Sunday, July 5, 2015

What about Physician-Assisted Suicide?

"There's more to life than living and more to death than dying.” Those are the intriguing words on the cover of Finding Frances, a 2010 novel by Janice M. Van Dyck.
Frances is a 74-year-old woman who, beset by illness, is ready to die. She doesn’t want further medical care that might save her, so she asks her son to help her bring closure to her life. But permission to die is not easily granted. The doctors want to keep her alive by all means possible.
As is noted early in the book, “medical intervention saves lives, but there is a point when medical intervention stops being a life-saving measure and starts interfering with a natural death” (p. 39). That is the situation Frances faced.
After two interventions, Frances exclaims, “I don’t want any more saving” (p. 60).
A Washington Times review of Finding Frances remarks,
Our current medical system is required to do whatever it can to prolong life. Is there a way for us to improve on that model? Van Dyck brings these questions smoothly to the surface without ever pushing an agenda or setting up arguments. She leaves the reader wishing death could be made easier and glad that the family and hospital finally helped Frances go.
The sticky matter of euthanasia has been discussed/debated for a very long time, but it is even more relevant, and stickier, now than ever before because of the way medical establishment can extend life almost indefinitely.
Even though I have spent much more time and energy thinking about “youth in Asia” than about euthanasia, I have long supported the idea of “passive euthanasia.” That means allowing a person to die with dignity as comfortably as possible without using all means possible to prolong their life.
Back when “Obamacare” was first being debated, critics charged that the ACA was sanctioning “throwing Grandma under the bus.” Well, while they certainly want a gentler way to “check out,” there are many grandmas, such as Frances, who are ready to die and who do not want massive medical intervention to sustain their physical life.
Perhaps the government (whether through Medicare, Obamacare, or whatever) does not have a mandate to provide funding for extending the life of people who no longer have any desirable quality of life left or any hope for things to get better.
For many years now, 25% of the Medicare budget has been spent on the last month of people’s lives. Probably most of these people, and their families, would have been better off had the patients been allowed to die naturally rather than to receive extensive treatment that extended low-quality life for only a few days or weeks.
There are many helpful articles about such issues available here in a 2014 Wall Street Journal webpage.
But is there any possibility of affirming physician-assisted suicide, which would be a form of active euthanasia?
Suicide has sometimes been called “a permanent solution to a temporary problem.” But some people have a terminal illness, are in great pain, and have absolutely no hope for the restoration of health or any satisfactory quality of life. Theirs is not just a temporary problem that might be solved.
In spite of widespread opposition, maybe for such people physician-assisted “suicide” should be a viable option. That might well be the most loving, and thus the most ethical, course of action.

Note: Finding Frances and related end-of-life issues will be discussed at this month’s Vital Conversations meeting beginning at 1 p.m. on Wednesday, July 8, at Mid-Continent Public Library in Gladstone, a suburb on the north side of Kansas City. Visitors are always welcome.


  1. Well said, Leroy. I agree entirely, I think. Naturally some people are afraid of a slippery slope; that if physician-assisted suicides are permitted, eventually the controls would be lessened so that physicians are decided for others whether their life should be ended. That seems like a highly unlikely slippery slope to me.

    1. Thanks for reading and responding, Anton.

      Of course, most changes are accompanied by dangers, and there are reasons to be wary of misuse of a new situation created by a change.

      But I can't really imagine any widespread shift from doctors trying to keep their patients alive at all costs to them agreeing to snuff out the lives of their patients quickly or without careful deliberation.

  2. I agree with much of what you say and you so well point out in your Blog, but can we put in the necessary precautions to prevent `Wrongful Death` for other reasons than the individuals wishes?
    I realize there are difficult situations where some people are Religious and some are Not, but we need to really think this one through because Now Modern medicine can keep most people alive, as you stated, almost indefinitely.
    I may face this Very situation with my wife who has a terrible Terminal disease-Alzheimer`s.
    I would like your and your other readers opinion on what they think I should do when she get`s to the point where her body organs start shutting down. I dread the thought of facing this situation, as I LOVE her so much and do Not want to think about Living myself without her. She was diagnosed in July of 2009 and the Alzheimer's Association has been trying to prepare me for what is sure to eventually happen.
    Thanks in advance Leroy&others for your opinions in this Very sad situation.

    1. John: I'm really sorry to hear about what you're facing. I know I have similar feelings about losing my wife, which I faced briefly when she fought cancer last year, thankfully successfully. I can't tell you what to do, but my brother and I faced nearly the identical issue as you are with our father. My brother and his wife, admittedly, handled the decision-making, but we were not in any disagreement. We were rarely sure how aware he was of what was going on as he approached the end. He seemed conscious at times of our presence, and could respond with a squeeze of the hand and an occasional facial recognition. As his organs began to shut down, we simply kept him as comfortable as possible. It was all very difficult, but his death was relatively peaceful. We never considered anything like hurrying death, but we didn't fight it because when the organs shut down, he could no longer process food. One of the marvels of modern medicine, too, is that we need not spend our last few days in pain. My heart goes out to you.

    2. John Tim, I appreciate you sharing your sadness and concern about your lovely wife Donna. June and I have grieved with you since you first told us about her condition.

      For people with Alzheimer’s, I think active euthanasia is probably not (ever) legitimate. But such cases certainly make passive euthanasia attractive. That is, while taking any steps to hasten death would be highly questionable, allowing natural death to take its course without resorting to any means (tubes, breathing apparatus, etc.) to prolong life would be the best course of action, it seems to me.

      You will, of course, want to do whatever is necessary to keep Donna comfortable and (relatively) free from pain. And even when she is no longer able to respond directly to what you say to her, you will still want to talk to her and play music for her. We have no way of knowing what Alzheimer’s patients are experiencing on the inside, and I have heard that music has a way of connecting with them in a way speech doesn’t.

      I am glad you are moving into a community where you will have support and help with your care of Donna. And I pray that together you will have many good months, or even years, left. Certainly, I understand your dread of what is coming, but knowing that you are a man of strong faith, I am confident you will find the Lord’s comforting present sufficient to sustain you and lead you through whatever lies ahead.

    3. I once read the definition of suicide as being the intentional taking of ones own life. If someone is in pain or bedridden with a disease that is slowly killing them and all they can do is lie there then that is not living. I believe a lot of times people cling to life for their loved ones and because they know it will hurt the ones they love when they die. It is important that they know it is ok to go. We say we are being humane to our animals when they are in pain and have no more productive life to live but we can't do that for the people we love. I know people are unsure because they feel maybe doctors will start misusing the power but I think it would be the opposite. I think you will have a lot of red tape to go through. At the very least stop trying to keep those people alive when it is clearly their time.

  3. Facebook Friend Mike Greer just now posted these comments there:

    "It is beyond me to comprehend why those mature adults who are facing an imminent and excruciating death must have 'permission' to hasten the inevitable. I prefer the words death with dignity over assisted suicide in these cases.

    "I also am convinced that in this society we exaggerate the ability to alleviate pain and suffering through the use of chemicals. There are some obvious reasons why we do so."

  4. When one of my grandmothers was about 90, she was diagnosed with liver cancer, and was asked whether or not she wanted aggressive surgery. She said yes, but cursed the recovery room nurse when she awoke from successful surgery. It turned out she figured she would die during the surgery, thus ending the several years of slow decline she was experiencing in a nursing home.

    Another relative has been in hospice for about a year. We never knew her wishes, so the family has taken hospice as a moderate course, even as she has become very incapacitated in this time.

    I give these examples not as a personal badge, but as evidence of how universal this question is. My wife and I have filled out two rounds of advance directives and durable medical power of attorney to allow our families to navigate our ends as gracefully as possible when the time comes. I do not think too many people would rather be a human vegetable rather than deceased, but I know some do. Today, most state and Federal laws give too much ground to the inevitable self-interest of the medical establishment in sparing no expense, and too little to finding ways to offer merciful ways out when that would be most appropriate. The slippery slope in this case runs both ways, and there is simply no honest way to totally avoid making certain decisions. We cannot hide from the responsibility by talking about "playing god," because that is what we do all the time in both medicine and our private lives, as we take actions that have major consequences for ourselves and others. If we bury our heads in the sand, others will make decisions about us, even if not "for" us. Probably using how much money they found in our "wallet biopsies" to decide. Cheers for states like Oregon that have begun exploring options.

    For those who might want a completely different angle on this issue, and happen to be in the Kansas City area, my wife is about to appear in a KC Fringe Festival musical "Taking Care of Mom." She plays a retired biology teacher who is in Alzheimer's decline, and has decided to end her life before she is too far gone to do it. The show is at the Just Off Broadway Theatre, which at 31st and Wyandotte is literally "just off Broadway" as that is the next street over. The first performance is Friday, July 17. Check this web site: and then click on "Find a Show." Scroll down to the third row for "Taking Care of Mom," by Jack Phillips.

    1. Thanks so much, Craig, for posting interesting and helpful comments (as usual)!

  5. Thinking Friend Doug Hohulin writes,

    At the end of life, we should focus on comfort care and not prolonging life. I do not support assisted suicide but I support comfort care, not being aggressive in treatment, but being aggressive with pain management, even if it does shorten life.

    "A great book on the topic is "Being Mortal: Medicine and What Matters in the End" by Atul Gawande.