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Voting About Life and Death (John Ballard)

In the interest of full disclosure I should say that my position of beginning-of-life and end-of-life issues is that in most cases it's no one's business but that of the family and whatever professionals they solicit in making those decisions. "Beginning of life" means everything from contraception to viability (in the case of an unborn baby) and "end of life" means whenever an individual or their designated agent for medical decisions decides that death is or should be eminent. These limits are subject to legal and/or criminal considerations but respecting a profound diversity of social and religious opinions there must be a bright line protecting private decisions from what various faiths and society might deem normative for everyone. 

Considering mankind's history of wanton killing of one another, matters of life and death should be way down the list of inflammatory subjects. But I suppose since those two realities are universal to the human condition, we are prone to personalize them more than any other experience. There cannot be one without the other. Having said all that, I can now link to a post at The Health Care Blog discussing briefly a ballot issue to be voted on tomorrow in Massachusetts, The Massachusetts Death With Dignity Act.

As described by the state secretary, “This proposed law would allow a physician licensed in Massachusetts to prescribe medication, at a terminally ill patient’s request, to end that patient’s life. To qualify, a patient would have to be an adult resident who (1) is medically determined to be mentally capable of making and communicating health care decisions; (2) has been diagnosed by attending and consulting physicians as having an incurable, irreversible disease that will, within reasonable medical judgment, cause death within six months; and (3) voluntarily expresses a wish to die and has made an informed decision.”

There are, of course, a number of other safeguards built in, such as the need to make the request twice, separated by 15 days, in the presence of witnesses. However, there could probably be stronger safeguards to protect individuals who are experiencing depression and anxiety, and might have preferable alternatives to physician-assisted death.

Oregon and Washington State have already enacted legislation commonly called "assisted suicide", apparently with little evidence of abuse. One commenter at the link made the point that…

It’s really interesting how close the outcome was in Oregon back in 1994: 51.3% in favor, 48.7% against. Then 60% were against repeal in 1997.

Last year one of my high school classmates killed himself after being diagnosed with cancer which had by then metastasized. Prior to his death he took care of as many details as he could to help his wife after he was gone. Although they lived in Oregon I am told he opted to use a gun, outdoors in the back yard while lying on a towel, perhaps to minimize cleanup. His son told me his father was aware of the "cocktail" which is available in Oregon. He commented that it was comforting to know that the option was available. There is no way to know why he opted for a gun, but it may have been fear that a drug would prolong the dying experience. 

 

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4 responses to “Voting About Life and Death (John Ballard)”

  1. Ruchira

    Good points, John. I admire your friend’s courage.
    Recently, a friend’s husband who had lived in an assisted care facility for many years (the friend had an apartment on the premises and she was with him for most of the day) for advanced Parkinson’s Disease, requested palliative hospice care and discontinued all prescription meds he had been taking. His condition, already precarious, deteriorated further. But he said he was relieved. After a few weeks, he explained to his family that he no longer wished to live such a severely diminished life. He then went on a no-food-no-water fast. He died nine days later. It took a lot of physical and mental courage to go through with such a protracted dying process. The family is sad but at peace with his decision.
    As I grow older and see my friends age, “Death With Dignity” sounds as wonderful as the next miracle drug!

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  2. John Ballard

    No food or hydration can be a very long death. One can only hope that somehow the mind is strong enough to regulate the rest of the body in ways that make the process more endurable. Something tells me that it may be so.
    When my father had a stroke it made him into a different person — unable to use language (though he could babble and display a range of emotions) and crippled on the right side in the manner of many strokes. Because he had no desire to eat someone made the decision to give him nutrition with tubes, first through the nose, then later with a PEG attachment. He lived in that condition almost another year, during which time my mother was with him daily the entire time, basically serving as second-shift care-giver. I decided at the time I wanted nothing of that nature to happen to me. It is part of my advance directives that if I am not able to participate in my own nutrition that is a sign that it is time for me to be allowed to go.
    That way out can take much longer than many people imagine. Following a massive stroke in his early eighties my Dad’s older brother was left comatose. The family wisely decided to allow him to pass as he lay. I don’t think he showed any sign of discomfort. They said he looked like he was sleeping. His body took sixteen days with no food or hydration to finally die. I have mentioned this story to a couple of hospice nurses I have met in my care-giving assignments and they are not at all surprised.
    In cases such as these I see no reason for any measures that hasten death. Thanks to the details of the legislation that would not be an option anyway since the subject must be his own pro-active agent setting the process in motion.

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  3. Elatia Harris

    A haunting topic to be sure, and the older I get, the more embodied the haunting! When I read these stories I cannot but reflect that, at the precise time you know you need to die sooner than later, and can embrace that as a deliverance, you must have your wits about you so completely that it might be more rational to live. I can think now of all sorts of problems that would make me strongly prefer an end to life over enduring them, but I cannot be sure of my feelings in that moment — can anyone? In my teens, assisted suicide was a a non-starter of a topic — really un-American. There was a lively debate at that time in England, however — should it be legal and voluntary? It should be voluntary with no legal consequences to any helper or physician involved, many Brits then believed. An aged woman, A Dame of the British Empire, an activist for elder affairs whose name I have forgotten, made the most cogent remark of anyone, to my hearing. It would be fine if medically assisted suicide were voluntary, she opined, but, human nature being what it is, it wouldn’t be voluntary for very long. I am old enough to see her point even more vividly now.

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  4. John Ballard

    In my post-retirement job as senior care-giver I have seen enough dementia and Alzheimer’s to conclude that the word “voluntary” sometimes loses all meaning. That is why I have become evangelistic about promoting advance directives any chance I get.
    A properly executed and witnessed advance directive for medical care should be part of everyone’s medical records, readily available to family and medical personnel, with at least three designated agents who know who they are, all of whom have agreed to that responsibility. This is a tall order, but I am an admitted extremist in this matter. In fact, this should become obligatory for all Medicare beneficiaries and updated no less than every five years.

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