No one can charge the advocates of assistance in dying with stoic acceptance of defeat. Every two or three years they return to their cause with conviction, but the flaws in their arguments remain the same. We freely grant that most of those who favor “choice in dying,” or assistance by physicians to hasten death with lethal overdoses of medication, are motivated by an honest desire to relieve-or end- intolerable suffering. I cannot support their efforts for several reasons.
First, I believe that the idea of “autonomy” as the absolute unconditional power of individuals in all matters of life and death is wrong. In fact, each of us lives in a matrix of relationships with others: family, work, spiritual organizations and so forth. We all have responsibilities as well as rights, and our goals of care we choose for ourselves in consultation with others. Moreover, the ending of our life by choice may be seen as a cold, angry rejection of attempts to help and support us in suffering. If a brother is about to jump off a bridge to drown, is my impulse to pull him back or give him a compassionate push into the dark river below? Laws like this steadily erode the ancient role of family, the original non-governmental organization, and substitute the all powerful state in its place.
Second, there is no effective or practical way to grant a “right” to a small subgroup of alert, rational individuals who choose death. In all societies this exclusive right will become a general one, so that persons who are distraught with grief or world-weary in the extreme will demand sound access to quick and painless death, even though they are not terminally ill. The expansion of the “right” in Holland and Switzerland –progressive, advanced nations–is evident and includes euthanasia of children and adults for intractable depressions, seizures, and developmental disabilities. Inevitably the “right to die” becomes a duty to die and attempting to put this genie back in the bottle fails.
The cleverness of assisted suicide proponents is shown by their advocacy for patients with heart breaking neuromuscular disease or agonizing metastatic cancers. Once the door is opened here, it will open wider and wider. This explains the extraordinary fear and anxiety among people with progressive, chronic, non-fatal illnesses. They wisely fear the creeping growth of assisted dying and are acutely aware that politicians and their physician enablers will start “quality of life” discussions which may result in curtailed access to “futile care.” Disabled people can judge their own quality of life, and they remind us that in a good society the weak are safe and the strong are just. Disabilities concentrate the mind wonderfully: behind the “quality of life” smokescreen they see shadows of the Nuremberg laws and the “cleansing” from society of “life unworthy of life.”
Finally, I have promises to keep. Fifty- one years ago I took the ancient oath that I would not kill any patient, nor harm anyone by doing procedures for which I was not trained. The Connecticut State Medical Society was founded in 1792 and has always been a Hippocratic professional society. Recently, however, the CSMS has adopted a position of “neutrality” in the fight against assisted suicide. “Neutrality” in this context signals our patients that we are selling out one of the core values of Western medicine which we inherited from physicians who lived as long as 2,500 years ago. We had promised to pass the oath to those who will practice when we are gone; but the chain is breaking, and so is my heart. With great reluctance and sadness, I’m announcing my resignation from the CSMS.
Our choice, if this bill becomes law, will be the choice made by Dr. King and by Mahatma Gandhi: civil disobedience, defiance, and peaceful resistance.
By the way, you should know that the Canadian assistance in dying law demands that if a physician refuses to obey the law, the physician must obtain the services of a colleague who will assist the suicide or face sanctions, loss of privileges, and loss of license. Look it up.
Joseph F. Andrews Jr., MD, is from Trumbull.
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