Right (or Wrong) to Die (February)
For February 2019, the Rights Writers discuss their issues in the context of US political discourse (including public opinion), particularly in light of the two-year anniversary of Donald Trump’s presidency.
Like many other wealthy countries, the United States recently reached a critical demographic milestone in which its fertility rate fell below the replacement rate. Practically speaking, people are having living longer and having fewer children. Americans are aging, putting the concerns of the elderly on an unprecedented level of national importance. The right to die, also known by the more antiquated term, “physician-assisted suicide,” has galvanized religious leaders, legal experts, healthcare executives, and older Americans of diverse political persuasions to answer questions of human dignity and the limits of biomedicine’s ability to define the soul. In the privatized, institutionalized, litigious world of American healthcare, older patients frequently face political opposition on moral, religious, and legal grounds when they make the difficult decision to hasten their own death.
The most famous line of the Hippocratic Oath declares “First, do no harm.” In a pluralist society like the United States, doctors recognize that they must respect the sincerely-held religious beliefs of patients, but rarely confront how their own religious or moral beliefs may conflict with the treatments their patients ask of them. As individuals protected by the First Amendment, may doctors refuse treatment based upon their religious tenets? Trump’s first Supreme Court Justice pick, Neil Gorsuch, would say so. The controversial justice made headlines during his confirmation hearing when his 2004 philosophy of law dissertation and 2009 book surfaced, in which he argued that doctors have a right to refuse euthanasia or assisted suicide based upon the medical providers’ constitutionally-guaranteed religious freedom. Gorsuch is not the first conservative political appointee to make such an appeal to religious freedom—George W. Bush’s Attorney General, John Ashcroft, attempted to overturn Oregon’s right to die law by declaring that doctors who prescribed lethal substances were in violation of the federal Controlled Substances Act. His directive was struck down by the Supreme Court, but after two conservative nominees to the Court by President Trump tilted the political favor of its legal rulings, the future of right to die laws is more tenuous than ever.
Choosing to end one’s life is rarely an easy or happy decision, no matter how much pain you are in or how supportive your loved ones might be. Right to die advocacy groups do not insist that doctors or hospital systems violate religious doctrine, but they do ask that patients with chronic illnesses be given the option to choose a quick, painless death. Lack of public awareness and stigma remain major hurdles to overcome if the laws are to reach a greater number of their target population. The suicide rate of white men over the age of 85 is 40 per 100,000, over twice that of any other demographic by age and race. Many use guns to put an end to chronic pain and loneliness. Public health researchers have long advocated that improved case management and right to die laws would increase quality of life near the end of life, both for the patients and their families.
There are myriad reasons why an older patient might want to pass away with medical assistance. Invoking one’s “right to die” means the patient wants to end their life on their own terms, quickly and painlessly. Often, they have suffered a long, debilitating illness that drastically reduced their quality of life without hope of recovery. To date, seven states and the District of Columbia recognize the right of die of chronically ill adults determined to be cognitively sound by two psychologists. Even in those states, the patient must jump through numerous bureaucratic hurdles, find a doctor willing to prescribe the self-administered lethal injection, and obey a mandatory waiting period of several months. Through the political hurdles an interesting paradox emerges: The majority of Americans back the right to die, and support for the measure is growing, yet very few people have taken advantage of the right to die of their own accord.
Since Oregon became the first state to legalize the right to die in 1997, only three thousand Americans have opted to receive the lethal, painless injection. Many rural Oregonians still do not have access to a physician providing right to die services within one hundred miles of their home. Healthcare systems sometimes hesitate to provide right to die services due to religious, moral, or financial/legal reasons. Several faith-affiliated hospital systems choose to opt out of providing dying with dignity services. For example, the Catholic Church interprets aiding the onset of death as a challenge to its fundamental mandate to preserve life, so Catholic hospitals are prohibited from offering lethal injections. For others, hastening death is anathema to the biomedical ethos of extending life at all costs. Dr. Alan Williamson, vice president of medical affairs of the secular non-profit Eisenhower Medical Center, explains, “[Our] mission recognizes that death is a natural stage of the life journey and Eisenhower will not intentionally hasten it.” Hospital executives worry about grieving family members suing and spreading bad publicity. Concerns surrounding the ethics of right to die laws are valid and require further conversation with all impacted parties, political, religious, moral, and medical. Ultimately, it is up to voters to advocate for or against proposed right to die laws in the balance of preserving life at all costs on the one hand versus empowering older adults to control their time of death on the other.
Extending the right to die painlessly is a human rights issue. With more tough conversations and public education, Americans are increasingly choosing to prioritize the legalization of right to die in all states and celebrate the bravery of older people who choose to end their life on their own terms.