• Uncomfortable choices
    May 02,2013

    None of the options in the debate about end-of-life choices is likely to make legislators or the public comfortable.

    The bill passed by the Senate and the one moving toward final passage in the House vary widely in their approach, reflecting the lack of comfort that legislators feel. They will have to resolve their differences to produce a bill, or the status quo will continue, which itself will make many people uncomfortable.

    The status quo troubles people because patients with terminal illnesses, suffering extreme and irremediable pain, who wish to obtain a medication that will hasten their deaths must do so within the shadow of illegality, endangering the professional status of the physicians who choose to help them. Presently, these decisions occur furtively and with an overlay of guilt.

    We can argue that people should not seek that ultimate recourse and that physicians or family members should not help them die. But it is what happens, and it will happen as long as death singles out a certain number among us for a painful and unendurable end.

    The Senate has passed a bill protecting health care providers from legal retribution if they are involved in helping a patient end his or her life. The Senate bill makes people uncomfortable because it does not define a humane process for helping people at the end of life. Backers of the Senate’s version of the bill insist that the state should not involve itself in that process.

    The bill moving toward final passage in the House establishes a process like the one in Oregon and Washington allowing physicians to prescribe a lethal dose for a patient who has met strict criteria. The patient must have received a diagnosis of terminal illness with six months to live or less; must be in sound mind; and must have made the request three times, one time in writing. The patient must administer the dose himself or herself.

    In Oregon and Washington there has been little indication of dire consequences. Still, this bill makes many people, even some of its supporters, uncomfortable. Critics worry that putting the stamp of state approval on suicide, even for people at the end of life, devalues life and may send a message that suicide is a legitimate way out. They worry that depressed young people will get the wrong message.

    Critics also worry about a potential slippery slope toward euthanasia. And they fear that the existence of state-sanctioned suicide will create pressure for ill people to make a quick exit and that heartless relatives could push people toward that exit. They worry that a terminal diagnosis is often mistaken and that people sometimes live for years beyond the time when it was expected they would die.

    These are all real and legitimate reasons to be uncomfortable with the legislation. No one wants dying people to feel obliged to depart. No one wants to suggest that anyone is not deserving of the most heroic efforts, the most steadfast support and enduring love that family members and caregivers can summon.

    Supporters of the bill must acknowledge the discomfort created by the bill and by the process it outlines. What allows them to persist year after year on a topic that many might wish would vanish is that the bill is meant to create a choice that people may or may not avail themselves of. Ultimately, lawmakers will have to choose which option makes them the least uncomfortable.

    Rep. Thomas Koch, of Barre Town, spoke out against the bill but unwittingly expressed an argument in its defense. He said it was the “antithesis of medical care” and was a form of surrender.

    Surrender is accurate, but if part of medical care is the easing of pain, then it’s not the antithesis.

    “It could be compared to the employee in the process of being fired saying, ‘You can’t fire me; I quit,’” he said.

    In facing up to the inevitable, people struggle to maintain their dignity. Quitting instead of being fired is one way they do it. Surrendering to the inevitable does not come easily, and people seldom know what is truly inevitable. But for some people, at some times, the humane choice is to let them decide.

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