The Globe and Mail has an editorial saying “Make the right to die legal, with protections.”
Time and again, opinion polls show a large majority of Canadians support the idea that the terminally ill should be able to decide when and how they die. They believe that competent adults in unbearable pain, suffering from an illness that will never improve, have the right to die with dignity.
And yet the Canadian government is no closer to resolving how – or if – to reform the law against euthanasia; no politician is brave enough to champion such a contentious cause, or even to launch a national debate probing public opinion.
But if that’s what the polls show, why does it take bravery? Why is the cause so contentious?
No doubt because it’s not a matter of majorities but of religion and religious influence. Religion, you may possibly have noticed from time to time, has power and influence that is out of proportion to its popularity. This is all very suitable, no doubt, because its power and influence Come From God, meaning, they are not Of This World, so naturally they get to trump measly stupid little humans.
Research shows that, in places where assisted suicide is legal, there is an initial spike in requests. However, the number then diminishes. “Many people, once they know that if all else fails, this is an option, they won’t make that call. The stress is gone,” says Udo Schuklenk, a Queen’s University professor who chairs the Royal Society’s committee on end-of-life decision-making in Canada. The committee will release a report this fall.
“Often when people talk about end-of-life decision-making, the assumption is, it’s about pain,” he adds. “But it’s not. The concern is more about losing control over the quality of their lives.”
Quite, and it’s a reasonable concern.
I wrote about euthanasia (in Canada) back in 2009, after my dad died. http://filsalustri.wordpress.com/2009/10/07/in-defence-of-euthanasia/
That’s a beautiful piece, Fil.
Udo has a good post on “slippery slope” arguments against assisted dying.
http://ethxblog.blogspot.com/2011/08/how-not-to-argue-against-assisted-dying.html
Yes, why does it require “bravery?” Why, for the same reason it requires “bravery” here in Vermont. The least religious in the nation with the highest number of self-declared “no religion” citizens. 64 percent of Vermonters support the right-to-die legislation that’s been introduced in recent years. Yet it doesn’t pass.
Because of the fucking Catholics. The 25 percent of our population whose voices count more, apparently, than the vast majority of voters. The church meddles every time, and our media and lawmakers given them craven, outsized deference in the conversation.
I cannot imagine why. The church is in a moral and PR shambles, Catholics are outnumbered by the irreligious — what possible consequence do our lawmakers think could happen if they ignore the Catholics? Seriously. . I don’t get it. Maybe Eric has some ideas?
Ophelia, thanks for the kind words.
Josh, I think the bravery is required if one intends to remain in office; that is, supporting this sort of thing is political suicide. Of course, *that* is because of the pervasiveness of religion. Conversely, though, one might also argue that experts are no longer trusted as they once were. And that, I think, is largely due to a general degradation in the educational system (in North America, at least).
There’s also some evidence that religiosity and intelligence are inversely related (e.g. http://onefuriousllama.files.wordpress.com/2011/09/lewis-ritchie-bates-2011-the-relationship-between-intelligence-and-multiple-domains-of-religious-belief-evidence-from-a-large-adult-us-sample.pdf) but “intelligence” is a slippery creature. It’s also true that scientists tend to be non-theistic (http://www.stephenjaygould.org/ctrl/news/file002.html).
This is a long way (sorry) of saying: it’s not as simple as blaming catholics. If we’re ever to understand the problem well enough to address it meaningfully, then we’ll have to understand all the effects and interactions – more than just those I’ve suggested here. Our societies are “complex systems” and we’ll have to understand them as such to improve them intentionally.
Oh, you’re right, it’s all those things, and it’s not just the Catholics. I didn’t mean to imply that’s all it was.
But I *do* question whether supporting euthanasia really is political suicide. Really? Given the numbers I cited above for my state, isn’t it possible that’s just a hang-up we need to get over? Was it political suicide for the Oregon legislators who passed it in 1997?
Josh,
Maybe I’m just old and cynical (in fact, I’m sure I am), but it seems to me that even the most sensible people can be made out to be idiots during an election – and the most blithering idiots can be made out to be statesmen. Rick Perry comes to mind in the latter category. I also think the press has not been supporting Obama as much as they could/should. The play up preposterous stories that undermine the respect people should have for him.
I would also remind you of Churchill’s quote “The best argument against democracy is a five-minute conversation with the average voter.” Now he was apparently referring to a specific kind of democracy (I forget which exactly), but the point remains. If, as I contend, most voters haven’t a clue what’s really going on, then it also stands to reason that they’d be quite gullible.
Or maybe I’m just too cynical.
I’ve wondered about this issue before – despite being very much pro-autonomy, I’m worried that it would be nearly impossible to build a system that could accommodate assisted suicide while effectively preventing all screw-ups. There’s a huge danger of “assisting” people in unwanted death. For just about any real-world medical test you’ll get false positives and false negatives. What happens when the false positive translates to “We thought this person wanted to die but really they didn’t”?
There are precious few diagnostic tests that can boast a specificity of 100%. If loss of control is the primary reason that people would ask for help dying, then the people who will want help most are likely to be the people who are least able to clearly and independently articulate their preferences and participate actively in the process. Should rational people be able to decide to die? Easy; yes. But what do you do when perfect results are unlikely? Even if we remodel the Hippocratic oath into something more realistic (Do the miminum amount of harm possible) I think I’d rather not kill someone who wants to die than kill someone who doesn’t.
Jess, you seem surprisingly unfamiliar with the process. Have you not heard of advance medical directives? Emphasis should be placed on the word “advance.” In every state they must be completed by someone of “sound mind”, without duress, and anyone with a conflict of interest (a doctor, for example), cannot co-sign as a witness. The laws are all worded differently, but they all accomplish this.
Did you just not know that?
My guess is in Canada, and most everywhere else, they believe the clerics when they make noise about how many voters they speak for. But clerics are tricky and dishonest. They don’t count bums on seats.
Look at Scotland. The Catholic church is making threats about all the voters it controls. But… they are using (baptisms – deaths) as the source of their numbers not (church attendances) and even (church attndances) would vastly overstate the number of people who feel a cardinal can tell them how to vote.
Politicians need to wake up to the fact that the churches only have the influence politicians are willing to give them. And that bowing to the clerics far from being a vote winner these days.
Jess & Josh,
You’re both right.
Jess, nothing is perfect. Sorry, but so what? There are some people these days who act as though the only safe acts are those with zero risk. That’s just not possible, and such people are entirely deluded. I attribute that to poor education systems that don’t teach kids about statistics and probability.
Josh, you’re right too; there are plenty of checks & balances in place to prevent the kinds of errors that Jess points out. These are relatively easy to define, especially since the mechanisms for them already exist in other forms (e.g. lack of coercion, no conflicts of interest, etc). The problem is not the mechanism, but the… special status that life and death have when compared to other decisions we make.
It’s understandable – self-preservation and evolution and all that – but those kinds of feelings and drives were needed back when we couldn’t think rationally and didn’t have technology to help and protect us. Now that we’re better – and in my mind there is no doubt we are, on the whole, better now than ever before – we don’t need the baggage of those feelings and drives.
Gordon,
That sounds like a reasonable explanation. The Canadian churches (catholic predominantly, but also others) tend to sound as if they speak for everyone – even atheists, since they need to worry about our salvation as well as their own.
And people still – still, even after all the buggery and other criminality recently uncovered about priests – think that priests are to be trusted. That’s a big part of it here too.
*sigh*
I don’t know how I missed the editorial, and didn’t pick it up till this morning, and you got there before me, although before coming over here to B&W I did put up a very short post about it. However, this is a good discussion, as is Fil Salustri’s story about his father — thanks Fil — and the reference to Udo’s piece. Which reminds me, Udo was heading a study by the Canadian Academy of some such on assisted dying. Is there any sign of that? (I haven’t done a search of his blog, so it may be there — this is just a quick jot to express my gratitude for highlighting this.) Things seem to be moving though, at long last, and more people seem to be putting the point straight up, with the marginal note about the influence of religion here.
This still takes courage by politicians, because churches, while they may not have as much power as they imagine, do have access to a lot of people at election time. And the Roman Catholic Church is almost frenetically active all the time. When Parliament “debated” Francine LaLonde’s bill last year and earlier this year, it was obvious that those arguing for it were making concealed (and sometimes not so concealed)religious arguments opposed to it. A large number of MPs are religious, and this extends even into the NDP. Another feature is the fact that one church, the RCC, has a diplomatic representative in Ottawa. The effect of this, I suspect, is underestimated very often. There should be some way to bring this institution to an end. It is wrong for a church to have diplomatic representation in the capital. How do we even begin to fight against this?
Fil, your story about you and your father as he was dying is a remarkably thoughtful testimony to your own fear and indecision about what your father saw so clearly. It’s something that I can resonate with. The passage that I thought most perceptive is this one:
It’s true, look into the eyes of someone who is dying, and wants the suffering to come to the end, and you will know. It is not a difficult thing to identify, but it is a difficult to know what to do once you have recongised it.
My own mother was in this situation for nine months, and I didn’t know what to do. She had a bowel obstruction (a tumour) and her bowel ruptured. Instead of doing what her living will asked, the surgeon operated, and she spent nine months on a vacuum dressing, until, finally, too weakened to fight any longer, she died. Every time I went to see her she would say, “I shouldn’t be here.” She woke up in the ICU with the same words. I tried to think of a way that I could help, but, under the circumstances there was nothing to be done, our laws are so tight, and hospitals make it impossible simply to say, “I’ve had enough”. Besides, the rest of the family continued to try to convince her to go on living. And yet, every time I went to see her, she would say, “I shouldn’t be here.” And so she was forced to endure 9 months of torment that she thought, by making a living will, that she had made impossible.
It is simply ridiculous of people to say that the vulnerable would be put at risk. It’s not hard to tell when someone has had enough, and if we could talk about it freely, they would tell us clearly what they want. We need the law to be changed, so that we don’t have to play this song and dance around the bedsides of people who, given the chance, would express their wills clearly. The mad part is that it is the living and whole whose fear of death is holding up laws that would relieve the sufferings of so many.
I think if left to themselves a fair percentage of catholics, and other religionists, would actually go along with a law that permitted euthanasia with “sufficient” controls. Many catholics I know, in and outside my family, no longer believe that suicide is a grave sin any more than they think sex before marriage is bad, or abortion is always sinful. The problem comes when the RCC executive hierarchy gets into the act, exerting unconstitutional political pressure on legislatures, as we have seen so often lately. The answer to this is to remove their tax-exempt status whenever they use their corporate muscle to interfere unconstitutionally in politics. Same goes for any other religion. They’d quickly learn to STFU.
Thanks everyone for your kind words about my dad’s death.
Since there seems to be a theme of the impact of religiosity on this, I’d like to offer up 2 of my pet peeves in that regard.
1. The fundies are being disproportionately vocal on these issues, for all the wrong reasons. So it (a) can appear there’s greater conflict than there actually is, and (b) they are influencing a number of moderates who, lacking better information, are being swayed by their foolishness.
2. The church – esp but not only the vatican – is remaining too quiet on these matters. I see this as very harmful, and I attribute it to their false assumption that keeping people believing in god is better than the alternative, regardless of the falsehoods they may spread in doing that.
I sincerely believe that it must be made more difficult to spread actual lies. Canada has certain restrictions on “free speech” that (tries to) prevent hate speech, and also the spread of lies. The idea is that anyone can say anything so long as it’s demonstrable that one didn’t know it was a falsehood. One must then stop saying those things. Of course, there’s a lot of gray, and one must err on the side of freedom in those cases. But, for instance, young earth creationists are clearly wrong about the age of the earth. That is, imho, entirely off.
The problem is, Fil, that the fundies have all sorts of representation in parliament/congress. And the more loudly they shout the more those representatives listen. The problem with the campaign to liberalise our laws regarding dying is that the whole thing is still bound up with religious prejudices. It’s not that the church is silent. The church, including the Vatican, has been very vociferous on these issues, and continues to fund organisations — huge numbers of them! — which active campaign against change. The dying, which is the interest group involved, is a group that is constantly going through new members, so they can never become a real pressure group. The only thing left is for the majorities that keep turning up in the polls and surveys to become politically active in order to see this change accomplished.
Sounds like a job for The New Atheism. Your assignment: shout louder than the fundies do.
Hey, I’m tryin’! I’ve even started a new blog for this: http://replacinggod.blogspot.com/
I do think that the problem with respect to this issue has more to do with the feelings of the politicians themselves than church pressure or fear of a voter backlash. Pressure from the church was enormous when they passed the same-sex marriage law, and there’s more fear of backlash from progressives than conservatives (cf. the lack of abortion legislation). A lot of our politicians are themselves religious though and don’t like the idea of sanctioning homicide. But maybe we will finally get some rational end-of-life legislation at the end of this. It will happen–maybe once people see it working in Quebec (if legalisation of euthanasia happens there first, which it might), or if another Sue Rodriguez case goes to the SC (which could happen), maybe via federal legislation once we get a progressive government back in power, or perhaps even sooner than that (it is cheaper to let the aging population die on their own terms than imposing unwanted and expensive palliative care upon them, and that just might appeal to Conservative governments groaning under the demand for health care money).
For all intents and purposes, my grandfather drowned to death in the hospital while the doctors looked on. He had emphysema, due largely to smoking for most of his life, and with his age combined with the condition there really weren’t any treatment options available to him.
When it got to the point where he was in the hospital and there was no going home, the doctors administered morphine to ease/calm his breathing. As his breathing became more difficult, they increased the dosage. In the last few weeks he was on such high doses of morphine that he couldn’t remember his own children.
Slowly, over the course of months, a man whose few fears included drowning, drowned to death on his own lungs.
My mother (who is the daughter of the grandfather mentioned above) told me once that what the doctors did was, more or less, a form of assisted suicide. I was fairly young at the time and given the dosage of morphine it wasn’t hard to imagine that my grandfather was effectively dead before his heart stopped beating….but he was still responsive, to a degree. He knew you were there and could communicate in a limited fashion. To this day I have a borderline phobia of hospitals, and I really think his prolonged, morphine-addled life made his death even harder than it already would have been, on the family included.
I think my little rant has gone on long enough, and at least vaguely alluded to a point, so I’ll stop here before it turns into a diatribe.
PS: Coincidentally, I’m from Royal Oak, MI, former home to the late Dr. Jack Kevorkian, so this kind of attention to the subject is 15 years late in coming in my opinion.
Chris,
That’s a sad, sad story; my condolences to your family.
This is an important feature of the palliative care issue: in many cases, the “treatments” can relieve pain, but that just leaves the patient to suffer mentally. In other cases, as in Chris’s grandfather, the treatment is closer to torture. I think the underlying common theme here is that society wants the dying people to just die quietly, without disturbing them. I find that cowardly and selfish. We need to be stronger, and we need to help those who choose to die on their own terms.
Fil and Josh,
Thanks for your comments.
Fil, I’ll be the first to agree that statistics are often poorly understood and that in most situations a zero-risk tolerance is ridiculous. It seems to me like we differ at two main points: 1) whether we can refine a system sufficiently to prevent all error, and failing that 2) whether murder is an acceptable risk for an elective medical procedure.
Having advanced directives about how to euthanize and when would be reassuring but still not perfect. Having a patient in sound mind with a terminal illness and a sane family (uncommon!) also would make things easier, but even this isn’t perfect. My confidence in the “checks and balances” you mention is rather less than yours; I suppose we could try to make a crack-free system that would stipulate that suicide assistance be offered only to terminally ill geriatric patients with unambiguous wishes and either no or very transparent family/support persons. People rarely come so neatly packaged, and the systems of checks and balances that I’ve seen in medicine leak a lot (in the US, anyway; a universal health system would probably help).
Assuming for a second that some failure is inevitable, what you’re suggesting is a very different thing than doing any old procedure that carries a risk of death, and it’s also very different than DNR orders, as a person who is acutely dying has in a sense chosen and effected it for her or himself. Regarding your question “Sorry, but so what?” – I’ll have my MD in a couple years, and frankly, I am not ok with doing a procedure that has a greater-than-zero risk of making me a murderer, and one of my patients, my victim. One needs no imaginary god friend to rigorously err on the side of not actively depriving sick people of wanted life.
Jess,
On your first point, “whether we can refine a system sufficiently to prevent all error” I think the answer is a resounding ‘no.’ At least, that’s my answer.
As to the other point, I’m a little confused by the use of ‘murder.’ My understanding of murder (which might be wrong) is that it includes 2 key characteristics: being unlawful, and being premeditated.
Right there, there’s an opportunity. That is, if assisted suicide were made lawful, then it’s not murder.
Also, you wrote: “I am not ok with doing a procedure that has a greater-than-zero risk of making me a murderer, and one of my patients, my victim.” I’m glad you think this. Death is as a general rule a bad thing under any circumstance. However, I’m unconvinced again of the use of ‘murder’ here. *Except* for assisted suicide, I can’t see an MD premeditating to kill one’s patient. You might someday accidentally kill a patient (though I hope that never happens to you or your patients), but that’s not premeditated killing. Indeed, if you premeditated anything, it was to attempt to save a life.
So, I’m inferring that you’re only not okay with assisted suicide because that would make you a murderer? Am I understanding you correctly?
Your last statement is important too: “One needs no imaginary god friend to rigorously err on the side of not actively depriving sick people of wanted life.
100% agreement there. But what of people with *unwanted* life?
It always come back, I think, to two fundamental questions:
1. Is a person’s life so sacred that it is worth preserving even if that preservation entails torturous suffering by that person with no hope of respite? I would say not. There must be an opportunity for that person to end their life and thus end their suffering. What is to be gained by extending their suffering? I have no idea.
2. Should doctors be charged only with preserving life at all costs, or with helping people live *well* for as long as possible and no longer? I would argue for the latter.
Though I hate hypotheticals, I’m going to use one. Sorry. Also, set aside all legal aspects.
Two palliative patients, both in equal and excruciating pain.
One wants assisted suicide; the other does not.
But neither have made clear whether they want assisted suicide or not, so medical staff don’t know which is which.
Neither patient has families.
The one wanting assisted suicide is intentionally denied assisted suicide; the one NOT wanting assisted suicide is killed without additional pain from the killing itself.
Both are definitely “mistakes.”
But which is the worse mistake?
I believe in this case, forcing a person suffering against their wishes – when nothing else can be done and death is the only and certain outcome – is worse than killing an equally tortured person who wants to live. This is just what I believe, not something I can say factually. I believe this because there is nothing to be gained by letting a person suffer if the next step is death.
So, since mistakes are inevitable, I would rather those mistakes err in favour of those who want to die with dignity.
I welcome all comments on this.
Finally, in any case, I would not suggest anyone assist in the suicide of another so long as it’s illegal.