Monday, October 20, 2014

The Right to Die - Not A Black and White Issue




Wikipedia - The Right to Die

The right to die is an ethical or institutional entitlement of any individual to commit suicide or to undergo voluntary euthanasia. Possession of this right is often understood to mean that a person with a terminal illness should be allowed to commit suicide or assisted suicide or to decline life-prolonging treatment, where a disease would otherwise prolong their suffering to an identical result. The question of who, if anyone, should be empowered to make these decisions is often central to debate.

Proponents typically associate the right to die with the idea that one's body and one's life are one's own, to dispose of as one sees fit. However, a legitimate state interest in preventing irrational suicides is sometimes argued. Pilpel and Amsel write, "Contemporary proponents of ‘rational suicide’ or the ‘right to die’ usually demand by ‘rationality’ that the decision to kill oneself be both the autonomous choice of the agent (i.e., not due to the physician or the family pressuring them to ‘do the right thing’ and commit suicide) and a ‘best option under the circumstances’ choice desired by the stoics or utilitarians, as well as other natural conditions such as the choice being stable, not an impulsive decision, not due to mental illness, achieved after due deliberation, etc."


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Wikipedia - Assisted Suicide

Assisted suicide is suicide committed with the aid of another person, sometimes a physician.[1] The term is often used interchangeably with physician-assisted suicide (PAS), which involves a doctor "knowingly and intentionally providing a person with the knowledge or means or both required to commit suicide, including counselling about lethal doses of drugs, prescribing such lethal doses or supplying the drugs.”[2] Assisted suicide and euthanasia are sometimes combined under the umbrella term "assisted dying", an example of a trend by advocates to replace the word "suicide" with "death" or ideally, "dying". Other euphemisms in common use are "physician-assisted dying", "physician-assisted death", "aid in dying", "death with dignity", "dying with dignity", "right to die" "compassionate death", "compassionate dying", "end-of-life choice", and "medical assistance at the end of life".

Physician-assisted suicide is often confused with euthanasia (sometimes called "mercy killing"). In cases of euthanasia the physician administers the means of death, usually a lethal drug. Physician-assisted suicide (PAS) is always at the request and with the consent of the patient, since he or she self-administers the means of death.

Physician-assisted suicide is different from euthanasia. With physician-assisted suicide, the patient receives the medication and takes it on their own. With euthanasia, the doctor administers the lethal medication to the patient. According to several studies, more than half of the doctors polled have received requests from a patient wanting to end their life. The physicians are only allowed to prescribe the lethal medications in the states where it is legal, regardless of what the patient wants or the prognosis for their disease.

Discussion of assisted suicide centers on legal, social, ethical, moral and religious issues related to suicide and murder.


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Can A Christian Support “Physician-Assisted Suicide?”

by Roger Olson
October 18, 2014

Introduction

If you expect me to take a definite stand for or against Physician-Assisted Suicide (PAS) you will be disappointed. This blog is a place where I often reflect about difficult and controversial issues; I don’t always take a stand about them. One of my goals as a Christian theologian and educators is to help people think through doctrinal and ethical issues critically and reflectively but not always to a definite conclusion. I have been doing this within myself about the issue of PAS for years. And, as I age and face the possibilities inherent in that process, I increasingly wonder if this issue (PAS) is as black-and-white as many people, especially Christians, have thought.

What exactly is meant by PAS? Here I can only state what I mean by it. The concept has many variations. What I mean by PAS, and therefore what I am musing about, is this: A person in great suffering for which there is no available relief asks a medical professional to help him or her die in the quickest and most painless way possible. Usually in PAS the suffering person himself or herself performs the final act that immediately results in death. The physician only provides the means. However, in some cases, the physician must go further and actually use the means on the suffering person. This kind of PAS is legal in some countries and a few states—with many qualifications and safeguards against abuse.


Is Suicide a Sin?

Of course, a background theological issue, especially for Christians, is whether suicide is a sin. Most enlightened Christians, and others, will say it is at best tragic but only sin when done for purely selfish reasons and where there are other possible remedies for the emotional or physical trauma and turmoil not tried. Few enlightened Christians believe or argue that everyone who commits suicide is automatically thereby condemned to hell. That was a common medieval belief still held by only a few. The question this raises, however, is whether PAC, assuming it is a last resort, is a selfish act. One would have to ask the suffering person’s loved ones. In the kinds of cases I’m thinking about, all empathetic and reasonable loved ones would give their own right arms to see the person’s suffering cease.

So, in order to shed light on this difficult subject, it is helpful to state more specifically and clearly what kinds of cases I’m thinking of as possibly justifying PAS. Some years ago I read about an elderly mother of two adult sons who were both suffering a debilitating disease that rendered them completely paralyzed. (I remember the name of the disease; I’m just not mentioning it here to avoid a flurry of comments about it.) It was a genetic disease that often leads the person to a near vegetative state of tremendous pain and paralysis. There is no treatment for that pain and paralysis in the late stages of the disease. Her sons were confined to beds in a nursing home where she visited them daily. She watched them slowly suffering in great agony while unable to communicate let alone take care of their own automatic bodily functions. Finally one day she brought a pistol to the nursing home and shot both of them. The jury gave her ten years’ probation. I sympathized with that jury and with the mother even as I felt tremendously conflicted about her act of euthanasia.

As I have aged and I have had more contact with elderly people whose quality of life is extremely poor—down to nothing. Some people, for reasons of disease or age, come to the point where they have no quality of life. Medical provision has often kept them alive years beyond their ability to live a life of dignity and even relative physical comfort. I know elderly people who live with severe pain all the time and who cannot feed themselves or take care of their own bodies and who express the wish to die daily.

Self-Afflicted Death

Some years ago, of course, Dr. Kevorkian brought this issue to public attention in the U.S. by stepping across professional and legal boundaries to aid suffering people to commit suicide. I watched one television news “magazine” segment that focused on one of his cases. The patient was suffering the last stages (but with perhaps months to go before natural death) of ALS (“Lou Gehrig’s Disease”). The man had reached a stage where he could no longer move any part of his body except his eyelids and a finger and indicated that he was in tremendous pain that pain medicines alone could not alleviate. He requested Dr. Kevorkian’s assistance in ending his misery and Dr. Kevorkian complied by setting up a contraption the patient could use to push down a plunger to release a stream of poison into his bloodstream through an IV to which he was already connected. He died painlessly and quickly.

Some patients simply choose to forego all treatments for their terminal disease and die naturally. Usually this also involves gradually starving to death or dying by dehydration. It can take weeks. Few people blame them or even call it “suicide.” And yet, in a way, it is suicide.

Benevolent Common Practice

Some years ago I had the privilege of teaching nurses in several cohorts in a “degree completion” program. My course, which they were required to take as part of their studies, was called “Developing a Christian Worldview” and included a unit on Christian ethics. We talked about the ethical issues surrounding death including suicide. One thing that struck me was that almost all the nurses who worked in hospitals agreed that PAS is quite common. They said that in many terminal cases a doctor will order pain medicine in gradually increasing doses that eventually suppress breathing. And that so long as the doses are necessary to alleviate pain, even if they result in death, most district attorneys will not prosecute the doctors or nurses involved. They said it is one of the best kept secrets in the medical profession—given how common it is.

And yet we criminalize the same practice if it is done earlier than that and outside the context of a hospital [or home-based hospice care]. What sense does that make? Okay, well, the legal argument is that injecting someone with a dose of pain medicine strong enough to suppress breathing is not PAS so long as the intention of the act is only to relieve pain. But how different is that from other PAS the intention of which is only to relieve otherwise unrelievable pain? "Greyness" surrounds the issue at such a point.

Conclusion

I do not have all the answers to this, but I believe it is worthy of renewed discussion both among ethicists and lawmakers:

(1) First, can PAS ever be ethically justified? Let’s not begin with the worst case scenarios in which it might be abused to kill people without their consent. That’s not even in consideration here. Let’s start with the worst case scenarios of people in tremendous suffering that cannot be relieved any other way than PAS.

(2) Second, can laws be crafted that absolutely de-criminalize PAS that also guard against abuses?


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Amazon link. May 2012
Publication Date: May 2012

Death is inevitable. But bad deaths those accompanied by unnecessarily prolonged pain and suffering, often aggravated by immensely costly and frequently futile medical treatments, can be avoided. This book explores the pioneering, highly pragmatic and practical work carried out by the international death-with-dignity movement over the last forty years to eliminate the last bad death. It offers clear and valuable examples of how, through frank communication with caregivers and loved ones and the use of Advance Medical Directives such as living wills, those who are facing the possibility of death in the foreseeable future, and those who help them cope, can greatly minimize or eliminate end-of-life turmoil, family dissention, and pain. It also proposes a comprehensive rethinking of end-of-life-care assumptions and a realignment of strategies to create a caring continuum to meet the rapidly expanding demands for death with dignity in the coming years.

Richard Cote' based this unique book on five years of intensive primary source research and more than one hundred in-depth interviews with death-with-dignity pioneers, activists, physicians, nurses, hospice workers, and their patients on four continents. It is written in narrative style for a general audience and intensely documented for the scholar. It illuminates the subject using 92 images and twelve hyperlinks to exclusive YouTube video interviews with death-with-dignity leaders worldwide. It explores the modern history of the death-with-dignity movement through the lives of its founders, leaders, and activists. Using personal case histories from around the world, it also portrays the often heart-breaking conflict between the final wishes of those who are living or dying in pain and the religious, medical, and laws which force them to spend their last days, months, or even years in avoidable pain and suffering against their clearly-stated will.

Drawing on the most recent scientific and medical information, it also describes the rapid evolution of legal, dignified, readily available, painless methods which the tortured and the dying can use to hasten their own death without assistance, in the company, if they choose, of their friends and loved ones.

PLEASE NOTE: this 379-page book replaces and updates Cote s 42-page 2008 technical booklet (now obsolete and out of print) titled In Search of Gentle Death: A Brief History of the NuTech Groupan end-of-life technology development organization. All of NuTech s work is now described fully in Chapter 6 of this new 2012 book.


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Amazon link. April 2000
Publication Date: April 2000

The strength of the right-to-die movement was underscored as early as 1991, when Derek Humphry published Final Exit, the movement's call to arms that inspired literally hundreds of thousands of Americans who wished to understand the concepts of assisted suicide and the right to die with dignity. Now Humphry has joined forces with attorney Mary Clement to write Freedom to Die, which places this civil rights story within the framework of American social history.

More than a chronology of the movement, this book explores the inner motivations of an entire society. Reaching back to the years just after World War II, Freedom to Die explores the roots of the movement and answers the question: Why now, at the end of the twentieth century, has the right-to-die movement become part of the mainstream debate? In a reasoned voice, which stands out dramatically amid the vituperative clamoring of the religious right, the authors examine the potential dangers of assisted suicide - suggesting ways to avert the negative consequences of legalization - even as they argue why it should be legalized.


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Amazon link. Fiction. April 2012
Publication Date. April 2012
Category: A Novel

While guarding an activist from an assassin, Cuddy makes himself the target

To impress his girlfriend and remind himself of his long-neglected athleticism, John Francis Cuddy is training to run the Boston marathon. But the private detective’s fitness regimen goes on the back burner when an old friend approaches him with a dangerous assignment. Euthanasia advocate Maisy Andrus has been receiving death threats, and the police are helpless to protect her. As he tries to keep the crusading lawyer alive, Cuddy realizes that the question isn’t who wants Andrus dead, but who doesn’t.

Protecting the right-to-die advocate dredges up painful memories of Cuddy’s wife, who died a slow death from brain cancer. The closer he gets to unmasking the would-be assassin, the more his old wounds open. When the killer starts taking potshots at him, as well as his client, Cuddy’s marathon training will come in handy.



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