Once again, the Connecticut legislature is considering whether to make it lawful for doctors to write lethal prescriptions for terminally ill people who request them. Proponents call the concept aid-in-dying. They view it as a choice issue, much like same-sex marriage, an idea whose time has come.
Nothing could be farther from the truth. I say this as a progressive believer in individual rights and disability activist.
The recognition of same-sex marriage reflects principles of equality. A right and status freely conferred on heterosexual couples is belatedly extended to those who chose a partner of the same sex.
Physician-assisted suicide is discriminatory. Suicide prevention continues to be a value for the general population. Only persons deemed to have less than six months to live are eligible for lawfully lethal drugs. This sets up an inherently bad dynamic. If it is thought that life is so burdensome for some that it is rational for them to die before death is naturally inevitable, the targeted groups can be increased over time in accord with prevailing opinion. Why not add people over 90 or people with irremediable disfigurements?
Physician-assisted death would not exist in a vacuum. It would be an overlay on a medical system where there is an imperative to reduce costs, where many people are unable to access care and where many practitioners still have the prejudices or misconceptions that abound in society.
People with disabilities, for example, are too often seen as individuals with some type of defining, global characteristic that trumps the many other attributes they may have. Yet we tend to be people with an ordinary world view who do ordinary things such as attending symphonies or voting.
James McGaughey, former executive of Connecticut’s Office of Protection and Advocacy, has written in regard to cases where disabled persons faced denial of life-sustaining treatment: “Physicians… did not understand the prospects of people with disabilities to live good.. lives…and recommendations sometimes reflected confusion concerning the distinction between terminal illness and disability.”
People do have the absolute right to refuse procedures they find unacceptable. This is where true choice comes in. Yet, the doctor’s focus should always be on what more can be done for the patient so he or she will feel physically or emotionally better. Is there enough pain management? Has the full range of palliative care options and complementary therapies been suggested? What resources will allow the person to maintain independence longer? Prescribing drugs with the sole intent of helping a patient kill himself is not medical care. It is simply closing a book.
If physicians are allowed to enable death or indeed made to feel that they should enable death despite the oath they have taken to do no harm, everything on the treatment continuum will shift. The withdrawal of care, instead of being the endpoint of the spectrum, becomes middle ground. It is this possible change in medical culture akin to what has happened to the Netherlands that will put people with disabilities and other marginalized groups at risk.
This is so even if the safeguards placed in a physician-assisted suicide law are technically observed. Quite simply, the traditional medical goal of preservation of life will play second fiddle to a host of other goals, the least of which is patient autonomy.
At issue is the acceptance of diversity. We all must be able to consult physicians without fear that their recommendations and practices will be tainted by quality of life assumptions.
Sen. Edward Kennedy was told he had three months to live after brain tumor diagnosis. He lived for a productive 15 months. His widow, Victoria Reggie Kennedy, in explaining why she opposed Question 2, a 2012 Massachusetts ballot initiative to legalize assisted suicide, wrote “Senator Kennedy called quality, affordable health care for all the cause of his life. Question 2 turns his vision of health care for all on its head by asking us to endorse patient suicide – not patient care – as our public policy for dealing with pain and the financial burdens of care at the end of life. We’re better than that.”
Massachusetts, a progressive state, proved her right by defeating the initiative.
Connecticut, an equally progressive state, is better than that as well. We must act through our legislators to prevent physician assisted death from coming here.
Lisa Blumberg, West Hartford