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This week, California’s governor signed California’s right to die law—making California the fifth State to allow physician assisted suicide for the terminally ill. Oregon, Washington, Montana and Vermont already permit that practice. The new law requires two doctors to determine that a patient has six months or less to live before the lethal drugs can be prescribed. There are also requirements that one of the meetings has to be in private, and that the patient must reaffirm in writing his/her decision for suicide.
The well-intentioned nature of the law and its emotional appeal can hardly be questioned. Posit the situation where a terminally ill person has a few months to live, with prospects of substantial pain and losing muscle control. As a human, it is hard to argue that a person in that situation must be forced to suffer through the remaining few months of his/her life despite his/her well thought out desire to die. That is the perfect example to justify this law. What this emotional, and legitimate, example fails to convey, however, is that it is impossible to limit the law to this “perfect” example, and there will be, and are, many instances where the law would be used differently. For example, consider the would be common situation where an old, ill person would feel pressured or obligated to end his/her life so that he/she would no longer be a burden on his/her children. Many times the person, absent a feeling of pressure or guilt, would not choose the “death” option. As many people who have taken care of an old, dependent relative may know, these situations are very taxing on the relatives and often result in testy issues between the old relative and those who take care of him, or even just between those who take care of him. Many other times, the motives of the relatives in supporting the “death” option is not pure, and is, for example, financial or merely due to the extremely difficult task of taking care of an old dependent. This will result in a situations where the old, dependent person will constantly wonder, “do they want me to kill my self? Should I?”, and relatives who may think “why doesn’t he?” In other words, the “option” to die will transform into an “obligation.”
In fact, it is instructive to study the numbers in Oregon, where in 2014, only 31.4% of people who exercised the “death option” expressed a concern for pain, but 40% expressed concerns on being a burden on their family:
End of Life Concerns (Oregon, 2014):
Losing autonomy: 91.4%
Less able to engage in activities making life enjoyable: 86.7%
Loss of dignity: 71.4%
Losing control of bodily functions: 49.5%
Burden on family, friends/caregivers: 40%
Inadequate pain control or concern about it: 31.4%
Financial implications of treatment: 4.8%
In addition to the concern of transforming “right to die” from an “option” to an “obligation,” there are also significant concerns on the slippery slope that opening this can of worms brings. Societies generally adapt to changing circumstances. (See, e.g., the rapid change in US culture from strong opposition to same sex marriage in the early 2000s to now when a majority of the country supports same sex marriage). There is now push in other States to pass similar right to die legislation. Once a “six month end of life option to die” becomes the norm, it is only a matter of time before there will be a push to expand the option, both beyond six months and also to other circumstances. In fact, that is precisely what is now happening in Netherlands. There, a similar right to die law was passed for patients who were undergoing suffering that was both lasting an unbearable. Later, mobile units were added to assess patients at their home and to facilitate exercising this option. (Euthanasia currently accounts for 2% of all deaths in Netherlands). Now, there is a push in Netherlands to afford the “right to die option” to all old people above the age of 70, even when they are not suffering from terminal illness.
At the end of the day, everything in life is a choice. A depressed person who is dissatisfied with his/her life may ultimately commit suicide. And there are legitimate cases of unbearable pain where euthanasia is likely the “best” option. The question, however, is whether we as a society want to promote and facilitate the situation where the old, fragile and dependent person will have an “obligation” to die for being old and a burden on others. Is that really what we stand for?
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