A Matter of Dying With Dignity

tt34_.jpgIt continues to be one of the most emotional issues of our day. Should a person have the right to terminate their life if they face impending death because of a medical condition? This issue bubbles to the surface as more states begin to legislate or place on the ballot the question of doctor-assisted suicide. It reaches the national conversation and bursts into the public's consciousness when someone becomes a cause célèbre over the issue. We only need to recall the tumultuous reaction to the Karen Ann Quinlan case (d. 1985) and Terri Schiavo story (d. 2005) to know that to be the case.

Now, Brittany Maynard has come to the forefront with a touching, intelligent and sensitive interview with a CNN Op-Ed article, where she explains her rationale for an intended doctor-assisted suicide. Maynard has an inoperable brain tumor, and the recently married 29-year-old is facing a prolonged, painful death, and even drugs might not be able to alleviate the pain. She moved from California to Oregon,where doctor –assisted suicide is legal, and received a pill that will end her life.

This issue seems separated along both generational and, to some degree, religious lines.

According to a NPR-Truven Health Analytics Health Poll, 55 percent of Americans favor physician-assisted suicide, for those who have less than six months to live. Age seems to matter on this issue. Fifty-six percent of people 65 or older oppose the idea, with 44 percent supporting it. For American 35 and younger, the results are reversed: 59 percent support it, with 41 percent oppose it.

A common thread among media analysts and many legislators is that physician-assisted suicide is inevitable. Five states allow it, which leaves 45 states to follow suit. Some are already likening this issue to same-sex marriage, a topic that will seem benign, in my opinion, in a decade.

Massachusetts, a liberal-leaning state declined to pass the legislation by a whisker. In New Jersey, my colleague and friend, Assemblyman John Burzichelli (D-Gloucester) has introduced a bill in favor of physician-assisted suicide. “I’m within spitting distance,” he said in a news report. “This is coming sooner rather than later.”

This view of inevitability rests on the premise born out in the polling data I referenced earlier. The supporting age demographics based on this issue favor his position. As that group grows, the overwhelming majority of public sentiment will grow with it.

Many religious organizations are vocal about this issue as well offering strong opposition to physician-assisted suicide. In its most succinct interpretation, they hold that life is sacred, and death should never be hastened.

I have great respect for religious organizations, that, at their core, preach a code of love, kindness and tolerance. However on this issue, I have to take a wider view than my own personal opinions. Quite frankly, those opinions have evolved as I have spent time talking with those afflicted with terminal illness and their care givers.

Whatever my personal and religious feelings, I represent all the people in my district. My intent is to allow free choice to prevail, in particular given the unimagined consequence an issue like this can cause for someone who might need this option.

But let’s hear from Brittany Maynard, http://cnn.it/ZcmJw5 who wrote: “When my suffering becomes too great, I can say to all those I love, ‘I love you; come be by my side, and come say goodbye as I pass into whatever's next.’ I will die upstairs in my bedroom with my husband, mother, stepfather and best friend by my side and pass peacefully. I can't imagine trying to rob anyone else of that choice.”

Brittany Maynard has said she intends to end her life Nov. 1, a few days after her husband’s birthday. Nov. 1 is All Saints Day, a day which many Christian faiths either celebrate or acknowledge. It is a day when we recognize the connection between our lives on Earth and those who have passed this way before us. I don’t know if Brittany Maynard is a saint, but her courage and consideration for those who might follow her certainly suggest a saintly approach to her departure.

When it comes time to vote on the issue of physician-assisted suicide, I will support this legislation. I will support it because we all have to face our Creator some day. And, at that time we must be ready to account for all the choices and decisions we have made in life ... and in death. That's my take. What's yours?

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  • Nancy Mangold Hartwick
    commented 2014-10-31 18:52:01 -0400
    I have Multiple Sclerosis and when the time comes, I would like to be able to determine myself when it is time to die with dignity. It goes far beyond the everyday pain that I experience and watching my body slowly be taken over by this disease. I do not want to be totally incompacitated, in pain, have no quality of life, and be a burden. It’s not a matter of being suicidal. It’s a matter of dying with dignity. As Anne Studholme said that for the few that it would help it would put other people in danger, I would like to know why those few people do not matter.
  • Anne Studholme
    commented 2014-10-16 19:02:56 -0400
    I should also add, in case anyone were in doubt, that palliative or terminal sedation is fully legal and available in New Jersey. It does NOT fall under the prohibition on assisting suicide. The Catholic Church and the American Medical association both fully support palliative or terminal sedation if necessary and desired by the patient to relieve end-of-life pain.
  • Anne Studholme
    commented 2014-10-16 18:59:03 -0400
    Just to be clear: the entities listed are a sample of those who oppose assisted suicide bills. They are by no means the only entities to oppose these bills. The comment text is my own.
  • Anne Studholme
    commented 2014-10-16 18:35:34 -0400
    Assemblyman Singleton has written a very thoughtful post on this issue. Many aspects of the Brittany Maynard publicity, however, may not be immediately apparent to people relatively new to this debate.
    The first is that we don’t know who told Brittany Maynard that “even drugs might not be able to alleviate the pain.” I am not a doctor. I am an attorney who has represented people with disabilities on a range of issues, including end-of-life. But it is important for anyone contemplating this question to know that all of the medical authorities, and the bill’s sponsor, and the bill’s most prominent supporters—including Compassion & Choices, who are promoting Brittany’s story—all agree that if a patient in pain is willing to accept palliative sedation, pain is—in their words, not mine—“Not an issue.”
    Palliative sedation can be provided in the patient’s home. It consists of sedation or anesthesia to the point where, if necessary, the patient becomes unconscious. Death will ensue, sometimes possibly more rapidly than if the patient were conscious, and sometimes more slowly, since the sedation suppresses stress response, among other effects. Palliative sedation is also referred to as “terminal sedation.”
    A debate on physician assisted suicide without full discussion of palliative or terminal sedation will ill serve the general public, who have been led, by Compassion & Choices, to presume patients elect assisted suicide due to fear of pain, and that that fear is justified. Writing that incorrect presumption into law, will make it that much harder for people to ensure their doctors are up to date on palliative care, and to insist upon end-of-life pain relief.
    Additionally, people should understand that the primary reasons actually given for seeking assisted suicide in Oregon (where pertinent records have been kept the longest) are not fear of pain, but, rather, distress over “being a burden,” desire to maintain “control,” and fear of inability to pursue previous life activities. These are, quintessentially, disability issues.
    And that is one reason why this question is not akin to gay marriage or other areas of civil liberty. In the case of assisted suicide, there are people who would be directly threatened if this bill became law. In the case of legalizing gay marriage, there are not.
    Assisting suicide—any suicide—is illegal in New Jersey. This bill would carve out an exception to that, if the person requesting suicide has a medical prognosis of terminal illness. This is not an exception for a person who is actively entering the process of dying. It is not an exception for someone in severe pain who would prefer immediate death at their own hand to palliative sedation. It is an exception because we feel uncomfortable at the disability issues associated with the late stages of terminal illnesses, and inclined to recognize that fear of disability as a valid reason for suicide. What will be recognized next? Oregon’s general suicide rate is unusually high, and rising. Acceptance of the “courage” and “nobility” of disability-avoidant suicide may have a role in that. And, if someone with a terminal illness may request a lethal dose of medicine to keep in their drawer or purse, why not a person suffering from psychologically agonizing, treatment-resistent depression or PTSD?
    The bill has many immediate dangers, as well: no requirement for a psychological assessment, no requirement that the patient communicate directly with the physician (communication may be via someone “familiar with the patient’s manner of communicating”), no witness of the actual ingestion of the lethal drugs, no witness to the death, falsification of the death certificate, witness to the request for drugs may be an heir, etc.
    I am not religious and I do not approach this topic from the point of view of religion. I approach it from the point of view of logic, and a concern that Compassion & Choices, the well-funded organization promoting this bill, on the one hand acknowledges freely that end-of-life pain can be treated, and on the other is all too happy to leave the public confused on that point.
    Nor does Compassion & Choices acknowledge the broad array of disability-rights groups who oppose these bills. Every group to have taken a position on this issue, including all of the following, oppose these bills as far too dangerous. For the few dozen people a year who might seek to take advantage of this bill (based on statistics compiled in Oregon), hundreds of thousands of others will be in danger, including people with disabilities who may feel the pressure of being “a burden,” and people with suicidal ideation who, if Oregon’s experience is any guide, will take this as a license to seek their own relief. That is why this question is one of public health and appropriate for public policy.

    Alliance Center for Independence
    American Academy of Medical Ethics (AAME)
    American Disabled for Attendant Programs Today (ADAPT
    Association of Programs for Rural Independent Living (APRIL)
    Autistic Self Advocacy Network (ASAN)
    Disability Rights Education and Defense Fund (DREDF)
    Disability Section of the American Public Health Association
    International Life Services
    Justice For All (JFA)
    National Council on Disability (NCD)
    National Council on Independent Living (NCIL)
    National Spinal Cord Injury Assocation (NSCIA)
    New Jersey Medical Society
    New Jersey Statewide Independent Living Council (NJSILC)
    New Jersey Progressive Center for Independent Living (PCIL)
    Not Dead Yet (NDY)
    Patients Rights Council
    Physicians for Compassionate Care
    Resources for Independent Living, New Jersey (RILNJ)
    Second Thoughts
    The Center for Bioethics and Culture Network (CBC Network)
    World Association of Persons with Disabilites (WAPD)
    World Institute on Disability (WID)