By RICHARD T. HULL
Special to The News
The current debate over physician-assisted suicide has focused on the pain of the terminally ill.
Proponents argue that patients should be able to choose a quick and painless death over a protracted and agonizing one. Opponents argue that the hospice approach and adequate medication can keep terminal patients pain-free.
One irony is that both sides are correct. Another is that their argument evades the more troubling parts of this issue.
Pain is not the only reason people want physician-assisted suicide.
My mother died of Alzheimer's disease. The person I had always known as "my mother" had "died" some years before--died when she no longer recognized members of her family, died when she had small strokes that robbed her of her dignity by robbing her of her inhibitions, died when she was seized by paranoia and became a thief of others' belongings that she thought were her own purloined things.
My father's best friend Frank also died of Alzheimer's disease. At least, I guess he died: He was locked away, raging, in a straight-jacket, years ago. My father would go to visit him and come home in tears because Frank would beg to be released, but then he would lash out, kicking and biting and raving, when his caretakers approached.
I live in fear that I may face the same fate. I anxiously note every occasional lapse of memory, wondering whether that's the first step dismantling my personality, transforming me from a caring, nonviolent person to a caricature of myself, or, worse, to a dangerous burden on my family and society.
I have already had a brain scan to get a baseline against which the rate of tissue loss can be measured.
I practice counting backwards from 100 in sevens.
Framing the debate about physician assisted suicide in terms of pain doesn't touch my concern.
It doesn't touch the quadriplegic who finds life in a wheelchair unfulfilling.
It doesn't address the worries of the Parkinson's disease patient in the middle stages of his disease who finds movement progressively difficult, or the fears of the individual who learns he has ALS or Lou Gehrig's disease.
It doesn't address the quiet despair of thousands of Americans who face protracted lives of unacceptably poor quality for irreversible medical reasons.
And it doesn't address the genuine concerns of those elderly who have worked
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hard and saved to leave a legacy to their children, only to see it eaten up by expensive treatments in a system dedicated to prolonging life for the sake of the prolonging.
Janet Adkins was a person who, in the early stages of Alzheimer's decided not to put herself or her family through the later stages. She approached Dr. Jack Kevorkian, a retired pathologist who had written in blunt language about the need for patients to be able to elect the time and means of their death. After some months of requiring her to consider alternatives, he consented to assist her.
On June 4, 1990, in a 1968 VW camper parked in a public campsite in Oakland County, Michigan, Janet Adkins initiated a sequence of valves and switches that first delivered an anaesthetic and then a fatal dose of potassium chloride through a needle in her arm. Her heart, depolarized by the KCl, stopped at 2:30 p.m.
A woman not terminally ill, not suffering in painful agony, had elected to die with the assistance of a physician in order to avoid terminal illness and its indignities. She made her choice while she was still competent, still able to assert that the values prompting her decision were genuine and authentic.
Does it ever make sense to restrict physician-assisted suicide to those who are still competent? Suppose I want to live my competent life to the fullest and then have it over with when my capacity to act with concurrent free and informed consent has departed.
Why shouldn't I be able to empower my physician to act when I can no longer do so, act so as to bring a life I have carefully, previously judged to be no longer worth living to a speedy end?
I am aware of the fears many have that physician-assisted suicide will lead to involuntary euthanasia. I think those fears are groundless, provided we are clear about what constitutes the legal and adequate reasons for physicians to act in assisting suicide.
The reason must be a persistent wish to die, stated by a competent individual who seeks to avoid the evil of a protracted death or a life whose capacities are diminished to a degree unacceptable to that individual.
The debate that focuses only on the pain of the terminally ill does not address all the circumstances that prompt people to consider physician-assisted suicide.
Like it or not, the problem is not only pain.
(Inset that was in original text)
What about the
still-competent person
who asks not to be
forced to endure the
destruction of
personality that comes
with Alzheimer's - or
the painful last downhill slide of
Parkinson's or Lou
Gehrig's disease?
(Original article reformatted)
RICHARD T. HULL teaches philosophy at the University at Buffalo and is a specialist in medical ethics. |