The case for assisted suicide

On several occasions, I have watched the slow and painful death of cancer victims. It is a degenerative process that takes the life from the individual before death can take the body. My duty has always been to give these people absolute comfort; but what comfort is there when a disease steals the mental capacities and spirit of a living human, leaving them to die with nothing, least of all their dignity. Having observed this process first hand, it is with strong conviction that I support the need for assisted suicide in the United States.

Derek Humphry, founder of the Hemlock Society (a leading advocacy group for humane euthanasia), personally endured the painful reality of his wife’s terminal cancer. It was after her death that he wrote a book describing her disease and their mutual decision to end her life before the cancer caused extreme emotional and physical pain.

“Having accepted that the disease was going to eventually kill her, … (Jean) died on her own terms, not those of the disease which ravaged her body” wrote Humphry in “Jean’s Way.” The publication of this book had an enormous impact on society. Not only did Humphry assist in his wife’s suicide, but the lethal dose of sleeping pills and pain killers that terminated her life was prescribed by a physician.

In many circumstances, the only way a person can end his or her life, with little pain, is through the assistance of a physician. It is this willing aid that creates the biggest obstacle toward the legalization of assisted suicide. But without this type of help, patients are often left to suffer.

After reading “Jean’s Way,” I was reminded of a former patient I had worked with who was in a state of “unbearable pain.” “Bill” was a handsome, successful, computer salesman when, on business in Los Angeles, he was shot through the neck. The gun shot that changed his life forever was administered by a 16-year-old trying to steal his car. Today, Bill is a quadriplegic. For him, a good day is having a successful bowel movement.

On several occasions Bill discussed suicide with me; repeatedly the question was “How?”. How can a man in an electric wheelchair with 24-hour supervision end his life … legally? Many handicapped individuals in the United States have resorted to extreme measures because assisted suicide is illegal. In “Final Exit,” Humphry wrote of a quadriplegic who committed suicide by “setting fire to his house and allowing himself to burn to death.” In another situation depicted by Humphry, a woman, paralyzed from the neck down in a car accident, described her condition as, “every bit as bad, if not worse, than terminal illness, where at least one knows that the misery will end, whereas my life may go on for many, many years.”

When an individual does not have the mechanical capabilities to end her life humanely, is it ethical for a society to force her to remain trapped in a body that only allows for existence and not meaningful life?

Why do people oppose assisted suicide? While there are religious arguments against taking a life, repeatedly the concern, when confronted with this issue, is the fear that a physician can potentially abuse the freedom of euthanasia. In order to legalize physician-assisted suicide, there are necessary steps that must be taken to ensure that ethical standards are followed by the individuals participating. The Netherlands is the only country that has begun to allow active euthanasia. Its Royal Dutch Medical Association (RDMA) has set up guidelines which provide a model for other countries to base their future laws on. These entail the following:

the patient must repeatedly and explicitly express the desire to die;

the patient’s decision must be will informed, free and enduring;

the patient must be suffering from severe physical or mental pain with no prospect for relief;

all other options for care must have been exhausted or refused by the patient;

euthanasia must be carried out by a qualified physician.

My thoughts return to a terminally ill cancer victim that I cared for. When I met “Jane,” she was a mere skeleton with a skull void of hair and arms thinner than those of a young child. Sometimes, Jane would smile as she digressed into nonsense dialect; it was her smile that told us she too knew her mental capacities were disintegrating.

Her confused state created many distressing moments. She would be assisted to the bathroom, forget where she was, and cry because she was lost in her home of 23 years. The most shocking episode for me was when I saw pictures of Jane taken the previous year. Repeatedly, they revealed a robust woman full of life and vigor. The confused and scared person I cared for was not Jane, but a reflection of a terrible ravaging disease. Her family anguished over the fact that she had to suffer for what seemed an eternity before death took her body. She had no choice about how her life was to end; the disease was in total control.

Is this how we want our friends, loved ones, and selves to die? Death with terrible suffering and lack of dignity? A person who owns a dog dying of cancer will put the animal “to sleep” instead of letting it suffer. Why can’t we be as humane toward our own kind? In the words of Margaret P. Battin, a philosopher at the University of Utah, “the central issue is one of control. Doesn’t a person have the right to determine the manner of his or her own death and to avoid suffering and pain?”

At a time when patient autonomy in medicine is being promoted and individuals have the power to control their own lives, should they not also have the power to control their own deaths?

Kristina Volpe is a student at the University of Maine at Orono.