expect to make physicians complicit in what we consider to be a “suicide-on-demand” paradigm, which invites no regulation, oversight, training and accountability to a wider community. Throughout history and across cultural contexts, broader community involvement has discouraged the taking of innocent life.
Under the proposed legislation, involvement in the decision to end the patient’s life, even of a patient’s next of kin (think husband or wife), is optional, thereby skirting the most rational and important safeguard against abuse. Many patients who are dying do not wish to assert a right, as to not be a burden. These patients are susceptible to subtle forms of coercion and control.
Financial pressures will certainly influence some doctors, families and third-party payers. As a result, patients, especially the elderly and disabled, could feel not a right to die so much as a “duty to die.” The safeguards of the larger community, one that will protect all aspects of the patient’s interests and dignity, are necessary.
The patient’s individual autonomy should be one of several guiding principles, but that autonomy must be held in balance with health-care providers and the broader community. Throughout history, human civilization has been maintained by the individual-community balance, sometimes in tension but always necessary.
In the biblical book of Genesis, for instance, human dignity is related to individual autonomy, never separated from human relationship. The primary dignifying relationship for the human is his or her relationship with God, a relationship that is empowered by the fact that the human is created in the image of God. As the image of God, the human is an actual representation of the creator on Earth.
Human dignity is also derived from relationships with other humans who are made in the image of God. In fact, human dignity can be described in terms of the community of the entire human race, so that one might say that the image of God is made more complete as each human being is born.
When we make human dignity merely a matter of human autonomy, we risk devaluing the dignity of human community, and we neglect the importance of the individual as a member of a broader community that itself enriches dignity. Such a balance between the individual and the community safeguards against radical individualism like the type that we see expressed in the D.C. Death With Dignity Act.
Given that options and choices already exist in end-of-life care that are highly regulated by a larger professional and ethical community, the legislation is simply not necessary.
When we turn human dignity into merely a matter of human autonomy, we not only diminish foundational truths about dignity but we also deny the individual their rightful place within a broader human community. Although it is perhaps well-intentioned, the legislation would undermine human dignity by severing the vital connection between the patient and the broader community where they are loved, cherished and honored.
We urge this community to not cross to the wrong side of history by allowing the taking of human life by physicians.
Allen Roberts is professor of clinical medicine and an affiliate faculty member of the Pellegrino Center for Clinical Bioethics at Georgetown University. Scott Redd is president and associate professor of Old Testament at Reformed Theological Seminary, Washington, D.C. Their opinions are their own.