Thursday, November 13, 2014
In 1994, Oregon voters passed the Death with Dignity Act, which legalized physician-assisted suicide for the terminally ill. Since then, it has become legal in 4 more states, including New Mexico, where the state court ruling that it is constitutional is under appeal. Is it, in the words of the American Medical Association’s code of ethics, “fundamentally incompatible with the physician’s role as healer”? Will these laws lead to a slippery slope, where the vulnerable are pressured to choose death and human life is devalued? Or do we need to recognize everyone’s basic right to autonomy, the right to end pain and suffering, and the right to choose to die with dignity?
Philosopher & Professor of Bioethics, Princeton University
Author, Far From the Tree & Prof. of Clinical Psychology, Columbia University
President, British Medical Association & Member, House of Lords
Prof. of Medicine and Ethics, University of Chicago & Member, Presidential Bioethics Commission
Author & Correspondent for ABC News
Philosopher & Professor of Bioethics, Princeton University
Peter Singer is a philosopher and author, best known for his work in ethics, and often described as the world’s most influential living philosopher. He is the Ira W. DeCamp Professor of Bioethics in the University Center for Human Values at Princeton University, a position that he now combines with the part-time position of Laureate Professor at the University of Melbourne. His books include Animal Liberation, Practical Ethics, Rethinking Life and Death, One World, The Life You Can Save and The Point of View of the Universe. In 2014 the Gottlieb Duttweiler Institute ranked him third on its list of Global Thought Leaders, and Time has ranked him among the world’s 100 most influential people. An Australian, in 2012 he was made a Companion to the Order of Australia, his country’s highest civilian honor.
Author, Far From the Tree & Prof. of Clinical Psychology, Columbia University
Andrew Solomon is a writer, lecturer, and a professor of clinical psychology at Columbia University. Solomon's newest book, Far From the Tree: Parents, Children, and the Search for Identity (2012), won the National Book Critics Circle award for nonfiction and was chosen as one of the New York Times “Ten Best Books” of 2012. Solomon’s previous book, The Noonday Demon: An Atlas of Depression (2001) won the National Book Award for nonfiction and was a finalist for the Pulitzer Prize. He is a director of the University of Michigan Depression Center and Columbia Psychiatry; a member of the board of visitors of Columbia University Medical Center, of the national advisory board of the Depression Center at the University of Michigan, and on the advisory board of the Depression and Bipolar Support Alliance. In 2011, he was appointed special advisor on Lesbian, Gay, Bisexual, and Transgender Mental Health at the Yale School of Psychiatry.
President, British Medical Association & Member, House of Lords
Baroness Ilora Finlay, a leading palliative care physician, is president of the British Medical Association (2014-15), president of the Chartered Society of Physiotherapy, and is a past president of the Royal Society of Medicine. She has led Palliative Care Strategy Implementation in Wales since 2008, and chaired the Welsh Medical and Dental Academic Advisory Board since 2012. Finlay was a general practitioner in inner city Glasgow before returning to Cardiff to work full-time in care of the terminally ill. She works at the Velindre Cancer Centre, covering SE Wales when clinically on call. Finlay started the Marie Curie Hospice in Wales and since 2008 has responsibility on behalf of Welsh Government for strategic oversight of all hospice and palliative care services in Wales. Since 2001, Finlay has been an Independent Crossbench Peer in the House of Lords.
Prof. of Medicine and Ethics, University of Chicago & Member, Presidential Bioethics Commission
Dr. Daniel Sulmasy is the Kilbride-Clinton Professor of Medicine and Ethics in the Department of Medicine and Divinity School at the University of Chicago, where he serves as Associate Director of the MacLean Center for Clinical Medical Ethics and as Director of the Program on Medicine and Religion. He received his AB and MD degrees from Cornell University and holds a PhD in philosophy from Georgetown University. Sulmasy was appointed to the Presidential Commission for the Study of Bioethical Issues by President Obama in 2010. His research interests encompass both theoretical and empirical investigations of the ethics of end-of-life decision-making, ethics education, and spirituality in medicine. He is the author or editor of six books, including Safe Passage: A Global Spiritual Sourcebook for Care at the End of Life (2014). He also serves as editor-in-chief of the journal, Theoretical Medicine and Bioethics.
55% voted the same way in BOTH pre- and post-debate votes (47% voted FOR twice, 6% voted AGAINST twice, 2% voted UNDECIDED twice). 45% changed their minds (7% voted FOR then changed to AGAINST, 9% voted FOR then changed to UNDECIDED, 5% voted AGAINST then changed to FOR,0% voted AGAINST then changed to UNDECIDED, 15% voted UNDECIDED then changed to FOR, 9% voted UNDECIDED then changed to AGAINST) | Breakdown Graphic
I just finished a book two days, called Me Before You by Jojo Moyes. It was phenomenal, NY Times bestseller, being created into a high budget movie, and once I finished I was asking questions about morality. Now I have never been in a situation like the main character of that book, a successful man who was living a dream life: successful CEO, money, traveling, and a beautiful fiance, who was then hit crossing the street and became quadriplegic. Moyes touched on the dark and sensitive topic of physician assisted suicide, and what it was like in the character's situation. This book was written in England so the laws are very different than they are here in the USA, but it's the same ethical questions: Who gets to play God? Who gets to decide when they want to die? Who gets to tell someone that they don't have the right to die? As I started to delve into this matter, I noticed its huge correlation with many other controversial topics: Abortion, Life Support, DNRs (do not resuscitate), and depression. And my stance on almost all of these difficult conversations, is that I have the right to MY OWN body. I can't decide to sign a DNR for a stranger that will say that if they are found unconcious you won't give them CPR, but I can sign a DNR for myself. I can't go around killing other people's babies, but if I know I can't be a suitable mother or it would be dangerous to conceive, I should have the right to make that medical decisions as well. I can't go around killing other people, but I can kill myself.
Did you know committing suicide is illegal in 41 states? Obviously, the person doing the act will not be put in jail, but if anyone knows of it or helps them in order to be more humane, they can be charged with homicide. When your dog is sick, you put him down at a doctor's office by means of a lethal dose. Sure you could take Todo in the backyard and shoot it or something along those lines, or even let it live out its illness, but our society has deemed that once an animal’s quality of life is negative, you let them go in a painless process. Why can't we do that for humans? Someone who knows they're going to die of MS, ALS, Alzheimer's, Cancer, or some other terminal disease shouldn't we let them? They're going to die anyway, and that's the sad fact of life. As an anonymous person online said in a forum on this topic, “When my mother was diagnosed with stage 4 pancreatic cancer, we took a family trip to Oregon. She took the orange pills mixed in Strawberry Yogurt, and she fell asleep. She died as as she had lived, with elegance. Because she didn't want to die as her mother had battling Cancer; screaming in a hospital bed writhing in pain.”
I have a very progressive point of view on this topic. Millennials are known for our new point of views on individuality, independence, and mental illnesses. And this whole idea, of the right to make your own choices about your body, is a huge concept for my generation. Sadly, us Millennials haven't made it up to the legislature because we are all in college or below, but once we start seeing the millennial generation in power, the legislature will change. I want to bring that viewpoint to a topic that also has impacted me a lot, not that any of my family members, or anyone I know has committed medically assisted suicide, but mental illness and suicide had touched me. And suicide is never humane, it can be painful a and long lasting process, because most things that can kill a person are hard to obtain. Why can't we make it easier for a person who is clearly suffering, mentally or physically, to die with dignity?
There is a lot for me to learn about this. I want to learn more about the laws, and the fine line of suicide and homicide. Because I feel like it's hard to tell sometimes and this process can be abused. When doing my research I also picked up another thing that caught my attention; the power complex that the doctors who deliver the dose receive. The doctors can get this god like feeling, and it can be abused. Knowing they administer death, that has to mess with a person, leading to a power complex. But I want to research more of the ethical reasons of happiness, and why people oppose this argument. Because yes, this is hard to think about. It's hard for some people to accept that mental illnesses are so real and impacting, and can lead to suicide. And that some illnesses can cause so much excruciating pain, that it's more ethical to do this process and save them pain and suffering. Yes it's hard, but the concept of death has always been hard for people to grasp.
I think its appalling assisted suicide is not legalized still. Ive seen my step dad die without any DIGNITY! NOT ONE BIT and im sure hes not the only one, I just know in my heart I wont go without and dignity either, its a game of STRIFE and Self Defense all the way. I ve been suicidal for over a decade and still want to have a movement in the universe based on every living soul is eachly diverse that not all will make it. I just feel life has been a punishment and social experiment if anything! I feel if my super EGO is god then he sent me to die, cus esteem is given not taken or forged! you either got purpose or you don't, no in-betweens I just feel its tramatizing to have to live without any help out especially with all this freely promoted "HELL TALK" and its I think we all know from GOD who sets the image of man always who either supports the life or labels it meaningless leading to my egos perception ofa meaningless uncrediable life form to which should not be kept or forced to live. I just hope the message reaches another soul who feels like I do. Life is a mutual respect commitment based on exchange and support only if you know how to but many, from what I see in my own self and othersw don't have skills for good communication or don't know how to seek results from the assisted suicide team. I feel SMI patuients need more than just hospitalization and meds and prisons its just crazy rude to through a suicidal person on a suicide watch without any realy means of recovery or hope nothing real sustainable. nor worthy of a exchange recipient to helper relationship. This is my own weakness I cant do anything more than im programed and I see no good change so I GIVE UP! Please legalize SUICIDE For all MOrtal beings! PLEAAAAAAAASSSSSSSSEEEEEEE!!!!!! DEATH WITH DIGNITY ALLL THE WAAAYYY!!!!!!!!!!!!!!!!!!!!!
YES we should because what if that person is in pain why should we make them suffer more ?would you like to bee in pain the whole time ?
No one has the right to tell you under which circumstances your life should end. Is the ultimate human right for you to decide how to end it.
It's especially on such emotional and personal subjects such as this that we must adjust our focus to ensure we have a wide-frame view on the entire topic. I think it's best to start at the root of the question and move
upward. In this case, the central topic, wrapped up into one word is "suicide", which is broadly defined as "the taking of one's own life", just as homicide is "the taking of another human's life". Our entire legal system relies
on the premise that each individual has a right to self-ownership, for instance, the notion of property rights is just an extension of self-ownership to objects that you have mixed your labor with, since labor is only a
description of your body carrying out work. Another example is the barring on both the government and of private individuals of imposing unlawful imprisonment upon an innocent man. This would be meaningless if a
person has no presumption of self-ownership, otherwise, the state could, for instance, imprison any unemployed persons and put them into a forced-labor camp because the state decides that this would be better for the
individual, as well as for "society" for her/him to be working rather than not. To be clear, I'm no more an absolutist than the common law already is, for instance, like Dr. Sulmasy says in his opening statements, drunk driving
laws limit the reach of our individual rights, but only because they pose an substantial, existential risk to OTHER PEOPLE who never had a choice in their decision to drink & drive. The key is that they have violated another
person's right to self. This brings me back to the definitions of Suicide and Homicide, while homicide is a legitimate crime since it is a prohibition on a person to the extent that they violate the rights of other persons, suicide is simply the "taking" of something that's already owned by the "thief".
Many of us choose to occasionally drink alcohol, smoke tobacco, "cruise" around the city in our car for fun, engage in surfing/skateboarding/snowboarding/skiing, eat fast-food & "junk" food, go swimming in natural
waterways, speed slightly on the highway, eat seafood, or go on vacations which increase our risks to travel-related fatalities and theft. All of these choices improve the quality of life of millions, if not billions, of people on this
earth (who usually live by the motto "everything in moderation") and also pose increased risks of limiting the life of an individual, but we allow them to fulfill their interests UNLESS WE CAN MAKE THE CASE that the person is uninformed of the risks. or incapable of making decisions for themselves (children and the mentally-disabled, for instance). If we take the logic of the "Against" side in this debate, wouldn't we slam our fist on the scales in
favor of quantity as opposed to quality just as they do in the case of suicide? Shouldn't we ban all recreational sports that kill people? ban all fast food (perhaps a government-scheduled meal plan would be helpful
instead!)? The list goes on.
An individual has the right to self-ownership unless a compelling case can be made against it. Perhaps the mentally-ill and mentally-handicapped, children, and those in severe short-term stress could be limited, regulated, or outright denied in their right to suicide based on the circumstances, but THE CASE MUST BE MADE. I am my own person, innocent until proven guilty, I am not the property of the government, "society", or even doctors. Doctors can join my friends and family, using their right to free speech, to persuade me one way or another on any choice I make with my life, but unless they can prove that I am not mentally-stable, the choice is up to me.
The con side hinted at it, but I'm surprised the question was never brought to the pro side.... what happens to society when doctors' objectives include a patient's death rather than the treatment of a patient's pain (potentially resulting in death). What happens tip the doctor patient relationship. What happens to the general public's (not just the doing public's) level of trust in the medical profession when a portion of its accredited membership are actively engaged in our death? Involving doctors, who we need to be able to count on to treat us, in suicide decisions has societal consequences beyond just personal choice. Just look at the growing number of anti vaccine, homeopathic, medical skeptics. I don't support this, but I talk tip these people with respect and time and again there is a root of general distrust. I in my opinion these topics are clearly related.
Some say Assisted Suicide is wrong, but others think it’s a blessing. Just about the half country has abortion legal, and thatch giving women rights to decide what happens to there body. So should men and women decide their fate by assisted suicide. Wouldn't it be more peaceful to go out painlessly.
It would be much better to go out peacefully because you wouldn't have to go through all that pain and suffering. Would you wanna be forced to sit around or lay around a hospital all day? What if you were brain dead? What if you were a vegetable and couldn't even move or go to the bathroom properly. You would wanna end it fast. Why not go out with some peace and dignity. Why suffer with one that pain.
Going through all that pain, and suffering is a lot worse than watching a loved one go through it. Imagine laying in a hospital bed having a few months left. Watching your family come and go to apologized, feel sorry, give you all that love, and attention they should have give you before.Why not end right then? Let your family move on, let you move on. It’d end suffering everyone so much more painlessly
Brittany Maynard a 29 year old women who has been diagnosed with terminal brain cancer. She lived in a state that was illegal to use assisted suicide. So she moved to oregon where it was legal. She was prescribed pills by her doctor to off her herself. “ It Would not tell anyone else that he or she should choose death over dignity. My question is who has the right to tell me that I don’t deserve this choice”. This should be a choice for people some may be afraid to do it but to others a blessing.
Assisted suicide should be legalized because it’s peaceful, painless, and allows one to determine his or her own faith. People would wanna go peacefully around belongings and loved ones. People would go painlessly before all the pain happens. They could skip all the pain. Some people would rather decide what happens to the,. Others then having a family member decide for them.
Isn't the only issue about choice? The question was legalize assisted suicide, yes or no. If we leave behind the cultural constructs and meanings of this and ask, only, if it should be legal, than we have a question of choice. Under that model, there will be doctors who will and doctors who won't. The same will be true of people, some will want it and some won't. How is this different than, say, abortion or gun rights. It's a matter of choice.
I was surprised to find the results online greatly opposed the availability of physician-assisted suicide as the live audience appeared to still favor it's legalization.
Since this question deals with the unquantifiable--the quality of one's life and pain at end-of-life, it was difficult for either side to provide a scientific grounds for its availability--both sides used emotional case studies and the against-side interpreted statistics with a rather biased representation, but the science of pain is very much in the eye of the beholder.
Growing up in a medical family, I've realized that the process of diagnosis is very much an interrogatory practice when it comes to pain--asking a person with a terminal illness to diagnose their pain as a "0 to 10" is a far cry from anything scientific. Without true advances in the science of pain and perception of it, there is no objective standard for which a doctor can properly treat it. At our current point, treatment of a patient's pain relies on the patient's direction (if your pain is a 10, you'll get a larger likelihood of aggressive treatment than a 3).
Since the diagnosis of pain and quality of life can only be determined by a patient with our current body of knowledge, it is only ethical to allow the same person to choose if they would rather end their life.
The current systems are an excellent start and have proper safeguards to prevent someone from using physician-assisted suicide to do themselves unnecessary harm. The alternative--having doctors guess or depend on a patient in a difficult state-of-mind request the doctor actively end their life through suspending feeding/life support or administering anesthesia is an unwise place to put the responsibility.
I was 18 years old-in nursing school-when my first patient died of cancer. Her name-- Lurleen. Three years later, when I became an RN, I then worked @ Stanford in Cancer Research. At that early time (1960s) most patients died. The research project was the last ditch effort for treatment. The patients were referred from local physicians that knew about the specific NIH research project. Some patients had terrible physical decay and also experienced major negative symptoms such as vomiting, diarrhea, and pain.
The patients and their families taught me so much. I was all of 21 years old when I started. Each death was different given the location of the cancer, the use of chemotherapy, and/or radiation therapy. How they lived life and their religious orientation also affected the dying process. The meaning of death was different for all of them. There were oh so many variables to consider.
As nurses, our priority was to give patients and families due respect and to support their present status as research subjects. At that time (60s) their stay in the hospital was long. Once accepted under the research protocol, all healthcare was provided for them till death. Thus we got very close to the patients and their families. I've held many hands and talked to oh so many patients at their life's end.
I have 'war stories' and I have 'endearing stories' such as my daughter being named after the wife of a newlywed patient-Larry. I met them in 1962. Tana was a nurse as well and their beginning marriage was similar to mine. We still are friends 55 years later. I still remember so many names and stories from my work in Cancer Research and patients in later years.
In our healthcare society we have a legal term called "Informed Consent". We also have the legal process of Informed Denial/Withdrawal whereby the patient or surrogate decision maker has the legal right to refuse treatment and/or accept treatment.
In reading some of the earlier notes, I felt saddened by comments of mistrust in the healthcare system and professional providers. Yes, there have been incidents that did not meet the Professional Standard of Practice. Yes, Safeguards do need to be in place in all healthcare settings as well as accountability for poor practice. Throughout my professional career-- clinically and administratively-- I've advocated for a patient's right for self-determination. The healthcare professions are filled with outstanding individuals committed to the best interest of others they provide services to.
I believe that 'Death with Dignity' should be the mantra used today NOT Physician Assisted Suicide. A patient has the right for 'self-determination' that is balanced with the legal and moral standards in our country. I support the movement allowing personal choice on how one should spend their last chapter in life. I support Compassion & Caring's efforts for laws to allow a patient to end suffering at the end of their life. The bill to support death with dignity is being presented in CO this January 27, 2015. I will go to observe the process and support the bill. I will engage my representatives to tell them my story and experience with dying patients, family, and friends.
If the moderator of the program had used the phrase "assisted dying" or "physician aided dying" instead of the negatively loaded word "suicide," the result would have been quite different. A Gallup poll in May 2013 found that 70% of Americans favor allowing doctors to hasten a terminally ill patient's death when it is described as allowing doctors to "end the patient's life by some painless means." However only 51% support it when the process is described as doctors helping a patient "commit suicide."
The word "suicide" is loaded with horrible connotations - it has the same root as "genocide" and "homocide." It is associated with teenagers hanging themselves because they didn't get into the right college. This debate was about people who are already dying - that's what the laws require. It's time for the doctors to catch on ---- they are doing great harm when they allow dying people to suffer unnecessarily at end of life.
I'd like to hear how the undecideds were swayed against. The final statement was so frustrating -- I'm very grateful for the debater's mother that she was convinced that her life was worth living and that worked out for her. But it's not an argument against making assisted suicide available. The debater's argument seems to be that the mere possibility of assisted suicide will drive people to choose it against their better judgment. In this case, it's very difficult to imagine that a woman who was convinced in the course of a debate over the idea that she had a reason to live would have simply chosen to die had the possibility not been denied her. Instead, this woman may have been one of those such as were mentioned in Oregon, who kept the option at the ready but ultimately never used it. We need to give people the credit for thinking critically about a literally life or death choice, not presume that they will be too dumb to decide whether life has value, and thus we must keep the decision out of their hands.
Dr. Shulmasy's arguments sound insincere to me. He claims the most common reasons given by people wanting to take their own lives is being a burden and not being in control. I have seem many people stuck in such a degrading vegetative state that few of us would want to go on like that. I think there are financial politics at play here. Dr. Shulmasy makes his living by caring for the (slowly) dying. If too many people were able to end their lives with the help of a physician, Dr. Shulmasy's income might decrease considerably. I don't care for his reasoning.
Isn't the question more whether there is open communication with your doctor? Doctor's need to trust their patient's opinions more.
In all honesty, I cannot fathom how this is even a debate. It should be a deeply personal choice, and it's so offense when I hear others claim that Brittany Maynard made the wrong choice. For whom? You? Why do you get to give your opinion, and really, who asked for it? If you've ever watched someone with terminal cancer slowly die like I have (I led a cancer support group for those with terminal cancer for many years), then you would understand just how ridiculous this "debate" is. I've watched lovely end-of-life transitions at the hands of those terminally ill--absolutely beautiful celebrations of their life. I've also watched terrible end-of-life transitions where the family is left in horrendous medical debt, exhausted from sleeping in a hospital chair, and broken. In this day and age where our health care insurers practically decide whether we're comfortable with the best drugs or hurting because they won't cover those specific medications, it's offensive that armchair quarterbacks are judging whether this should be legal or not. Like the argument with gay marriage: If it bothers you that someone is planning a death with dignity, don't do it.
I am somewhat bemused that fence sitters swayed against. From where I sat Singer & Solomon offered a stronger argument - while I was already for the motion I found myself decidedly more in favour following the debate. Still young at 27, I am lucky to have avoided terminal illness or chronic pain thus far, but have such empathy for those that are suffering. I would like them to have the option to choose (and for me to potentially have in future).
Why is it that with matters pertaining to suffering the human species treats other species more 'humanely'??
Brittany asked the poignant question of WHO had the right to deny HER the right to die in her own terms. Denying her such choice means imposing others' convictions (religious or other) on her. She was even clear that she did not advocate her choice as the right one for everybody. Everybody should have the right to choose when the time comes, and that choice should be personal and based on one's convictions. Religious or other kind of beliefs CANNOT inform legislation; in so doing, government would be endorsing the views of one particular religion or set of religions on the whole of the population. Those who are AGAINST assisted dying should simply not take it, but leave the rest of us decide without interference
I suspect that one's decision on how to end life is tied in closely with how one lived life. If life has been one of constant struggle, ugly childhood and you have received very little help of any sort along the way to make things easier, OR if life has been one of success after success, absent of any financial worries, plenty of friends, travel -- all in all a very happy one -- and you know you did it all by yourself, then you will probably choose what to you appears the easy way out. In the first case the person figures they have put up with enough suffering, and in the latter, they figure what's the point in suffering, I haven't done it or avoided it as much as possible so why put up with it now. In both cases, the lives they have led have tended to be self-centered and that's what will determine how they choose to go.
On the other hand, taking the lives of both of the above cases and changing one significant component, the outcome would be very different. But that component is the hangup for so many because it means surrendering to another how one chooses to lead one's life including how to end it. The other choice is to consider oneself as a signficant (NOT isignificant) component of the human race whose actions, moment to moment, have an impact on other human beings for better or worse. This awareness plays a sifnificant influence on the choices you make.
Some of these choices -- indeed many -- will cause you incovenience perhaps significant inconvenience, yes maybe even suffering. But what drives you is the feeling that that is the correct thing to do because it is benefitting other human beings.
To reach this state of mind is almost impossible to do without a good reason for doing so. Many of us have found this through a growing awareness of an infinite being who has communicated this lesson of how and why one should lead their lives for the benefit of the whole human race. This infinite being has been the source of our life, has communicated to us how we should lead that life, and yes, has communicated to us how we should let Him end our lives -- the life He gave each of us in the beginning.
In today's modern world there are available pain relievers so that those who are suffering agony from their illness or condition can be made pain free. Think Hospice.
"When the Son of Man returns will be find faith?" The decision has been I the hands of our creator since I he beginning of time. What makes it right for us to assume that responsibility now?
I support this legislation but I wonder if it should be called "Death with Dignity". I understand that the dignity lies in having the choice, but I think it implies, if unintentionally, that those who do not choose assisted death have lost their dignity.
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