More on the pro-PAS rejoinder in the New England Journal of Medicine

Today, by way of agreement, I’d like to add my two cents to Steve Phillips’s post of July 19 about the recent NEJM article proposing to sanitize, as it were, physician-assisted suicide (PAS) by trying to spare physicians from providing lethal drugs.

[I should write about something unique, and relegate this to a comment on Steve’s post, but I have been working on a presentation for my church on end-of-life issues, so I’ve been dealing with this topic recently.]

First, the authors of the NEJM piece “spin” the Oregon Death With Dignity process a bit promotionally, in my view. They describe it without any of the cautionary concerns raised by, for example, the CMDA. Check out the “Standards 4 Life” tab on the CMDA website; the worries raised there are not included in the NEJM article’s description.

Second, the authors claim to have dispatched five of the six “primary” objections to PAS. Palliative care is better, they point out. (OK, but it can improve more.) Oregon is not dispatching the vulnerable; most PAS requestors are white, educated, and affluent. The number of requests (30-50 per year) is not increasing, and the eligibility is not being broadened, so they consider “slippery slope” arguments mooted. Nobody is getting coerced in Oregon. And sanctity of life, they say, is subjective, and a PAS option for some would not affect “those who object.”

And, (the sixth objection), given the large majority of physicians who object, the NEJM article proceeds in bad faith, by appearing to suggest a solution that respects physicians’ conscience: doctors just have to provide the diagnosis and prognosis of a terminal illness. A “central state or federal mechanism” (note the impersonal wording!) can do the rest. In fact, as Steve smelled out, they are circumventing doctors’ care for their patients.

Leon Kass cited three “dangers” to a “right to die” in his 2002 book Life, Liberty, and the Defense of Dignity. I think they still apply:

1) “A right in aid-to-dying will translate into an obligation to others to help kill.” In this case, the state becomes the euthanizer. “God forbid,” Kass said. Someone—someone anonymous to the person making the request—will have to provide this “help.” These people will be bureaucratic executioners. I can imagine someone making parallels to capital punishment here, but PAS would not be an example of the state wielding its just powers of retributive justice. Physicians would be pushed into complicity, as would be government employees, taxpayers, etc. And, by the way, if you think you are a right to be made dead, that does not mean you have a right to oblige me to help you.

2) There will be “no way to confine the practice to those who knowingly and freely request death.” Reassurances about Oregon are cold comfort. Prevailing trends toward limiting moral status based on active, realized capacities will drag us toward frank euthanasia, and we can predict pressures to make decisions “for” comatose people, or pressures on depressed or burdensome folks to send in the government paperwork.

3) “The medical profession’s devotion to heal and refusal to kill—its ethical center—will be permanently destroyed…here is yet another case where acceding to a putative personal right would wreak havoc on the common good.” Steve nailed this one in his post.

Space does not permit me to rehearse Kass’s arguments why the “right to die” is incoherent. Suffice to say that it is contradictory to suggest that the language of rights, which assumes life and choices, can support a “right to be made dead,” which obliterates both.

Most certainly, a PAS option for some would affect those who object. And sanctity of life is anything but subjective; rather, it is grounded in quite objective arguments about reality and assumptions necessary even to discuss right and wrong.

I had been thinking that PAS was not so much of a front-burner issue recently. The NEJM authors say “[m]omentum is building for assisted dying.” Is it, now? I am not so sure, but I am reminded not to doze off.

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