Art Caplan has an opinion piece that came out yesterday – and it’s linked from just about every conceivable place on NBC and MSNBC. It’s an endorsement of the proposed legalization of assisted suicide on the ballot in Massachusetts. While disappointing, it’s not that big a surprise; Caplan has been sliding toward this unqualified endorsement of legalized assisted suicide for several years.
I’ve long had mixed feelings about Caplan. He can write some insightful analysis and even show a willingness to break from the ranks of fellow bioethicists as he did in at least two instances – the so-called “Katrina killings” at Memorial Medical Center in New Orleans during Hurricane Katrina and in his criticism of the so-called “Ashley Treatment.” And, while he’s ended up on the same side as disability activists in some instances, he’s never given us more than a casual mention, at least in anything I’ve read. I know he reads this blog occasionally, so he gets information on disability rights activism and advocacy from here when he does stop by.
As I’ve said, Caplan produces some excellent analysis at times. Other times – as in his latest effort – I get the feeling he more or less “phoned it in.” By that I mean that he provides nothing more than very superficial statements and arguments with few concrete facts. That’s exactly what he does in his latest, an endorsement of legalized assisted suicide, and it’s little more than a reproduction of the talking points assisted suicide advocates are using right now in Massachusetts.
Here’s an excerpt:
The proposed Massachusetts law is very restricted and contains important safeguards. Experience in other states shows little reason for worry about abuse or misuse. Instead the more people who are going to die know they can end their lives sooner if they choose, the more many of them fight harder to live.
Even the editorial board of the Oregonian had questions about the glowing reports of the success of the safeguards as they stated in September of 2008 (editorial is unavailable except through paid archives):
On the negative side, Oregon’s physician-assisted suicide program has not been sufficiently transparent. Essentially, a coterie of insiders run the program, with a handful of doctors and others deciding what the public may know. We’re aware of no substantiated abuses, but we’d feel more confident with more sunlight on the program. (Emphasis added.)
I have not said much about the potential abuse of “death with dignity” laws. I have no special reason to believe there are serious abuses in Oregon and Washington, or that there need be any in Massachusetts, but we will never really find out if there is. The potential for abuse that most worries me is the legitimization of suicide, whose numbers are now rising. There are all sorts of reasons for people of all ages without terminal illness to want to get rid of their unhappy lives. They should not think that suicide is an acceptable and rational way to cope. Beyond that, I cannot see any good that can come of legalization of PAS. “Choice,” that all-purpose value word these days, used by the liberal left and the market right, is not a good enough reason to change some deep and valuable traditions of the doctor-patient relationship.
You can read his entire article on The Hastings Center’s “Over 65 Blog.”
Caplan’s sloppiness doesn’t stop with that small item. Making one of his rare references to disability groups, he makes sure to pair us with the “usual suspects”:
Some disability groups and religious organizations are fighting hard to get a “no” on the “Question 2,” initiative as well. They believe that the terminally ill who are disabled deserve better palliative care and emotional support rather than a prescription of deadly medicine. They also worry that people may feel compelled or coerced into choosing death because their care is expensive, they see themselves as a burden to others or because relatives are thinking that they do not want to spend the grandchildren’s college tuition to keep grandpop going in a nursing home or ICU. Given the current push to contain medical costs, the biggest fear is that the vulnerable will get the bum’s rush to the hereafter. (Emphasis added.)
A little later he adds this “straw man” version of concerns of opponents of assisted suicide:
The critics are worrying about a shift to mass suicide inspired by heartless doctors and families pressuring dying patients to end it.
As luck would have it, there are several disability-centric related critiques of assisted suicide that have been published lately. Just today, the NY Times published an op-ed by Ben Mattlin titled “Suicide by Choice? Not So Fast.” Here’s an excerpt, relating some concerns – the real concerns upon which Caplan built his Straw Man:
I was born with a congenital neuromuscular weakness called spinal muscular atrophy. I’ve never walked or stood or had much use of my hands. Roughly half the babies who exhibit symptoms as I did don’t live past age 2. Not only did I survive, but the progression of my disease slowed dramatically when I was about 6 years old, astounding doctors. Today, at nearly 50, I’m a husband, father, journalist and author.
Yet I’m more fragile now than I was in infancy. No longer able to hold a pencil, I’m writing this with a voice-controlled computer. Every swallow of food, sometimes every breath, can become a battle. And a few years ago, when a surgical blunder put me into a coma from septic shock, the doctors seriously questioned whether it was worth trying to extend my life. My existence seemed pretty tenuous anyway, they figured. They didn’t know about my family, my career, my aspirations.
This is but one of many invisible forces of coercion. Others include that certain look of exhaustion in a loved one’s eyes, or the way nurses and friends sigh in your presence while you’re zoned out in a hospital bed. All these can cast a dangerous cloud of depression upon even the most cheery of optimists, a situation clinicians might misread since, to them, it seems perfectly rational.
Just yesterday, The Phoenix – a Boston weekly paper – published a long article by S.I Rosenbaum, titled “Killing with kindness: Why the Death With Dignity Act endangers people with disabilities.”:
I think my opinions about doctor-assisted suicide crystallized the night Mike — my wheelchair-using, ventilator-breathing boyfriend — choked on pineapple juice, passed out, and died.
He was dead for several minutes, on a steel table in the ER. The doctor shocked the pulse back into his heart and dropped him into an induced coma, but it still wasn’t clear whether he would make it. As I stood by his bedside, shaking, one of the nurses touched me on the shoulder.
“Maybe it’s better this way,” she murmured.
I’ll never forget that moment. We’d been watching a movie together a few hours before. We had plans to go clubbing. Maybe it’s better this way?
I’m not a violent person, but I wanted to punch that lady in the face.
When I started going out with Mike, I thought that prejudice against people with disabilities was something we’d left behind along with Jim Crow and sodomy laws. I was shocked, again and again, to find that I was wrong. So wrong. Everyone I met had ideas about what it must be like to date Mike — that we never went out, that we couldn’t have sex, that I must have to take care of him all the time — that were so false as to be laughable. We did laugh at that stuff. We had to. But for every person who came up to us to congratulate Mike on his “bravery” in taking a trip to the mall, there was someone who actually thought he’d be better off dead.
Some of those people were doctors.
I defy anyone to interpret anything in either of those articles as saying there’s a great fear from “heartless doctors.” (There are some outright bastards out there, but that’s not the real issue) The real issue is the fear of medical professionals wanting to be “compassionate” based on what they believe about our lives.
I can already hear Caplan and others voicing objections – saying that assisted suicide legislation is limited to people who are “terminally ill.” We’re just being paranoid.
No. We’re informed.
The organizations pushing legalization of assisted suicide are sophisticated and well-funded. And, like many advocacy organizations, they are following an incrementalist strategy in terms of their policy goals. Through polling, focus groups and experience, they’ve developed a vocabulary about these topics that draws a favorable response from the public. And, for the moment, the more “respectable” groups are sticking to policy that is allegedly limited to people who are “terminally ill.”
But the signs of more expansive “advocacy” are already in evidence. The assisted suicide vigilante group Final Exit Network (FEN) facilitates the suicides of old, ill and disabled people and makes no secret that they don’t limit their “eligibility” to “terminally ill.” Think of them as the Tea Party arm of the “Right to Die” movement (and, no, that’s not a compliment). Their activities and agenda clearly involve people with disabilities. Recently, Derek Humphry (Hemlock Society co-founder, FEN advisor) sent an email to his “right to die” email list announcing a chapter of FEN was opening in Oregon, where they will do the kind of “underground” assisted suicide the “legit” advocates claimed that the law would prevent.
Meanwhile, the “legitimate” group Compassion and Choices is engaging in a campaign to promote the “death with dignity” of elderly people who are just plain tired of living through “VSED” – voluntarily stopping eating and drinking. They are successfully enlisting hospice and palliative care professionals to facilitate the process. Ironically, Caplan recently published an article in The Lancet about the death of a man who had horrible bed sores and refused to let staff move him to try to help the sores heal. Caplan thought a case like this – which ended in the man’s death – deserved a discussion of the limits of autonomy, the effects on medical professionals, and the effect on patient care over time. Frankly, I think that the program by C & C is much more deserving of that kind of conversation, as they are actively engaging a growing body of palliative care practioners to become comfortable in playing a role in the deaths of people who are simply old and say they don’t want to live any more. That is going to have a much more far-reaching range of effects than the one individual who wanted his bed sores left untouched.
But questioning the effect of an effort like C & C’s would mean inviting the retaliation of a large and powerful advocacy group. That’s probably farther than a certain bioethicist is willing to go. Maybe he’ll just wait until they’ve pushed agenda and it’s viewed as acceptable by the public and the medical profession. Then he can write and tell us that it’s all ethically OK – and use their talking points to do it.