The subject of Medical Aid in Dying (MAID) recently came up in a well-written and emotionally appealing article entitled “CT must no longer delay compassion at the end of life” published by the CT Mirror on July 29 . The article defends its position well, citing multiple justifications for why passing such legislation would be beneficial rather than harmful.
Notably, it fairly draws the distinction between physician prescription and physician administration. However, in its attempt to minimize the impact of a MAID law, it doesn’t go far enough in explaining how such laws, when passed elsewhere, have been able to subsequently expand by broadening eligibility criteria and other forms of recontextualization.
I would like to offer a different perspective for consideration after first exploring the roots of our current worldview on this subject. As a consequence of the European ‘Enlightenment’, several important changes were set in motion in Western culture regarding how persons and society were understood compared with preceding Western history and with the way much of the world still operates outside the West. For the sake of brevity, I’ll mention two: Persons came to be viewed (and to view themselves) more individualistically than communally, and progress was defined more materially than metaphysically.
We usually focus on the positive aspects of individualism — and its corollary, personal choice — as a bedrock tenet of American culture. Yet many prominent public observers, including Sen. Chris Murphy and Gov. Ned Lamont, have recently drawn attention to the “Loneliness Epidemic” that is currently sweeping our country. I do not mean to draw a direct correlation between medical aid-in-dying and loneliness (nor do I mean to exclude one), as these are complex subjects; I merely wish to suggest that the two phenomena share common denominators — lone agency and a sense of resignation — and that their synergy may potentially result in negative mutual reinforcement.
The Enlightenment’s focus on rationalism produced unprecedented scientific and technological achievements. However, their benefits are not without negative consequences, a prominent example of which is nuclear technology, which has produced both nuclear power and the atomic bomb. Most technologies have pros and cons, depending on how they’re used. In healthcare, they have cured diseases, extended life beyond its natural limits, and artificially terminated it, but they do not ultimately determine the quality or meaning of life — or death.
Because we currently tend to solve problems and define progress by technological advancements, it is easy to turn to technology for answers, even to problems it has created. But unlike technology, human life is not mechanistic or reductive, but rather metaphysical — even mysterious — according to humanity’s view of itself through most of human history. The American healthcare system has many opportunities to improve people’s health and well-being. Perhaps we could reframe our questions (and our redirect our legislative efforts) to design programs to understand and improve lives rather than adopting technologies to end them.
On a personal note, as a physician, it cannot be overemphasized that our profession is designed for healing and has been for millennia. Physicians take the Hippocratic Oath (originating in Ancient Greece between the Third and Fifth centuries BC), swearing to do no harm to patients. Here is an excerpt from the 1923 Loeb translation: “I will do no harm or injustice to them. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course.” Presuming medical aid-in-dying has already been suggested, prescribing takes it a step further by providing the necessary authorization and provision, though it stops short of direct administration.
The public trust in the physician to promote healing rather than harm has imbued the ethos of medicine since ancient times. 1994 marked the first passage of a medical aid-in-dying law, Oregon’s ‘Death with Dignity Act’. We may ask ourselves: Over the course of the last 2,500 years or so, have we seen an abrupt increase in compassion in the last 32 years since the introduction of medical aid-in-dying? And if so, might we not feel even a little bit better as a society?
An interesting study was released earlier this year demonstrating that young people in the West are more unhappy than ever, particularly in several countries where medical aid-in-dying is legalized. “Out of 136 countries, young people ages 15 to 24 in the U.S., Canada, Australia and New Zealand rank between 122 and 133 for happiness.” The causes for this are multifactorial, but feelings of depersonalization from social disintegration play a role.
Again, I do not mean to draw direct correlations between such complex subjects, and cannot hope to do so in an article of this size and scope, but all variations on the theme of life’s meaning are worthy of our consideration as we consider changing course on a very consequential road in our state, and which should perhaps inspire us to redirect our attention to root causes of deeper woes.
Thomas Mezzetti MD lives in Burlington.