Earlier this month, Washington State released its report on the first 10 months of its brand-new assisted suicide law. You can read a pretty typical press account at this NY Times link.
However, neither the Times nor most of the media gets at some of the troubling information that emerges from this report – limited as the information is. The best analysis I’ve read so far is at Bad Cripple, the blog maintained by Bill Peace.
Here’s an excerpt from his analyis and comments from his blog essay “Assisted Suicide in Washington: Death Toll 36“:
Why are people choosing to die? Here is where we get into why assisted suicide is so dangerous. I am opposed to assisted suicide as are many others with a disability (though not all) because of the reasoning involved and justifications used to make it legal. So, why did people choose to die in Washington: from the executive report.
Table 3. End of Life Concerns reported from the After Death Reporting From. Data is available for 44 of the 47 participants in 2009 that died.
- Losing autonomy, 100%
- Less able to engage in activities making life enjoyable, 91%
- Loss of dignity, 82%
- Losing control of bodily functions, 41%
- Burden on family, friends/caregivers, 23%
- Inadequate pain control or concerns about it, 25%
- Financial implications of treatment, 2%
I am not terminally ill but have experienced or felt every single one of the above feelings. I do not have the ability to walk and hence have lost some individual autonomy in certain circumstances. There are activities I once enjoyed that I can no longer do that made life enjoyable. I have lost a degree of dignity. I am certainly socially inferior, less dignified, to those who are bipedal. I have lost control of many bodily functions. I do worry about being a burden to my son when I am old. I do worry about the financial implications of my disability. I would be a fool if I thought otherwise considering that I am sitting on a $400 wheelchair cushion designed to last two years at most (insurance does not cover such luxuries). I have in the past experienced gut wrenching pain that made me wish I was dead. Yet here I sit at my desk and cannot help but be perplexed. Why does my crippled body command so little respect. Why is my existence so easily called into question?
Please go and read the rest of the blog entry here. –Stephen Drake
There it is: AUTONOMY. For years, that’s #1 for me and I’m never the only one.
Stephen: I appreciate your post but would offer two important clarifications re the “End of Life Concerns” list you cited.
First, you must be terminally ill – 6 months or less – to potentially qualify for assisted dying in Washington (or Oregon, and I am also assuming Montana though I have not read their statute).
Second, the EOL concerns you quoted are presumably a CONSEQUENCE of said terminal illness and never independent grounds for suicide, assisted or no.
I find two things particularly and paradoxically interesting about the public argument over physician-assisted dying. First, the anti-PAS position correctly shows that the statutory safeguards designed to deny impulsive or depression-fueled decisions are flawed. Patients so inclined can easily ‘shop’ for a doctor & psychiatrist sympathetic to their desires. But secondly, although there remains demonstrable public support for assisted dying rights in many areas of the country (remember Oregon passed and upheld their law by referendum), the longitudinal evidence clearly shows that the overwhelming majority of terminally ill in Oregon (where the law has been in effect for 13+ yrs) do NOT choose to avail themselves of the option. The annual number over 12+ years in Oregon is stil around 40, with the vast majority of these individuals being caucasian, highly educated, and carrying health insurance with hospice benefits. So the centrist pro-PAS crowd is correct on their stance that assisted death is a option of last resort and not the preferred method of palliation at the end of life nor fueled by racial inequities or the lack of education or health insurance.
Advances in palliative care and hospice have clearly obviated the need and subsequent desire for terminally ill individuals to actively end their lives; or at least, with authorized pharmaceutical assistance.
Disability rights advocates make important and persuassive arguments regarding the sanctity and value of life regardless of circumstance. And the overwhelming number of dying individuals affirm your position; that is, they don’t choose to end their lives, legally or otherwise. However, I would suggest that in those rare instances where an actively dying individual is experiencing intractable physical pain and wants to die, assisted death in such an instance bears little in common with what we usually consider to be “suicide,” nor would legally honoring such a request justify fears of an impending ‘slippery slope.’ I believe this entire debate would greatly benefit from a clear and mutually agreeable distinction between “disability” and “terminal illness.” Certainly the latter often includes the former but the former does not imply the latter –nor should any law. I may be hopelessly naive but I feel that there is room for a middle ground agreement on this issue.
Just my two cents. Thanks again for your post & website.
Okakura,
First of all, it might be a good idea to ask assisted suicide proponents to try to make some kind of clear distinction between “terminal” and “disabled.” If you read the mainstream reaction to the Final Exit Network by Compassion & Choices, they focus on the means used to help people commit suicide and the lack of professionalism. They steer clear of criticizing them for the “nonterminal” aspect of their activities.
Also, there *is* an unavoidable group of people in the gray area. What about a diabetic who needs daily insulin shots? Someone on dialysis? Someone with quadriplegia who has been on a vent for 20 years – aren’t they “terminal” if they go off the vent?
It’s nice to think that people draw clear lines between ill/disabled/terminal, but human beings don’t really think like that – we form associations. The feelings of “being a burden” and “loss of autonomy” are common in many elderly people – and Oregon has a high elderly suicide rate. Part of that may just be they’re seeing their own devaluing of their lives as age creates its inevitable changes – and figuring those feelings are a justifiable reason for suicide.