Death with “Dignity”- Physician Assisted Suicide

September 10, 2004

Although I have spoken about this elsewhere, I wanted to post some ideas about Oregon’s Death with Dignity Act here.

Via healthlawblog, anop/ed piece in the New York Times this summer discussed Oregon’s Death with Dignity Act. After telling one of the horrific stories typical of those who support Oregon’s experiment (capable man incapacitated with crippling painful terminal disease, doesn’t want to go on living like that, able to “die with dignity” by taking a lethal dosage of medication prescribed by OR doctor under OR law…) and ranting about Attorney General Ashcroft’s attempts to get the law overturned, here is what Mr. Kristof concludes:

The Oregon law deserves to be upheld. It forces us to examine the question of what is special about human life. The answer, I think, is the autonomy and dignity inherent in our individuality — in making hard decisions for ourselves and determining our own destinies. Oregon honors that vision of what is sacred about life.

Autonomy (one of the four basic principles of biomedical ethics proposed by Beauchamp & Childress) is important, and I also believe it is inherent in our individuality. But life (as well as the ethical obligations of non-maleficence and beneficence) is also important, and there are many religious and philosophical reasons for protecting it. I think most religious and philosophical traditions would allow a person to exercise autonomy in refusing medical treatment for terminal illnesses (and legal precedent in the United States supports this idea as well).

However, refusing medical treatment is a far cry from intentionally drinking a lethal dose of medicine to end it all (“with dignity”, mind you). When one drinks a lethal cocktail like the one prescribed to the patient in Kristof’s piece, one drinks with the intention of ending life. When one decides not to allow medical treatment for a terminal (or other disease), although the result may be the cessation of life, the intention is often to simply let nature take its course and live for another 2 years or die tomorrow.  Indeed, intentionally bringing about one’s own death by drinking a lethal concoction or otherwise is different enough from refusing medical treatment or demanding that medical treatment be stopped that in that instance our concern for protecting against the intentional ending of human life ought to outweigh the concern for personal autonomy. We let it happen in outlawing suicide– and as I mentioned I fail to see a reason (or value) to allow autonomy to outweigh protection of life in this situation as well.

If the reason for allowing a patient to hasten death by drinking a lethal cocktail of drugs is to palliate pain and not have to undergo futile treatment that would sap dignity, that concern is addressed by allowing a patient to forego medical treatment and take pain killers (though not in a lethal amount) to alleviate the suffering.

I think the Oregon law is a travesty and that it ought to be repealed. It allows what no other state has ever allowed under any circumstances- suicide. The intentional killing of oneself. It excuses physicians from what has typically been a crime- assisted suicide. Finally, it seems to me to be against a doctor’s ethical obligation of non-maleficence to engage in such a behavior.

The so-called “Oregon experiment” was not even worth trying in the first place. The law seems unjustifiable and contrary to normative values in the United States. It should be repealed.

God’s will and personal autonomy

September 10, 2004

Upcoming large decisions in my life have caused me to once again wonder at the distinctions between God’s will and personal autonomy. Many, relying on the Alma 34 admonitions to pray about, well, nearly everything, would say that perhaps we should not do anything without the first feeling the Lord’s sanction. This leads to a sort of “Saturday’s Warrior” view on life, according to which we may find ourselves eternally hampered if we make a “wrong” choice regarding, for example, whom we should marry.

Many decisions in life are indeed vitally important, such as where to live, whom to marry, which career to pursue. While I do, of course, believe that the Lord can “direct [us] for good” when we trust in Him with all our hearts, I do not believe that for most people there is only one career to pursue or one person to marry. This is because I believe that the Lord grants us a good deal of personal autonomy, and even helps us to accomplish the righteous desires of our hearts- even the CHANGING righteous desires of our hearts.

The Lord in the Doctrine and Covenants tells us that

26 [I]t is not meet that I should command in all things; for he that is compelled in all things, the same is a slothful and not a wise servant; wherefore he receiveth no reward.

27 Verily I say, men should be anxiously engaged in a good cause, and do many things of their own free will, and bring to pass much righteousness;

28 For the power is in them, wherein they are agents unto themselves. And inasmuch as men do good they shall in nowise lose their reward.

D&C 58:26-28.

Taken in conjunction with Section 9:8-9, I take that to mean that I should make my own decisions, then present them to the Lord for approval. My experience seems to indicate that there are often a wide range of decisions that would be aceptable to the Lord, even regarding such questions as whom one should marry!

Shortly put, my belief is that since God wants us to be happy (see 2 Nephi 2:25), He allows us great latitude in following the desires of our own hearts, so long as they are righteous desires (which I suppose we find out by FIRST reaching a decision, THEN praying about it). Sounds good.

But then I read Elder Scott (GREAT talk, by the way, and WELL WORTH a read- especially if you too have a large decision looming), and worry that perhaps I take the Lord’s role in these things too lightly:

Have you noticed that when you have determined to accomplish a very important task, many other good ideas for other things to do seem to come to your mind? If they are allowed to interfere, they will distract you from the more important objective. I have found help by writing down those thoughts as they come, promising myself that as soon as I finish the important task, I will attend to them in priority. That practice helps me stay focused on those matters which are essential.

I believe there are times in your life when, because of your righteousness and your determination to do what is right, Satan will not be able to deflect you into serious transgression. He will switch then to the strategy of placing before you a banquet of good and worthwhile things to do, meant to distract you from those that are the most important and essential to accomplish in your life.

So, the trick seems to be distinguishing those decisions which are permissible exercises of my personal autonomy in following the righteous desires of my heart from those which would “distract [me] from [those things] that are the most important and essential to accomplish in [my] life.”

How do we then balance God’s will against our personal autonomy? Elder Scott urges that

as you pray for guidance, the Holy Ghost will help you identify those matters that are vital and necessary to accomplish above others. That means that at times you may have to set aside things that would be worthwhile and enjoyable to pursue–for those that are most vitally important for that period of your life.

This is frightening, to an extent. In making a decision such as the one I am trying to make right now, are my own desires speaking to me or it the Holy Ghost? Or is this one of those situations where either decision would be acceptable, and it is thus within the realm of my own personal autonomy to decide, and the Lord will bless and validate either decision?

Bloggernacle insights welcomed. I don’t want to shortchange myself of something that would be the “most essential and important” to accomplish simply because my personal autonomy may conflict with God’s will…