Prescription Death: Refuting the ‘Right to Die’

As health care costs continue to rise and a growing number of Baby Boomers approach old age, end-of-life issues are looming larger than ever in the public debate. What is “the right to die”? How should we, as a society, approach questions of health care, treatment for the elderly, and euthanasia? The Patients Rights Council, formerly the International Task Force on Euthanasia and Assisted Suicide, is the nation’s oldest and largest organization devoted to protecting the rights of patients in all end-of-life situations, and so is on the front lines of the debate surrounding these issues. Margaret Cabaniss spoke with Jason Negri, the assistant director of the PRC, to get their take on the discussion — and what can be done to shape its future.

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Margaret Cabaniss: We hear so much about “the right to die” today; where does the Patients Rights Council stand on this issue? What rights are in jeopardy when we’re talking about end-of-life matters?

Jason Negri: It’s a misnomer to refer to doctor-prescribed suicide as “the right to die.” It sounds catchy, of course, and the other side uses it as a sound bite to garner support. When you come right down to it, we all have the right to die. The Patients Rights Council recognizes that anyone can legitimately refuse medical treatment; if a doctor ignores a patient’s wishes and provides him or her with medical treatment anyway, that doctor can be sued for battery.

But current discussions are not about an individual’s right to die; instead, the phrase is used by those who are specifically promoting death by prescription. We at the Patients Rights Council are concerned about allowing insurance companies and the government to get involved in a person’s end-of-life decisions — to offer death as a cost-effective treatment.

Think about what the long-term consequences of that would be: If we accept the argument that death by prescription is a civil right, then shouldn’t it be available to anyone at any time? Today, we’re only talking about people with a terminal illness, but why should it be limited to them? As we’ve seen with so many other things, what starts today as an individual right rapidly becomes an expectation for everyone.

Playing devil’s advocate for a minute: Couldn’t someone respond, “Well, no one is forcing you to choose this option; it’s a free choice, not an expectation”?

Well, consider a person who is battling severe illness or pain. People in these circumstances are already vulnerable to suggestion and pressure: In addition to their pain, uncertainty, or fear, many can also worry about becoming a “burden” to those they love. And, acting out of love, they might choose doctor-prescribed suicide to alleviate that burden — when in fact they could have recovered or enjoyed more good years with their families. Is that really an outcome we want for those we love the most? Is that choice really “free”? People need our compassion, support, and treatment — not our determination that their lives aren’t worth living.

And you believe the high cost of medical care factors into that determination?

Jason Negri

Absolutely. Once the crime of doctor-prescribed suicide is transformed into an accepted medical treatment, it becomes just like any other medical treatment — with one huge difference: It’s now the cheapest option. We’re having an ongoing national discussion on health care that is driven by rising costs, particularly the high costs of treatment at the end of life.  Already in Oregon and Washington, where death by prescription is an available “treatment,” there are examples of patients who have been explicitly told that their health insurance will not cover the cost of their life-saving medication, but it will cover a prescription for suicide. And leaders in the movement to legalize prescribed death have been saying for years that economics, not the quest for broadened individual liberties or increased autonomy, will drive assisted suicide to the mainstream of acceptable practice.

Doctor-prescribed suicide reduces the value of a life to a cost-benefit equation — and, like I said, pressure for those with terminal illnesses to just “get out of the way” and to “stop being a burden” on the rest of us is already huge. If doctor-prescribed suicide is not only accepted but suddenly also the cheapest option, the pressure to choose it will be overwhelming, especially to those already vulnerable.

Aside from putting pressure on the patient, what other dangers do you see inherent in legalizing euthanasia?

Well, death is final. For people battling illness, one day they may be ready to give up, and the next day they may be prepared to fight. This is just part of the human condition. Giving someone the legal equivalent of a loaded gun on a day when they’re depressed or in pain — like when they’ve just received a terminal diagnosis — is a very dangerous thing.

And, of course, people make mistakes, including doctors. Many of us probably know people who lived for five, eight, even ten years after they were told they had a terminal illness, and we’re grateful that they lived for so much longer. But on that day they received the terrible news, some of them might have wanted to end it all. Thankfully, the law prevented them from doing so with ease. What if they had had a doctor standing ready to prescribe death? What if family members had encouragingly nodded their understanding and assent, wanting to support them in their decision?

We can’t afford to make a mistake regarding death: There’s no reversing it.

Do you see people becoming more comfortable with doctor-prescribed suicide as a legitimate option?

Actually, for now, society seems to be trending in the other direction, based on the polls. Two years ago, when polled on this issue, there were more Americans who saw doctor-prescribed suicide as morally acceptable than there are today.

But it’s easy to see why some people favor it. Modern society has been conditioned to want the “quick solution”: When we’re sick, we pursue every medical option there is to keep us feeling young and healthy as long as possible, ignoring the fact that the human body isn’t designed to go on forever. At some point, things break down. But while we may acknowledge that in principle, we still want to feel as good as we did in our 20s. And when medicine can’t deliver on that false promise, it’s easy to throw up our hands and say, “Then I don’t want to live anymore!”

We’re also a very utilitarian culture, and very concerned with our self-image. So when we try to imagine not being able to do the simple things we enjoy now — or even perform basic functions like walking or bathing — we tend to think, “I wouldn’t want to live like that.” Doctor-prescribed suicide can seem like an “easy out.”

But it’s very common for people who cavalierly swore in their impregnable youth that they’d rather die if they could no longer do such-and-such to realize, when it actually happened to them, that they fiercely wanted to live. Humans have a remarkable ability to adapt to changing circumstances, and it’s dangerous to base public policy for everyone on how we feel in the prime of our health.

So what options are there between the extremes of doctor-prescribed suicide and just telling people to “suffer through it”?

Great question! Nobody should tell a patient to “suffer through it.” Catholics know that, in the Parable of the Good Samaritan, Christ didn’t tell his followers to ignore the man who was robbed, beaten, and left for dead on the highway. The judge and the Pharisee who passed him may have prayed for the poor man and might well have told him to “offer up” his sufferings. But the man who was praised in the parable is the one who actually went out of his way to help the victim and tried to alleviate his sufferings.

Experience shows that virtually everybody who expresses a desire to die actually wants to live, once you have addressed their problems. We need to offer proper medical responses and comfort care to those in need. Pain alleviation has made tremendous strides in the past few decades, such that no one should have to live in intractable pain. The Patients Rights Council has published a book called Power Over Pain, co-authored by a lawyer and a doctor who is board-certified in pain medicine. I highly recommend it to everyone.

What about before we reach that point? Is there anything people can do now to make sure their rights and wishes are respected in those situations?

I’d say, for anyone over the age of 18, make sure you have a well-drafted durable power of attorney for health care, which designates someone to make medical decisions on your behalf if you become unable to make those decisions on your own, either temporarily or permanently. It’s very important to note that this is not the same thing as a living will, which is a dangerous document, subject to interpretation by those who might not share your views and values or may not have your best interests in mind.

The Patients Rights Council has carefully crafted a durable power of attorney for health care called the Protective Medical Decisions Document (PMDD), with different versions available to comply with the various states’ laws. There is no charge for it, though we do ask for a small donation to offset printing and mailing costs.

The Patients Rights Council isn’t a Catholic organization, but obviously we share a common concern about a person’s right to life. What do you see as the best arguments against euthanasia that both religious and non-religious people can agree on?

We’ve discussed a lot of them already: the possibility of error, the reality of using doctor-prescribed suicide as a means of cutting costs, the pressure on those already vulnerable to get out of the way. From our experience, these are the most persuasive arguments for a lot of people. We need to remember that reasons grounded in Faith are important to those who are of that Faith — but our positions are well-grounded in the moral history of the Judeo-Christian tradition, and as such, our position is shared and supported by Catholics, Christians, Jews, Muslims, and people of different faiths, or of none. We’re talking about helping — not hurting — people, and that message transcends sectarian differences.

Margaret Cabaniss

By

Margaret Cabaniss is the former managing editor of Crisis Magazine. She joined Crisis in 2002 after graduating from the University of the South with a degree in English Literature and currently lives in Baltimore, Maryland. She now blogs at SlowMama.com.

  • http://www.bannonoceanart.com bill bannon

    Infallibly condemned and Catholics have no idea how rare that is….Evangelium Vitae:

    “Taking into account these distinctions, in harmony with the Magisterium of my Predecessors and in communion with the Bishops of the Catholic Church, I confirm that euthanasia is a grave violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person. This doctrine is based upon the natural law and upon the written word of God, is transmitted by the Church’s Tradition and taught by the ordinary and universal Magisterium.”
    …………………………………………………………………………………….
    Abortion is also infallibly condemned is section 62 of the same EV…..with similar wording. The Pope had polled all bishops worldwide by mail, email, etc….which made ex cathedra unnecessary.

  • Mike Walsh, MM

    Negri: “Once the crime of doctor-prescribed suicide is transformed into an accepted medical treatment, it becomes just like any other medical treatment — with one huge difference: It’s now the cheapest option.”

    Precisely. Originally sold under the aegis of “freedom”, abortion-on-demand now serves primarily to regulate the underclass created by poverty programs whose principal result (goal?) was an expansion of the federal government. In like manner, the promotion of death-on-demand is the first step in the attempt to solve a similar problem –the growth of mammoth unfunded entitlements– caused by a similar attempt to increase the scope of government. Sold first as “freedom” and even “mercy”, later it will be sold as “justice” and finally it will simply be mandated. You can pretty much count on it.

  • Anna

    Thanks for the PMMD link; it makes me nervous asking a lawyer who may not share my concern over the very real threat of involuntary euthanasia to draft as airtight a pro-life document as possible, so I’m happy to find a trustworthy one already written. Not that the “ethics” boards can’t cheerfully override it if they want, but it could still buy time…

  • mrd

    I am a pulmonary and critical care physician, orthodox Catholic and have spoken in my diocese about end of life issues. I have cared for literally thousands of patients who were on life support over the last 15-20 years. I have a particular interest in this topic.

    I certainly agree with the many of the concerns expressed in this piece and share the view that physician assisted suicide is immoral. I also think there is a valid concern that in a nation in which health care cost are exploding there will be some pressure to devalue the life of the elderly or disabled, especially the neurologically compromised. I do have several points to make:

    1) First all of us within the Church and the pro-life movement there is a need to recognize that not every withdrawal of life support is a form of euthanasia. There are clearly situations in which further attempts at prolonging life may involve methods which are either excessively burdensome or do not offer a proportionate benefit and thus may be withdrawn or not employed. These are “extraordinary means” of prolonging life. The Church recognizes this, and in fact Blessed John Paul II did as well, since during his final illness with sepsis he did not return to the hospital were the full panoply of life support equipment could be employed. Given the legitimate concerns this article expresses there are well meaning individuals who will be overly suspicious of recommendations from physicians that further attempts at aggressive treatment are causing suffering and not doing any good.

    2) In order to distinguish such situations from situations where a patient is pressured to omit ordinary means of preserving life (a kind of passive euthanasia, which is probably an order of magnitude more common then is physician assisted suicide) There are a couple of things you can do:

    a) Have as at least one physician regularly involved in your care, someone who is a practicing orthodox Catholic loyal to the teaching of the Church. I am saddened that this is rarely something Catholics specifically seek. Even orthodox faithful ones. It is important that this person is also technically highly skilled. Unfortunately this is not synonymous. I have seem at times good, Catholic doctors of an older generation simply lack the needed skills and knowledge to deal with these often complicated and difficult situations. Conversely many more recently trained physicians have marinated in a liberal, atheistic stew for college, medical school, and post graduate medical training, and think all religious belief is benighted superstition. Thus although there medical knowledge and skill is very great, morally they may be ciphers. The Catholic Church has been imploding for decades and this includes the loss of both Catholic medical schools and teaching hospitals.. So the situation is difficult and you need to shop around before you get ill. This is not to say each and every specialist or physician who cares for you need share our beliefs. This is not possible, but surely finding at least one who does often is possible. How do you know? Ask your doctor, tell them you feel this way, how easy would it be to care for you ? Does your doctor share any beliefs? In the absence of a Catholic you may be able to find a sympathetic Evangelical Christian or Orthodox Jewish physician who approaches medical moral issues similarly.

    2) Ordinarily do not have a living will. These often obscure the issues because they can not deal flexibly enough with the facts as they exist at the time. For example I have observed individuals at early stages of diseases which are ultimately progressive being made “do not resuscitate” inappropriately, since while at some point there disease may be terminal but they may still have several years to go . For example Emphysema. A 55 year old man with moderately severe emphysema, but still walking is a different specimen than an 85 year old man with advanced emphysema who is bed ridden. The benefit burden ratio of various kinds treatments or life support is different in ways a living will ( even a Catholic one) does not address.
    adequately. The exception to this rule would be for the unfortunate individual who has no relative or friend to serve as a “durable power of attorney for health care” ( see below) In this case I would get a specifically Catholic living will, there are orthodox Catholic organizations which have these.

    3) Do have a “durable power of attorney for health care”. This is a person who you legally appoint with their agreement who can make decisions for you, based on your previous wishes if you can not speak for yourself. This person should obviously be an orthodox Catholic, and be mentally capable of dealing with the complexities and stress of a health care crisis. It is not great to ask someone who has emotional problems, or the like. ( It is surprising how often the DPA is someone who is ill suited to this purpose.) When a proper DPA is in place, this gives the medical staff a person who they can explain the pros and cons of any course of treatment if you can make decisions for yourself. If they share Catholic values it is protection against an inappropriate course that would be “passive euthanasia”. On the other hand “Tis the way of all flesh” than we should die, and a good DPA can work with the medical team to make sure futile treatment or excessively burdensome measures are not continued.

    Beyond this I must note the real problem is not that there are lots of folks getting involuntarily put to death against their families wishes. This is vanishingly rare. More commonly it is that Catholic families agree to what amounts to passive euthanasia because Catholics no longer make these sorts of decisions any differently that the general population. One example that I recall is a family of a man who had a major operation the complications of which made it likely he would be paraplegic. In order to recover he required life support which the family withdrew, not because the life support was burdensome or ineffective, but because they felt he would not want to live as a paraplegic. This is not an appropriate method of decision making for Catholics, or really anyone on a variety of levels, not least of which is the fact that many people say they would not want ‘to live” with a particular disability, but change their mind when confronted with the actual situation. It is sadly common that Catholics make these decisions with no more concern for what is or is not Euthanasia the general public. Interestingly as well is that in the 20 odd years I have doing critical care I have seen a Catholic family request the “last rites” exactly once! I know its the “Sacrament of the sick “now, and I wonder if the lack of direct connection with the 4 last things has made it fall into oblivion. In any case all these phenomena are part of the overall crisis within the Church today.

  • Tony Esolen

    I agree with all that MRD has said above; I’ve heard these things from my sister, a specialist in infectious diseases. If you do have a Living Will, and you’re not alone, by all means get rid of it…

    Two things: My sister tells me that patients who are not terminally ill are “let go” in hospitals all the time. Example: a woman walks into the hospital with pneumonia. She is senile, but still, obviously, able to take care of herself most of the time. The pulmonologist persuades the family not to treat the pneumonia. My sister kicks into gear — she actually had to put pressure on the hospital’s lawyer. Result, in this case — Grandma was cured of the pneumonia and went home. Family? Not happy. Other patients she’s seen haven’t been so fortunate. Then there is the matter of giving morphine to people who are having respiratory problems but who are not in pain…

  • MRD

    Just a note morphine is also given to ease air hunger (the feeling of shortness of breath) in patients in whom mechanical ventilation is withdrawn or not used. This is not euthanasia but a legitimate use of morphine and the double effect. Example 95 year old male with end stage emphysema on a ventilator who can not be weaned. There is no moral obligation to continue permanent mechanical ventilation which is burdensome, but withdrawal of the ventilator will result in shortness of breath that can be alleviated with morphine. no doubt it can be used wrongly, but bear in mind there are uses other than pain control.

    I am grateful for your comments Tony, and note that this proves their are a lot of technical issues surrounding critical illness. This is all the more reason that it is about time for Serious Catholics to start to look specifically for serious Catholics as care givers who can help them navigate the waters.

    Let me reiterate, The big problem is not that hospitals will covertly euthanize you. This is possibly a problem down the road. In real;ity their is no need for the hospitals to do this. Families are out in front and asking for it. This includes “Catholic” families. When Grandpa has a big stroke, his family is more likely to ask for a morphine drip than to ask for the last rites.

    This is easy to understand. In the real world morphine can relieve suffering, in the Church under the current “Von Balthazar theology of “everyone” gets to heaven, last rites do… what? Sometimes morphine is appropriate, sometimes it is not, but Catholics are not making these decisions with reference to Catholic teachings, which are in essence defunct. (Not preached about, not acted on, they reside in musty old tomes of medical ethics and non referenced encyclicals like Evangelium Vitae. The tiny percentage of Crisis readers know, but does the person in the pew next to you know what Evangelium Vitae is about?

    When was the last time a priest anywhere said to withhold ordinary care from a sick person was a mortal sin.. Well when was the last time a priest said from the pulpit anything was actually a mortal sin.? In fact when was the last time a Bishop or a priest publicly used the phrase “mortal sin” . The bottom will continue to drop out until someone in power realizes the bigger problem is not “out there” with the evil secularists. They are are of course evil, but they are doing what pagans will do. The key problem is inside the church.

    Catholics no longer believe what the Church has traditionally thought, and this includes the clergy. nothing is a sin, and Christianity is seen as some sort of emotional balm, rather than the pathway to saving our souls. Until this is fixed expect to see worse.

  • http://theorist-wwwsummaomniacom.blogspot.com/ Theorist

    The moral complexity of this whole situation shows how important it is for things of this nature to be handled locally -and not by a much larger program like NHS or even large/subsidized insurance companies.

  • mj anderson

    This is a timely discussion–for the nation and for me personally.

    Below I want to make an important point about “quality of life” since no machine can ever measure or assess this elusive concept.

    My mother died eight weeks ago, at 83, of COPD and heart failure. Two good Catholic physicians told her in 2008 that she might live another year at best. In the next three years we had six hospitalizations where doctors could only offer palliative care. She grew too weak to feed herself. Some did suggest that she decline all treatment rather than “prolong an already difficult situation.” None thought she would leave the hospital alive–but for God’s purposes, that we cannot know, she survived.

    Mother was a retired health care professional– she understood well the complications of her condition. She chose to use a durable power of attorney rather than a Living Will. Her case was beautifully managed by mostly dedicated doctors and nurses who shared her goal of living to the limit of her abilities while she could –to go to family events, to celebrate her good days with outings however difficult to accomplish. She resisted any drug that diminished her awareness.

    Her wit kept us all encouraged: “It takes longer to die than to have a baby” she quipped when she came out of a coma of four days in the summer of 2010–she had “expected” to die 10 months earlier during a previous crisis. At this point doctors were both amazed and cheered to see her survive
    –not on machines, though on oxygen.

    Her final year was mostly bed ridden. Near the end she required the assistance of a bi-pap machine at night. CO2 narcosis diminished her lucidity, though we had moments of clarity. Fortunately her death was not difficult, not a struggle–she had already had plenty of that. She simply grew too weak to take the next breath.

    What accounting system will measure the value of her last years where:

    she welcomed two new great grandchildren– as she had promised her youngest grandson that she would live see his children.

    the return to the faith of two non-practicing Catholic nurses who marveled at her determination to read her prayers no matter how sick she grew.

    Trouncing all comers in Scrabble despite her infirmities –thereby teaching teen great-grandchildren that they do not know everything

    She educated children, grandchildren and great-grandchildren in the art of living until you die and that each moment was worthy of living.

    Is this “quality of life”? Where families understand dying as part of living and therefore do not shrink from it, the lure of “right to die” will …die.

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