Map of life expectancy at birth from Global Education Project.

Wednesday, May 20, 2015

I understand that there are two sides . . .

to the question of physician aid in dying. The California Medical Association has become the first state medical association to adopt a neutral position on a law allowing physicians to prescribe lethal doses of drugs to terminally ill patients. All the others continue to oppose it. In the U.S., it is now legal only in Oregon. Physician assisted suicide is legal in several European countries and, following a recent Supreme Court ruling, in Canada. In the Netherlands it is tolerated. Legalization is contemplated in France and the UK.

Requirements vary. In Switzerland, people don't even need to be terminally ill, they just have to convince two doctors that their suffering is unbearable. In spite of dire predictions, experience is that few people ultimately avail themselves of the option -- though more discuss it and accept prescriptions. Generally speaking, you have to make the decision while you are cognitively reasonably intact, which means this is not an option for people who are severely demented.

I'm sure you are familiar with the many perfectly respectable concerns. People may kill themselves because they are depressed, because they think they are a burden to others, or because they receive in adequate palliative care. Many people argue that with proper palliative care, nobody would really make this choice. And people with disabilities and their advocates argue that there is a slippery slope toward devaluing the lives of people with severe chronic illnesses or disabilities.

Finally, many doctors don't like the idea because they don't want to participate personally and they fear being in the position of having a patient ask for help in dying.

I think that these understandable fears are addressable by a well-thought out legal and regulatory regime. But it is really impossible to draw bright lines here and plenty of dystopias have been imagined around state sanctioned and facilitated suicide. (Including by Kurt Vonnegut Jr. who I greatly admire.)

I am quite confident in opposing the death penalty under any circumstance, supporting reproductive rights for women, and the withdrawal of active life support on the patient's or health-care proxy's choice. This doesn't feel so clear to me. It does stop somewhere, but we need to have a serious, honest public discussion about where. I won't disparage any opinions based on a true set of premises.

(And no, there aren't any death panels in Obamacare.)

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