The Prof, some friends and I had a lively debate the other night about I-1000, the “Death With Dignity” (a.k.a. physician-assisted suicide, or PAS) initiative being considered in Washington State this fall.
I was torn about it: my libertarian and progressive instincts both told me to support it (individual rights), but I’m conservative enough to be cautious about a potential radical social change like this. The radical changes I tend to support, like, say, universal health care and high-speed rail, are commonplace in nearly every other industrialized nation — which makes them a no-brainer in my mind. But PAS has a much shorter track record, and is legal in only a handful of places.
I realized that I didn’t know much about the law, or how it had been administered next door in Oregon, so I decided to do some research.
The Seattle Times lays out some facts about I-1000, modeled on Oregon’s law: the patient must have less than 6 months to live, two doctors have to certify that diagnosis and refer the patient to counseling if they suspect depression. Also, this is not euthanasia (which is legal in The Netherlands): the doctor can’t kill you. S/he can only prescribe a lethal dose of barbituates, which you have to be well enough to take on your own.
The State of Oregon’s Dept. of Human Services provides annual reports on the law, going back to its inception 10 years ago (Oregonians pased it 60%-40% in 1997). A few dozen doctors statewide write an average of 54 prescriptions each year, and of those, an average of 34 patients actually use the drugs to end their lives (see the 10-year summary, .pdf). The overwhelming majority are terminal cancer patients.
Out of our conversation came several potential objections to the law:
- Suicide should either be completely legal or illegal. It’s either right to kill yourself or it’s wrong, and this law is a half-baked compromise
- the diagnosis could be wrong
- It’s a “slippery slope”: Why not 7 months? Why not include non-terminal patients (as former Governer Booth Gardener wants to do)?
- Patients may be depressed.
- It elevates doctors to a new role in society, giving them the kind of authority that we usually limit to the legal system (this is why the Oregonian newspaper objects, though they admit that their concerns about safeguards were unfounded)
- Relatedly, doctors are potentially persuadable (“come on doc, I got 7 months, but can you just say it’s 6?”)
- It’s not a fundamental human right. “The right is life. Where does death fit in?” writes Joel Connelly.
I’m sure there are others. Something that the insurance industry is behind it, so they don’t have to pay for end-of-life care. But there’s no evidence of that, just insinuation, to my knowledge.
The first thing to note is that no law is perfect, and the perfect shouldn’t be the enemy of the good. I want universal health care, but I’ll settle for insuring every kid under 18. At least for now. Which gets us to the “slippery slope” argument. Could this law eventually lead to total legalization of sucide? I don’t know. But I do know that the great thing about democracy is that we’ll get to choose. Slippery slope arguments are used all the time, from gay marriage to gun laws. Liberalism itself is one, big slippery slope between the good of the many and the good of the individual.
Second, with respect to the doctors, I realized that what we’re talking about is not so different from “Do Not Resuscitate” or DNR laws, which I support. If you can tell a doctor that you don’t want to be hooked up to machines, why can’t you tell him/her you want a lethal dose of pills? And while I suppose the doctor is potentially corruptible (as in #5 and #6 above), we already assume the impartiality of doctors in so many other places in our society (say, with respect to diagnosing that a criminal is legally insane), is this really the one place to make an exception?
That gets to the fundamental challenge of this law, and how you view it. One way to view it is through the abortion lens, which is to say that it’s a personal choice, and the government shouldn’t get in the way. Dan Savage makes that argument in a very moving piece about the recent death of his mother. Another way to look at it, though, is as a natural societal adaptation in the face of advanced medical technology. We can prolong life artificially nowadays, sometimes nearly indefinitely. DNRs, which became popular in the 1960s with the first wave of defibrillators, were society’s way of adapting. Advanced cancer treatments can prolong life as well, sometimes equally painfully.
Finally, I can’t quite figure out how it hurts me if a terminally ill patient wants the option to end their life. I support public education and universal health care because it hurts me — economically, socially, etc. — when a poor kid can’t get a good education or health care. I support gay marriage, though, because it doesn’t hurt me at all if two people want to get married.
In general, suicide has negative externalities, negative costs to society: it hurts the ones you leave behind, it costs society money, public suicides (say over the Aurora Bridge) cause anguish to bystanders, etc. But I don’t think those negative costs really apply to the three dozen or so terminally cancer patients who want to go, in peace, at a time of their choosing.
I’m open to persuasion, but I think as of now I’m voting yes on I-1000.