The Virginia Senate recently denied the ability of terminally ill patients to foreshorten their suffering.
This was the consequence of a recent vote on a bill proposed by Senator Ghazala Hashmi to legalize medical aid in dying (MAID). The bill failed to make it out of Committee.
I wrote about MAID (where a doctors can prescribe a lethal dose of barbiturate to allow a terminally ill patient with less than 6 months to live, to end their suffering) when Delegate Kaye Kory introduced a bill to the Virginia House previously.
This is a hot button issue of course, that fires up people’s ethical beliefs. And not surprisingly, I got some push back. But I take issue with two of the main objections.
Doctors should be healers and “stay out of the business of death” I was told. The problem with this is that all we doctor are in the business of death by virtue of practicing medicine. And the people we are talking about are beyond healable.
I think a higher priority for doctors is relieving suffering. And if that means letting a competent adult choose to hasten the inevitable, and foreshorten the dying process, to relive their suffering, so be it.
I see this as the ultimate patient autonomy. People be allowed to decide for themselves.
Abhorrence of Dying
This not allowing people a compassionate and dignified end because we so abhor the idea of people dying, has a malign influence in other fields of medicine also.
There is growing criticism of the management of other terminal diseases - cancer in particular, where people with very little chance of buying much meaningful extension of their lives, are coerced into pursuing definitive care (care that is trying to prolong life) with chemotherapy or surgery because death is so taboo.
Palliative care (where the emphasis is on function and comfort) is often denied because it is seen as allowing the person to die. “Throwing in the towel.”
I have seen and heard of multiple instances where, because of the doctor’s reluctance to accept their patient is dying, hospice has not been called in until within a few days of death - so depriving the patient of the skilled management of end-of-life-suffering (which is a specialty in itself).
This abhorrence is deeply ingrained in we doctors. We are taught throughout our training, that death is failure (though, as with so many serious issues in medicine this has prompted some black humor - in residency, the wags talked about a “Harvard death” where you have been such a skilled doctor, and have manipulated their medicines and IV fluids so well that their electrolytes are all within normal limits – even though the patient dies).
We need more fatalism. More of the old attitude, where, as end-of-life researcher Joanne Lynn puts it, illness is “like bad weather.” It “strikes without warning, and you get through it or you don’t.” And people prepared themselves by reading tracts like the Ars Moriendi (The Art of Dying) - a very popular work published in many languages in the 1400’s, when the – at that time incurable - Black Death was running rampant.
Longevity Over Suffering
For MAID to become a possibility in Virginia, it is of course the lawmakers who need to be persuaded.
Legislators in other states have somehow found the fortitude to allow doctors to prescribe for their patients. Or in other countries like the Netherlands and Switzerland they have been so bold as to legalize euthanasia, meaning the person doesn’t have to administer the medicine to themselves - a requirement of all the Death with Dignity laws in the US, which is a real catch-22 for people with some paralyzing condition like ALS.
A lot of concerns people and legislators have voiced are not being born out in states that have legalized MAID. There has not been a stampede - less than 1 per cent of terminal patients ask for a prescription – and then only just over half actually take it.
People do not seem to be taking their own lives capriciously. People resorting to MAID do truly have a terminal condition. People do fully understand what they are doing. There is not evidence that people are being coerced into ending their own lives by family, insurance companies or others for financial gain.
I am a supporter of organizations like Compassion and Choices who are pushing for MAID to be legalized.
Organizations like this, and I, question whether legislators’ are really doing the right thing when they let their own, personal ethical beliefs deny someone the ability to decide that ending their own life is the preferable option over being forced to go on in intolerable suffering.