In the Spirit of Collegial Inquiry...

updated: 24 Dec 98

The Right to Die and the Right to Live

LM:   Due to intense guilt feelings about being in lurk mode for a few (well..maybe more than a few) months, I've decided to open up a potential topic for discussion. Besides, I just finished grading 100 finals and figuring up final grades, and so have a little breathing room for the next 6 weeks. First, I'd like to put in my two cents worth regarding lurkers and why we do it. It has always struck me, on this and other list serves, that the people who are most likely to write in are people who, for one reason or another, are spending a lot of time at home. For example, students, stay-at-home Moms, people who are retired or disabled, etc. On the one hand, these are the people who perhaps are most in need of intellectual contact with others. Also, I think that these people simply have more time. I'd bet that the time factor makes up about 95% of the reasons for lurking.

As for the topic I want to introduce for discussion ... has anyone been following the right-to-death news regarding Kevorkian? At one point I had a strong interest in the subject, and did a lot of reading. Although many people seem to approach the subject from a religious point of view (wince), I am very much against physician-assisted suicide, but for humanist, and NOT religious reasons. My primary reason is that I think that the only reason anyone would choose suicide is because of physical discomfort, which should (and I believe, can be) handled by proper hospice care. My fear is that for political reasons, this country is shifting toward euthanasia because it is a cheaper alternative to proper medical care. And I think that the target of most euthanasia tends to be women, because they make up a larger percentage of the elderly.

Also, on one last note, I want to mention something about the right-to-die literature that is published by the Hemlock society and the people associated with it (such as Derek Humphrey). I read much of it years ago, and was really struck by how the individuals who were requesting physician assisted suicide seemed to regard their suicides not as a dignified end to a life well-lived, but as an escape from a less than perfect existence. I'm thinking here in particular of Ann Wicks' parents, who were not in pain, but were not as mobile as they had been, and were facing life in a nursing home. I realize that most of the argument for physician-assisted suicide is focused on unbearable pain, but it seems to me that if people are in unbearable pain, we need to care for them, rather than helping them to die. Well....that's my contribution to the dialogue. I hope that it sparks considerable debate!!

CW:   One thing we might want to keep in mind is that it isn't really any of our business (even if the person being euthanized owes me money) what an individual does with their body. People do things sometimes for dumb reasons but that is part of their own learning process. I am assuming of course that there might be some consequence to the person dying based on how they live their life (as the whole process of dying itself is part of living). If not, then it is not only none of our business but doesn't matter - there are fundamentally no consequences to our actions in such a scenario. So, I can't see why anyone would need to apologize to anyone else for how they choose to go. What I see with the Hemlock society is people who are living making excuses for helping other people die which might just be an attempt to cover their ass by legitimizing it or might be more than that. The fact is antidepressants are a great way to commit suicide if you are very seriously ill - and many people choose to quietly euthanize themselves in this way - with a doctor's help of course. It is very underground but very prevalent. The thing about Kevorkian etc is that they are simply making this underground activity more public as well as making a path for others to less ostentatiously follow. Whether it is a good idea depends on the individual case. In some instances one may not be able to make one's wishes known. Interestingly enough the Indian guru Naropa taught his students not only how to die at will but also how to help others release themselves from their physical bodies when they wanted to go. This knowledge was also known to some of the Native American shaman - one explorer (name forgotten, sorry) wrote about watching a contest in northern Canada in the late 19th century where two shaman did a sort of psychic wrestling match and one of them dropped dead on the spot after a certain amount of struggle. Unfortunately, this culture's crippling "certainty" that nothing beyond the limited awareness we currently possess is possible will most likely make it difficult for people let go of their bodies when they want to. This cultural attitude also makes it very difficult for people to maintain their bodies as they want as well - we are very much held hostage to the aging process even if we engage the latest research to extend the healthy portion of our lives.

EM:   since I have been the chief whiner about lurkers, no reason to quit when I'm on a roll, so I will extend my prior comments. It has been my observation throughout life that people always have time for whatever it is they want to do. When I was young and sex meant something to me, if I had to be at Times Square this Saturday night at midnight to meet an especially engaging inamorata, I would be there if the snow was 2 feet deep, and I had to borrow the money from Rose Shanis loan sharks at 36 percent per annum to do it. I respectfully submit that if anyone in this forum won a million dollars on the state lottery, and the claim had to be entered in the next 24 hours, I cannot imagine anyone who could not clear his/her schedule to meet the deadline. We do what we want to do, no excuses or apologies needed.

Now, for the idea of physician assisted suicide. I very much dislike the idea of physician assisted suicide, because I dislike becoming involved in any manner with physicians. Most of the time, in my experience, they charge too much and do too little. I am puzzled as to why anyone would want to consult with a physician, or anyone else for that matter, if he or she had decided upon due reflection that continued living had become more of a burden than it was worth. When the physician wants to commit suicide, who does he consult?

Does someone need permission or approval to say goodbye? There is much religious sentiment and twaddle that gets interjected into any discussion of this topic. My own guess is that most people, no matter what religion professed, are closet atheists, and they have no more desire to see what comes next than the most devout non-believer.

I have been a heavy smoker for well over 50 years, and have no least interest in stopping. I have midstage or more, emphysema, and will probably be presented with the opportunity in the next 5 years to see if I want to hang around any longer. When that time comes, I will consult nobody, I emphasize, nobody, for any assistance, advice, consolation, or other endearments.

I hope to survive on reasonably good working order for another 2 years, I will then be 71, which is the actuarial life expectancy for my cohort. If I should survive that long, my smoking, drinking, motorcycle riding and other unhealthful behaviors will be moot, at least from the insurance company standpoint. A few months ago I read an obituary of a lady Ph D at College Park who taught holistic medicine or something like it. She died rather quickly and unexpectedly at the age of 53. I'll bet she was death and damnation on smoking, too:):):)

I hate to mention the name of Hitler, because I hate him and his name both, but it is illuminating to realize that he did not drink, smoke, and was a vegetarian, as well as a sexual pervert. Three of the 4 women closest to him in his life committed suicide, and I include Eva Braun in that number. I suggest that if he had been able to enjoy a pipe, and some good Bavarian beer once in a while, and found a girlfriend who liked him, and was less concerned with power over his fellow humans, the course of history in the last 70 years would have been much different. The picture that comes to mind most easily of him is a frustrated, angry, and ugly little man in a uniform, roaring his silly bombast at a crowd of human sheep in Nuremberg, all of them as inadequate as he is.

CYD:   First, in response to Eric, who says: "My own guess is that most people, no matter what religion professed, are closet atheists." I had to laugh, because I had always guessed that most atheists were closet believers in God! (Also, those actuarials factor in smokers, drinkers and motorcycle riders. If it wasn't for those groups, longevity rates would show much higher. You haven't beaten the odds, Eric; you've helped create them!)

As for assisted suicide, I think that it not only sets a dangerous precedent for society, but places a terrible burden on the elderly and ill, and the person asked to assist, physician or otherwise. I disagree with the prevailing wisdom that most suicides are due to unbearable physical pain. Psychic pain, in my opinion, is less bearable than physical pain and precipitates the vast majority of suicides, even with the terminally ill.

My own experience is only my own experience, and has no statistical relevance, but I did recently have to deal with this issue myself. (I hope this message is not too long.) A little over a year ago, my 46 year old husband, Paul, died two and a half years after being diagnosed with cancer (yes, he was a smoker). During those years, we discussed at length what both our wishes would be at the end of life. Paul did not believe in "quality of life" arguments, and felt that life was life (I'm not even hinting about abortion issues here, just adult life) and "quality" didn't much enter into it. In the past, he had also expressed his fear about assisted suicides becoming more commonplace and acceptable, feeling this would pressure elderly and chronically ill people into ending their own lives early in order to leave resources for their heirs and the rest of the community.

We plotted a course for dignity in death, which included his written request to not be resuscitated and to not be fed by unnatural means, but did include hydration. These papers were filed with his physicians, hospital, and family members. I agreed to all his requests, but when the time came to actually carry them out, it was another story.

One evening toward the end, when his pain most more acute than usual, I accidentally overdosed him on morphine, trying to ease his suffering. When it became clear that I had given him too much, I rushed him to the hospital. After he was checked in, he lost consciousness and the doctor came in to instate the non-resuscitation order. I panicked. Paul was not ready to die and I certainly was not ready to be the cause of it. I rescinded the order, overriding Paul's own wishes, but I knew this was not what he had in mind when he wrote them. (After he recovered, he was glad I had suspended the order, even though we didn't have to perform any heroics.)

At the very end of his life, a different situation presented itself. He was no longer able to eat or drink by himself, and Hospice had been helping us for several weeks. There came a point where he was almost completely unable to communicate. About that time, we stopped giving him any nutrition as it was doing him more harm than good. A few days later, Hospice also suggested we stop intravenous hydration as it was artificially extending his life. I balked at first, and his parents and brother and sister were also very opposed (his sister is a doctor). Paul regained his ability to communicate for a very short time, and said that he was ready to die. Soon afterward, I agreed to take him off hydration, only trying to keep his mouth and eyes moist. His relatives were in violent disagreement with my decision, and pointed out that the papers directed otherwise. I was doing everything I could to keep Paul alive as long as possible, but not at the cost of making him suffer needlessly. Paul died peacefully holding my hand a few days later.

Although he has been gone over a year now, you can probably tell I am still second-guessing myself on all my decisions. His family and I have not spoken to each other for over a year, but I remain close to his teenage children.

These decisions are agonizing enough without bringing in the looming pressure for terminally ill persons to commit suicide to save their families and community from the costs of keeping them alive. Planned suicide is not just a personal decision. It affects all of society.

NBB:   Sorry to hear that your husband passed away two and a half years ago ... and so young, of cancer.

It is a terrible, terrible plague ... and one that now, unfortunately, is scheduled to affect 1 out of 2 males per ACS statistics in their lifetime ... up incrementally from about 1 out of 20 or so at the turn of the 20th century ... thus nearly now every family.

Decisions in this arena are, by their very nature, difficult. No point second-guessing those decisions, or hindsight tormenting. I'm sure you did the very best you or anyone could possibly under the circumstances.

Presently, by the way, I am dedicating a great deal of my energy in this field, to make a help some of the leading physicians around the country establish in-residence care facilities.

JCC:   Thanks to all of you for outlining the true core issues on assisted suicide about as succinctly (yet fully) as I have ever seen in one place and time.

For me the issue boils down to essentially that of who owns my life. Either it's a right of mine to decide or someone else may well play god (or personal representative of same in the matter concerned). You are right though to point out the generally greedy and dismal economics of it. I see what "should" be is a maximization of choices, but then again, people have clamored against nationalized health care and tend not to want to pay the costs for either of the choices. Consider many of the folk who hate abortion but seem not so activist about making adoptions simpler or increasing aid for unwanted children. I'm sure there must be many exceptions to the pattern, but let's face it... infants and elderly, at the extreme ends of our span of being, seems to be already regarded as a bit expendable, at least in practice. Can people expect their governments (or religious charities) to change the somber realities? Perhaps new concepts are needed for just who constitutes "family". Kurt Vonnegut toyed with the notion occasionally in his novels... creating random "relatives" for everyone everywhere, so that no one would be neglected. A bit utopian, with little legal precedent, but an interesting idea nonetheless.

LDL:   The point is that you have the right to make such decision for yourself, you should not, nor should society, have the right to restrict the decisions of anyone wanting to end their life. To take on the burden of making such decisions makes those who do tyrants, and demeans the dignity that is the right of any mature, rational adult. Fortunately, committing suicide is quite easy ... I can think of a half dozen painless ways off the top of my head.

It is justified and noble if a person decides to commit suicide to prevent unnecessary hardship and expense to their families, and for their own reasons. It allows people who care about life, one last tribute to the life they loved. Denying them that right for fear of encouraging more suicides is, in my opinion, a fearful expression of ones own aversion to the idea of mortality.

I suspect that, truth be known, those people who want to off terminally ill relatives, do so now. But usually we are not talking about Euthanasia, which implies the possibility of offing someone without consent ... we are talking about the right of a person to take their own life, and whether society should make that easier for those who lack imagination.

I vote, yes! Having worked as a nurses aide and heard people screaming throughout the night, "Kill me! Please, kill me!" suffering from pain because we have made heroin illegal ... I am disgusted with our society. Benevolently keep suffering people alive ... I don't think so!

EM:   I agree with everything you have written on the idea of suicide and whose business is it, anyhow? Other societies have had different views than ours on how best to end life, when the time seems appropriate to do it. Among some of the Polynesians, when a man reached the perceived end of his functioning, a small party was held, and the person most concerned would sail away in a small boat, never to return. The Eskimos had something similar. Socrates was from somewhere in the Dodecanese Islands, where the custom was on the 60th birthday of an individual to hold a grand party, after which the honoree drank a cup of hemlock. Socrates lived to be almost 70, I think, and so was overdue by his hometown traditions. I have sometimes wondered if his act of defiance and taking his life was not killing two birds with one stone.

I think a good life should be like a good book, have a clearly delineated beginning, middle and end. About 25 years ago I had the occasion to visit a nursing home, and I was provided a tour by a somewhat older, and singularly cheerless, nurse. We walked around the facility, while the nurse grimly recorded upon her clipboard the bowel movements of each patient. She explained to me that this was vitally important, and a major part of her job assignment. I reflected at the time on who was the more unfortunate, the person doing the counting, or the countee, and decided that they were of equally unfortunate status. If my choice for the next two years was to lie in bed in that nursing home, until my demise, or fall dead with a stroke this afternoon, I would happily bid adieu to all of you, and hope for a bit of lively discussion here about my unexpected and possibly unlamented passing from the scene.

NBB:   The issue of assisted suicide involves a double-edged power. While I agree with Laura that we should not deny our and death as part of an inevitable circle...there is, in life, an innate proclivity to remain alive as long as the glimmer of hope stays, a light even if seen when we are put underwater and innately struggle violently to come up, and to breath with every cell.

At the same time conditions can be so dismal, so hopeless, that it might make sense to assist the lifting of pain in those who experience the very last dire, agonizing moments of life. But as with convicts on death row, mistakes can be made, even if only for a small percentage - and the mistakes then are irreversible. Some estimate it is around 10% as I heard a radio show on this issue not long ago.

I know that all too well in the cases of illness as well. With cancer patients, into our caring arms we receive, for the most part, the terminal, the inoperable, those abandoned by conventional therapies, left to die, to go home and await their demise. When, to their prior caretakers' surprise, the pain in arrested, the life force in the body is turned around, and metastases vacated...pity to think the patient might have crossed the line, committed The Act.... and not in a final enlightenment, but in the shadows and under the leadened weight of illness, ignorance or simply fate.

Which reminds me, I haven't answered Laura...later when I am less busy...being on the road mostly with preliminary preparations for the new east coast cancer/alternative care site and... preparing for the holidays.

CW:   By the way, I forgot to say I thought Lisa's point about euthanasia becoming a way out of expensive medical procedures is a good one and very provocative - the alternative right now is simply no treatment or inadequate treatment. This is also becoming a reality in Canada which, unfortunately, is run by cowards of many stripes.

Regarding Hitler you might want to have a look at a recently released (in Vancouver) German movie: The Inheritors. The attitude and actions of the landowning peasants, the basic brutality of that life, was the stepping stone of Totalitarianism. It is a lethal combination of selfishness and docility - ironically, backed by the image of Christ, who was anything but selfish or docile.

JCC:   The real world always seems a little more sloppy, not quite the idealized model tailored to pat answers.What suggests itself to me is that where sentiments are so widely divided it is best that there not be too many laws. Otherwise, too many resources are wasted on punishing people who are sincerely trying to make the most ethical choice. Of course it can be counter argued that the great villains of history were merely acting in pursuit of a twisted vision of good. There is a somewhat fuzzy line where the actions of one person begin to cause non-trivial damages to another, something exceeding a snub or minor inconvenience. One might consider some element of negligent disregard for the other, or the intent to push cumulative displacement of another's rights to life, liberty, pursuit of happiness, etc. Legal systems do recognize the distinctions of intent. What preserves the law is the chaotic condition of multiple interests pulling in different directions. Maybe a certain level of discord and disfunction is the price of the general stability of human societies.

MO:   This discussion on suicide and a person's right or not to commit or assist a suicide is very interesting, but I think we might be talking about several issues at once and confusing them together. The two foremost issues I've read that encompass the whole thread are:

1. Is suicide ever the right thing to do? The answer to this might lead to the second question:
2. If there are circumstances when an individual should take their own life, is it ethical for another person to assist?

Question 1's answer can only be decided individually based on personal beliefs and perception of self and one's place in society. The question of whether individuals have a right to commit suicide is something that can only be important in the sense that a person that has connections to other people will be more aware of the impact their deliberate act will have on the survivors and feel a need to find a different resolution; and hopefully then find a way to deal with and eliminate the cause of the suicidal impulse. If the person has few perceived connections to society (and here people can find connections to more than just people, loved pets can sometimes make a suicidal person think twice). The most terrible things about suicide are that it's irrevocable and more often than not it's done by people that are suffering pain that is treatable.

In particular, as Cindy said, psychological pain can be more tormenting than physical pain; but depression and mental illness is so often untreated and even unrecognized that most suicides are committed by people that don't have an accurate perception of their present and future options and possibilities. They have no hope where mentally healthy people would see hope. Add to that all the people that commit suicide under the influence of drugs (including alcohol of course) and you've got the vast majority of suicides done by people not thinking clearly during the most momentous decision of their lives and of their loved ones lives. Almost all suicides are mistakes in judgement, and many could be prevented if treatment was sought.

That said, here I go against my Roman Catholic altar boy upbringing and say that I think there are a very few situations where suicide is a way to end more quickly an absolutely hopeless existence; especially where intolerable psychological or physical pain is involved. This is where some difficult decisions are, and in a more perfect world there would be very few suicides (more successful interventions) and NO unassisted suicides. I think the factors that could make a mentally healthy person want to commit suicide are so traumatic and disturbing that outside reference points provided by professional help and concerned family and friends are important. This is also the point where the mentally unhealthy or drug influenced people might be helped if they were identified. I'm not saying that a person can't end his own life by his own choice; it happens every day; but if there is an opportunity for all concerned to explore the issue and reach an understanding (if not agreement) then if the suicide does happen it may be a more peacefully accepted event by the suicide and the family and friends.

Question 2's answer is probably the more difficult one, unless you believe that absolutely no suicide is acceptable. But even if you believe that, you must understand that other people may think differently; and I think to deny an inevitable suicide some compassion at the final time by standing away is not the right thing to do. To hold a belief so firmly that you deny comfort to a person at the last bit of life is selfish, no matter how averse you are to suicide. I think assisting should involve your expression of your opinion, while keeping in mind that the final decision is not yours. And more importantly, the final responsibility is not yours.

Suicide is a self inflicted act even when assisted. Again, I think that every single suicide should be assisted by at least one very personally concerned individual. No one should have to die alone. If someone with a rational mind has adamantly chosen suicide to end a truly hopeless existence, then they should not be faced with the possibility of a botched suicide where their body still lives without a mind or their mind lives on without a functional body. The most difficult experience of the suicide may be that of the assisting persons, because they survive and live with all the decisions that were carried out. But at that point hopefully the suicide seems an inevitable and accepted act to them. Kevorkian is a grandstander, no doubt, but he is doing us a huge service by bringing the topic of the assisted death (suicide) to attention. It may be that the medical community has been quietly doing this "assistance" for years, but it is a subject that should be out in the open for discussion so that people know what their options are.

The most difficult problem is how to decide when and how to let people die when they can't speak for themselves. If they have previously expressed thoughts on the subject it might be a fairly straightforward although painful decision. But I think that very few of us can anticipate and plan for every possible medical emergency and status we might be subject to, and sometimes people are left with no possibility of communicating their wishes; so some of these life and death decisions must be made by others. If at all possible the closest, most significant family of the incapacitated individual should be involved with the medical professionals in this most difficult decision. At this point, this is not only the family's decision, the medical professional viewpoint is very important to establish that there is no realistic hope of a recovery.

Laura, I like your idea that we should not initiate direct harm against another person (I think that would then include property automatically) but there is some subjectivity in the terms "initiate" and "direct"; maybe not within an individuals perspective, but from person to person. I've had a very similar personal guide of behaviour for many years: "It's OK if it doesn't hurt me or anyone else". I include all living things among the "anyone else".

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