'Death
With Dignity' Claims Another Victim by Paul McHugh
May 24, 2013
edition of The Wall Street Journal
Now Vermont
has joined the misguided movement toward physician-assisted suicide. Nearly 30
years ago, Arnold
Schwarzenegger's "Terminator"
character made famous the phrase "I'll be back," the implacable
cyborg assassin's response to a setback. Today, similarly relentless
terminators are among us, also with a deadly mission: to move America toward
acceptance of physician-assisted suicide.
On Monday, the terminators gained a victory when Vermont
Gov. Peter Shumlin signed into law the "Patient Choice and Control at End
of Life Act." The bill had been passed by the state legislature the week
before without consulting the electorate, possibly because the lawmakers had
seen what happened last fall next door in Massachusetts, where voters rejected
a similar initiative. Now Vermont doctors will be able to prescribe lethal
medication to patients as the state joins Oregon, Washington and Montana in
supporting the practice.
So the terminators are back. The reasons for opposing them and opposing
physician-assisted suicide never went away. The reasons have been with us
since ancient Greek doctors wrote in the Hippocratic oath that "I will
neither give a deadly drug to anybody if asked for it nor will I make a
suggestion to that effect." The oath is a central tenet in the profession
of medicine, and it has remained so for centuries.
Dr. Leon Kass, in a brilliant
essay on the Hippocratic oath in his 1985 book "Toward a More Natural
Science," explains why this has been true. Medicine and surgery, he says,
are not simply biological procedures but expressions, in action, of a
profession given to helping nature in perpetuating and enhancing human life.
"The doctor is the cooperative ally of nature," Dr. Kass writes,
"not its master." It shouldn't need saying, but the exercises of
healing people and killing people are opposed to one another.
Traditionally
the public rests its trust in doctors on this understanding of medicine.
Doctors occasionally remind the public of it when they explain why they do not
participate in capital punishment or bear arms in military service. But the
terminators who champion physician-assisted suicide propose that, as seen in
intensive-care units, contemporary medicine prolongs unnecessary suffering.
As a psychiatrist, I work with
doctors on such units, and I can testify that all of them realize that human
life itself is limited in duration and scope. These doctors regularly consider
just how far they should go in sustaining a hope for recovery—cooperating with
nature's resilience in treating advancing disease. They also consider when
prolonging a futile effort should be replaced by comforting the person as his
life naturally comes to an end. The judgment is delicate, though, and most
families are justified in leaving it to skilled physicians.
Another argument for physician-assisted suicide is that
many patients with cancer live too long in pain. The suffering could be reduced
if their legitimate wish for death were fulfilled. These are the arguments
pressed by Dr. Timothy Quill and many in the Oregon "death with
dignity" group.
But scientific publications from oncologists such as
Kathleen Foley, who studies patients with painful cancers, reveal that, quite
to the contrary, most cancer patients want help with the pain so they can
continue to live. Suicide is mentioned only by those patients with serious but
treatable depressive illness, or by those who are overwhelmed by confusion
about matters such as their burden on loved ones and their therapeutic options.
These patients are relieved when their doctors attend to the sources of their
psychological distress and correct them.
In the nearly two decades that Oregon has permitted
physician-assisted suicide, I became suspicious that just such depressed and
confused patients number large among those who ask for and take life-ending
poisons. Why suspicious? Because the law does not demand a psychiatric
assessment before they take the fatal step. Yet all efforts by psychiatrists
anxious to read the medical charts of these patients after their deaths have
been thwarted by the champions of their suicides, who have shrouded the
patients' mental states in secrecy by raising the "privacy
privilege." I believe that these doctors are killing patients of the sort
that I help every day.
And then there is this talk about "death with
dignity," as the Oregon and Washington laws are titled. Surely what we
want is "life with dignity."
Seeking life, we're ready to endure much in order to keep it going. Think of
the life-saving and life-preserving colonoscopy—all dignity drops with your
trousers.
The advance of the hospice movement has made a shambles
of the terminators' insistence that medicine prolongs suffering and denies
dignity. The doctors, nurses and social workers committed to hospice care
demonstrate how an alliance with nature at life's end plays out in just the way
that the medical profession intends. As hospice ways become more familiar, the
public can overcome the fears that the terminators used to win over the Vermont
legislature.
For you see, the
terminators ultimately are not merely interested in killing people who are
suffering the throes of a final
illness. They have even others in mind, as history tells us. The drive to
allow doctors to "assist" in suicide is not recent. Its roots are in
the Progressive era of the early 20th century, when many Americans placed utter
confidence in reform and in technocratic elites. Then the enthusiasts for
euthanasia lined up with those clamoring for government intervention in the
name of eugenics and population control.
Across the decades, Americans have fought off such dire
temptations with reasoned arguments about the nature of medicine. Despite
Vermont's unfortunate decision, Americans elsewhere likely will continue to
defeat physician-assisted suicide at the ballot box and in the statehouse. But
the enemies of life are terminators—they'll be back.
Dr. McHugh,
former psychiatrist in chief at Johns Hopkins Hospital, is the author of
"Try to Remember: Psychiatry's Clash Over Meaning, Memory, and Mind"
(Dana Press, 2008).
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