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| By Myra Christopher |
I worked late Tuesday night and was listening to NPR as I
always do during my short commute home when I heard that, in celebration of his
85th birthday, Bishop Desmond Tutu announced that he supports
physician-assisted suicide and “prays that politicians, lawmakers and religious
leaders have the courage to support the choices that terminally ill citizens
make in departing Mother Earth with dignity and love.” I was stunned.
At age 30, I decided to spend my life working to improve
end-of-life care and that the way that I would do that would be by “doing
ethics.” I would spend my life arguing that the seriously ill and dying have an
inherent right to a “dignified death.” This year I will be 70, and I have had a
long and interesting career. Over the past 40 years, the issues of euthanasia
and physician-assisted suicide have been what I considered as recurring
distractions from what I have thought to be really important, i.e., advancing
palliative care. Bishop Tutu’s comments, however, cannot and should not be
considered by any one as simply a “distraction.” I believe they are a
“game-changer.”
In the late 1990s, I directed Community-State Partnerships to Improve End-of-Life Care, an
$11.25m Robert Wood Johnson (RWJ) Foundation grant award program. At about the
same time, Jack Kevorkian – or Dr. Death as he came to be known – came on to
the public scene. At a national conference, I was asked what I thought of Dr.
Kevorkian, and I said without hesitating that I thought he was a murderer and
should be imprisoned.
Envisioning Other
Options
After the conference, a communication officer from the RWJ Foundation
asked me if I knew the data regarding public views on physician-assisted
suicide. I said that, of course, I did – 50% of Americans were for it and 50%
were against it. She said, “You realize that when you made the statement you
did that half the audience turned you off,” and then asked me if I could
imagine saying something like, “Physician-assisted suicide is something good
people disagree about, but what we can all agree upon is that we must do a
better job of caring for those who are seriously ill and dying so that they
don’t see suicide as their only option.”
That statement made good sense to me and has served me well
over the years. To clarify my personal view, I always add that I am against the
“legalization” of assisted suicide but would NEVER pass moral judgment on a
caring committed physician or loving family member who assisted a patient or
loved one to die. Furthermore, I know that it happens all over the United
States every day. Years ago, an article titled “It’s Over Debbie” was published
in JAMA (Journal of the American Medical Society) in which a resident
anonymously reported having euthanized a young woman in agonal pain dying of a
terminal gynecological cancer. I got four calls, two of them from healthcare
professionals in Kansas City, telling me that the caller was sure the event had
occurred in their own hospital.
Personal Choice and
the Slippery Slope
I have shared in private conversations, however, that in
certain situations, I would personally choose to end my own life and expect others
to help me to do so if I were incapable of acting on my own behalf. I recognize
the logical inconsistency of my thoughts and have felt hypocritical from time
to time. But because so many people in the U.S. are not insured and do not have
access to healthcare, especially good end-of-life care, and because we know
without question that certain populations, e.g., people of color and those in
lower socio-economic situations, receive less care, worse care and have poorer
outcomes, I have felt that legalizing physician-assisted suicide could
potentially make these people even more vulnerable…that it was just too risky.
Even though the data from Oregon, the first state in the U.S. to legalize
physician-assisted suicide, has not proven that to be true, my fear has been
the “slippery slope,” i.e., if we allow competent people to make this choice,
are we then far from deciding the same should be true for those who cannot make
decisions for themselves. I still do not believe that concern is unfounded.
The Netherlands, the first country to legalize euthanasia,
now allows others to make decisions about ending the lives of those who are
unable to be self-determining. Furthermore, years ago, I debated this issue
with Derek Humphry, Founder of the Hemlock Society, and when I asked him if he
would support euthanizing people who had never been able to express their
wishes, he said something like “not now.”
No Safe Harbor
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| Bishop Tutu |
Ironically, in the early 2000s, two nurses in upstate New
York who published an online newspaper called The North Country Gazette,
decided that I was the leader of the euthanasia movement in the U.S. For
several months, they published a “front-page” article about euthanasia and
included my name in the headline. I wasn’t aware of it until I began to receive
letters from children asking me why I wanted to kill their grandmother and got
a couple of calls from national organizations with whom the Center was working
asking me to clarify our position on euthanasia. (I should point out that the
Center does not now nor has it ever had an official position on euthanasia.
Members of the Center’s board and staff are not of one mind about this issue,
and I suspect never will be.)
After hand-printing a few letters to children saying that I
was not sure why they thought I would ever want to harm their grandmother, we
learned the source of the perception. I honestly will never know why I became
the target of this series. I do know, however, that it was heart-breaking to me
that for nearly two years, if you Googled “euthanasia,” my name was the first
thing to pop-up.
Neither my ambivalence (or lack of intellectual clarity) nor
my efforts to claim the moral high ground – or even what I thought to be clever
communication strategies – had provided me a safe harbor or a pass from this
debate.
A Moral Right
Now on Tuesday night, Bishop Desmond Tutu, a person who for
years I have considered a global moral leader and personal hero, spoke with
conviction and confidence about euthanasia as a moral right, an
entitlement.
Ethics is not about black and white. In my experience, it is
clearly about trying to deal with “shades of gray.” But, from a philosophical
perspective, respect for human life is not negotiable and that has been a
sticking point for me. Tuesday night Bishop Tutu said, “As a Christian, I
believe in the sanctity of life and that death is a part of life. I hope that
when the time comes I am treated with compassion and allowed to pass on to the
next phase of life’s journey in the manner of my choice.” I do too.
Labels: advance care planning, assisted suicide, end of life planning, medical ethics, physician-assisted suicide
