Right decision, wrong outcome

Resistance is futile!: Right decision, wrong outcome

This is a terribly difficult thing to write about. I hesitate to attempt it, because I know it will be misinterpreted and because it is such a personal subject. I'm writing this paragraph after I've finished the entire essay, and after you read it you may understand. I hope you do, but even if you don't I have to write it anyway.

Suicide:

If you're not a regular reader of Gullyborg, you may have missed his article last week (Tuesday, January 17, 2006) regarding the Supreme Court's refusal to set aside Oregon's Assisted Suicide Law.

His opinons on that decision elicited a lot of comments, and mine were in support of the Oregon law and the decision of the Supremes.

To briefly summarize the law, it allows a physician to administer a lethal dose of drugs to end the life of a patient.

The restrictions are these:

• The patient ("he") must be suffering from a medical condition which in which the prognosis is terminal
  
• He must be in control of his mental condition to the degree that he is able to make such a decision
• The physician must not make this decision (to assist the patient in suicide) alone; at least one other physician must concur with the medical opinion that the previous two conditions have been met
• The patient must, in the opinion of the physician (or consulting psychologist), be "capable, acting voluntarily, and informed"
  
• The patient must be capable of making his wishes known to the physician (both written and verbal request)
• He must be able to rescind his request
• There is a 15 day waiting period between the time when he makes his request and the time it is acted upon
• He must be an adult: at least 18 years old
• No contract or other agreement, written or oral, can over-ride the request or the patient's decision to rescind it
• The decision to voluntarily request assisted suicide will not abbrogate or nullify any insurance policy
• The physician will not be subject to legal action, including civil action, for acting upon the request; no health-care provider or professional organization can take disciplinary action for the physician's participation; no legal, professional, organizational, contractual or financial penalty shall be applied to the physician ("health-care provider") for his participation

And here's the part that protects the patient; I cite it here verbatim, in the interest of accuracy:

127.890 s.4.02. Liabilities. (1) A person who without authorization of the patient willfully alters or forges a request for medication or conceals or destroys a rescission of that request with the intent or effect of causing the patient's death shall be guilty of a Class A felony.


(2) A person who coerces or exerts undue influence on a patient to request medication for the purpose of ending the patient's life, or to destroy a rescission of such a request, shall be guilty of a Class A felony.


(3) Nothing in ORS 127.800 to 127.897 limits further liability for civil damages resulting from other negligent conduct or intentional misconduct by any person.


(4) The penalties in ORS 127.800 to 127.897 do not preclude criminal penalties applicable under other law for conduct which is inconsistent with the provisions of ORS 127.800 to 127.897. [1995 c.3 s.4.02]

This means, among other things, that the family or friends, or other interested persons can NOT make the decision for the patient. Nor can they influence the decision of the patient through coercion, undue influence or fraud.


Gullyborg is a law student, and contends that this is "a bad law". I'm not sure of the reasons why he believes it is a bad law. He professes no moral judgement about the concept that a person in the last extremities of life should or should not be able to make this decision.

I disagree. I think that this is an entirely personal decision which can legitimately be made by a person in the last extreme of life. I hope that I may never find myself in the position where it seems an attractive alternative to life, but I also hope that if I do -- the option has not been taken away from me because of someone else's philosophical or intellectual or political priorities.

My position is that there are circumstances which may occur, wherein an individual may be fatally inflicted with a painful and debilitating disease or injury which leads him to believe that the only possible end to the agony is death, sooner rather than later.

The law, in my understanding, does not permit a person to choose death. Any person can do that, although they may not be able to enact it. The option of suicide is always available IF the person is capable of ending his own life. That capability may not be available, because the medical condition may be so extreme that he lacks the ability to do so.

The law seems NOT to provide legal permission for a person to end his own life. In fact, ATTEMPTED suicide has traditionally been unlawful. I believe they can put you in jail for it, though I have no doubt that most courts would find it difficult to apply such a punishment to an incapacitated person. Of course, there is no punishment for a SUCCESSFUL suicide.

The purpose of the law is to protect the physician who choses to provide this final mercy to a terminal patient. It also defines the conditions under which the physician can determine that the decision of the patient may be considered to be 'free and informed'.

Nothing more, nothing less.

The response of the Federal Government has been that physicians who "assist" a suicide by medical means may be prosecuted if these means involve the administration of restricted medication ... that is to say, a fatal dose of narcotics, or other federally controlled drugs.

I find that curious, since most states (and, as far as I know, the Federal Government) have historically executed Capital Prisoners by much more painful and barbaric means . . . hanging, firing squad, electrocution.

Now more states are using 'humane' means, which amounts to a three-stage administration of drugs:

1. a drug to put you to sleep
2. a drug to stop you from breathing
3. a drug to stop your heart

If the first series of drugs don't kill you, they'll do the entire procedure over again, until you are dead.

This is considered a progressive, humane method to execute a person who has somehow offended society's laws. Can a law-abiding person expect anything less?

The execution of prisoners may be at the hands of a physician; more frequently, it is at the hands of medical technicians. One presumes that the 'patient' has not been consulted in the decision.

Opponents of the Oregon Assisted Suicide law suggest that it is somehow frivilous, that it undermines the concept of 'sanctity of life', that it constitutes nothing more than an extreme way to "treat depression".

And yet, they may suggest that they want to keep the Medical Profession "out of it".
Curious.

I submit that Depression is not the primary consideration for those who are compelled to make this difficult decision.

No, I would not choose "Depression" as the word to justify this law.

"Agony"

"Indignity"

Yes, those are perhaps more appropriate word to describe the conditions under which a person might make this difficult decision. Add to that the fact that the physician has doubtless told the patient, if the patient is competent to understand the pronouncement, that the rest of his (the patient's) life will be a prolonged condition of pain, to be climaxed by an undignified death.

I have some history with this situation, involving a family member afflicted by both cancer (in several versions, including bone cancer) and Alzheimers. The Assisted Suicide law would not have been an option, because of the mental degeneration. Helpless, unable to feed, dress or express himself, he was reduced to catheters and diapers. He did not recognize family members, but was obviously distressed when these indignities were inflicted upon him.

Make no mistake about it, agony is a condition which cannot be ignored despite the non-fatal levels of narcotics which may be prescribed.

And the lack of dignity of this helpless person may have been alleviated only by the twisted Grace of Alzheimers, although we can't know if he understood what was happening to him. We can hope that he didn't feel the shame of being subjected to a dependency on care-givers who would change his diapers, empty his bladder bag, and provide daily sponge baths; who rolled him like a piece of meat to change his linen daily. It isn't a life which I would wish on someone I loved,

What if he didn't have Alzheimer's Disease? What if he was in full possession of his mental faculties, and realized what was happening to him? Would he be any less fearfull, less agonized by the pain as his bones rotted inside him?

I doubt it.

Personally, the idea of suicide is anethema to me. But more repulsive still would be to find myself in the position where I was in unrelieved and unrelievable pain, with no prospects but a painful death, knowing what anguish my family must be feeling, and yet be unable to do anything to stop the process before it became even more unbearable.

Is the Oregon Assisted Suicide Bill "a bad law?" I don't know. I don't know much about the law.

But I do know something about living, and about dying. Under extreme circumstances, the priorities somehow reverse themselves. It's difficult for us to make the decision for a loved one to live, when life itself it only unendurable agony.

And yet, it's not a decision we can make for him . . . to live in agony, or to die immediately and thus stop the unremitting pain.

If that loved one can make the decision for himself, do we have the right to stand in his way?

Put it another way: if you found yourself in the situation where your loved one had no future but PAIN, would you feel tempted to help them end it with a gun, a knife, a dozen pushes on the "administer" button on their morphine drip? Or would you sternly deny him his right to make the decision for himself.

Only if you had no heart.

But if that person truly loved you, would they be willing to trade their pain for the consequences of the de facto murder you would be committing?

If they were that kind of person, would you have loved them?

The answers are no, and no. And no.

UPDATE: February 2, 2006
It was never my intention that Assisted Suicide become a "recurring theme", although it is a subject about which I hold strong views.
However, while researching an unrelated subject I ran across this article from Talk Left (The Politics of Crime), which suggests that I'm not the only one who believes there is ample cultural and legal justification for assisted suicide.

The article, written April 8, 2005, cites a Connecticut man who handed a gun to a "cancer-stricken" friend, and 'counselled' him on the best way to shoot himself. No evidence that the man actually held the gun or pulled the trigger, and a compassionate judge sentenced the 74-year old 'assistant' to what is effectively no more than administrative punishment. Of particular interest are the comments attached to the article.

I call the judge compassionate because, in passing sentence, he stated "I can only say to you, I'm glad it wasn't me put in your position that day."

When we watch a loved one in unrelenting agony, our natural empathy makes us want to do anything we can to help. When that person tells us that they just want the pain to end, we may assume that their ability to communicate this choice is evidence that they are able to make an informed decision.

Then, we are presented with a quandry: whether it is worth the personal legal penalties to allow your loved one the last grace with dignity, and whether there are alternative methods.

Watching your friend blow his brains out is not the best solution, but apparently in Connecticut it may be the ONLY solution.

Living in Oregon, I am comforted, somehow, that people I love are not required to burden their friends and family with such an awkward choice. The Oregon Assisted Suicide law protects a physician from the consequences of granting this last request.