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 | A RIGHT TO DIE?
November 26, 1997NEWSHOUR TRANSCRIPT |
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The residents of Oregon voted earlier this month to maintain its law legalizing doctor-assisted suicide. The law, which has yet to be used, has been at the center of a national debate over whether or not patients have a right to die. Following a report from Oregon by Lee Hochberg, Phil Ponce discusses the religious, legal and health issues surrounding assisted suicide.
PHIL PONCE: We're now joined by Barbara Combs Lee, executive director of Compassion in Dying, a Seattle-based, non-profit organization that provides information, counseling, and emotional support to the terminally ill; Right Rev. John Shelby Spong, bishop of the Episcopal Diocese of Newark, New Jersey, who appointed a church task force that recommended sanctioning physician-assisted suicide in certain situations; Bishop James McHugh of Camden, New Jersey, a member of the Catholic Bishops Committee for Pro-Life Activity; and Dr. Herbert Hendin, medical director of the American Foundation for Suicide Prevention and author of the book Seduced by Death: Doctors, Patients, and the Death Cure. Welcome all.
A RealAudio version of this segment is available.
NEWSHOUR LINKS:
November 26, 1997:
Lee Hochberg reports on the continuing fight over the Oregon's assisted suicide law.
June 26, 1997:
The Supreme Court rules against doctor-assisted suicides.
June 26, 1997:
The legal details of the Supreme Court ruling.
January 8, 1997:
The ethical battle of physician-assisted suicide.
April 8, 1996:
An examination of medical ethics.
April 8, 1996:
The right to die debate.
October 7, 1996:
The Supreme Court looks at doctor-assisted suicide.
OUTSIDE LINKS:
PBS' FRONTLINE looks at Dr. Kevorkian.
Ms. Lee, first of all, how concerned are you that the Drug Enforcement Agency is going to revoke the licenses of doctors who might take part in this program?
BARBARA COOMBS LEE, Compassion in Dying: Well, we think the law is on the side of Oregon doctors and Oregon voters. The question turns on what is a legitimate medical purpose for the use of controlled substances. And we think that it's fairly well established that the final authority on what is a legitimate medical purposes is the lawmakers of an individual state. In this case the lawmakers are the people, themselves.
PHIL PONCE: Mr. McHugh, is the DEA doing the right thing, in your opinion?
BISHOP JAMES McHUGH, National Conference of Catholic Bishops: I believe they are. There's no such thing as just controlling drugs in one state. We're dealing with a phenomenon that's going to be nationwide in drug control and drug enforcement, is the nationwide concern.
PHIL PONCE: Bishop Spong, your take on the DEA's stance.
BISHOP JOHN SHELBY SPONG, Episcopal Diocese of Newark: I'm always amused at those people who want to get the federal government out of everybody's back except--off everybody's back, except in those instances where they happen to agree with the policy of the federal government. I would suppose the right of an individual to determine how that individual shall die, according to that individual's values system and faith commitments.
PHIL PONCE: Dr. Hendin.
DR. HERBERT HENDIN, American Foundation for Suicide Prevention: I think the issue is more that it would be unprecedented for the Food & Drug Administration to permit what would amount to a treatment when that treatment has not been studied. We don't know its efficacy. We don't know the complications of it, and the little that we do know is that it doesn't work. The information we have about dosage comes from the Dutch, and they tell us that the doses don't work in 25 percent of cases. In the Netherlands, they have to intervene with injections. In this country families have to intervene with plastic bags. The issue is medical practice. This is something that doctors are going into blind, and since Oregon doesn't even require doctors to report the cases, that we won't even learn from it. It's an experiment. The patient is a guinea pig, and the doctor is guessing. I've spent a lifetime working with suicide patients, and I see people take four and five times the lethal dose, and they don't die. They go into coma and after three, four days, and some of them survive, and some of them don't.
The basic arguments.
PHIL PONCE: We'll get into some of those substantive issues--some of those particular issues a little later, but first, Ms. Lee, in a phrase, why is it you support the right of patients to have access to doctor-assisted suicide?
BARBARA COOMBS LEE: Well, as a nurse, I practiced at the bedside of dying patients for over 20 years, and from that experience and my experience in health policy, it seems really self-evident that when terminally ill people are facing a situation of irreversible duration and intolerable suffering that they should have the choice and the control to hasten their death if that's the only way to avoid their suffering.
PHIL PONCE: And, Bishop Spong, what is your take on that?
BISHOP JOHN SHELBY SPONG: I believe out of my own faith tradition that life is sacred. But I don't identify life with a breathing cadaver. Nor do I identify life with a person who is writhing in pain and unable to have that pain alleviated. Once again, I think it is the right of the person to determine how and in what manner that person shall die under the circumstances. Now, I don't mean by that that if someone is suicidal that we should encourage them to commit suicide. I'm talking about the very distinct period of life where all hope has been abandoned, where pain is intensive, and where the application of drugs makes it impossible for the person to continue to have a relationship with his wife or his children. At that point I think I had the right to say to my doctor I would prefer not to have that kind of existence continued.
PHIL PONCE: Bishop McHugh.
BISHOP JAMES McHUGH: No. I disagree with Bishop Spong, my friend from New Jersey. Actually, life is a gift from God. We're stewards of the gift of life. We're not the absolute masters. No taking of life is justified, and that's what we're talking about here--the direct termination of a human life. In those final stages of disease there are ways to cope with pain, medically acceptable ways to cope with pain, and the patient is not going through this severe suffering. The patient's life is managed, if you will, by the medical profession. If they cannot cure, they can at least provide compassion and care, and that's what's the medical profession generally does. At the same time of course it's not necessary to use every possible means to prolong life for each additional instance. There comes a point when the medical technology can no longer bring about a cure, and then the patient can legitimately say begin to desist with the medical treatments and allow me to pass away. That's a very different thing than a doctor intervening and directly terminating a patient's life or anyone else, for that matter, directly intervening and terminating life.
PHIL PONCE: Dr. Hendin.
DR. HERBERT HENDIN: Yes. My opposition comes largely from my experience looking at cases and talking to doctors and examining the situation in the Netherlands and also in this country. And I'm persuaded that the care of the terminally ill is much worse once you have legal sanctions. What starts off as something intended for the exceptional case quickly becomes a routine way of dealing with serious or terminal illness, and palliative care and hospice care are two of the first casualties that you see. In addition--
PHIL PONCE: By palliative care, what does that term mean, Doctor?
DR. HERBERT HENDIN: By palliative care I mean care that will make a patient feel better, will feel comfortable, and invariably the cases that ask for assisted suicide want to live when they receive competitive palliative care. Most of the requests come because patients are not being relieved of suffering, and they're making the request to doctors who don't know to relieve the suffering.
PHIL PONCE: Ms. Lee.
BARBARA COOMBS LEE: If I could respond to that, I would tell Dr. Hendin that, indeed, palliative care has been the main beneficiary of the Oregon Death with Dignity Act so far. Since its passage, we've seen a great resurgence of interest in the medical community in palliative care. Hospice referrals have increased by 20 percent, and now Oregon leads the nation in prescription of morphine. This has a salutary effect on end of life care.
DR. HERBERT HENDIN: It does initially, but this is the same experience they had in the Netherlands. The scare and the fear does motivate doctors to learn something about palliative care. Once it's legally entrenched what happens is what the experience of the Netherlands was, that this becomes the easiest solution, and doctors no longer gravitate toward palliative care. They take the easier solution of assisted suicide.
BARBARA COOMBS LEE: I don't think the--
DR. HERBERT HENDIN: I think you're perfectly right, that the initial reaction is going to be people are scared, doctors are scared, they don't know what to do, and they have an interest.
As goes Oregon...?
PHIL PONCE: Bishop Spong, if I could ask you a question. Excuse me, Bishop Spong. Question: To what extent do you believe that what the voters decided in Oregon is reflective of the mood of the entire country, or is Oregon representative, or is it an aberration?
BISHOP JOHN SHELBY SPONG: I think it's far more supported around the country once the issues are clarified. There's an enormous amount of mystification around this. Dr. Hendin has just given a version of the slippery slope argument saying what can happen. There's never been an advance in the human race in area that there hasn't been great fear about where this should lead and what might happen as a result of this. We're in this problem because human beings are geniuses. We have pushed back the barrier of death to the point we've prolonged life to a significant point, and now what we have done, what we have begun to do is to keep death from coming when it ought to come naturally, ought to be welcomed. I'm always amazed that people of faith wind up fearing death so much as they want to stand against it and all of its forms. I think death is a friend of life that can be welcomed into one's being, and I think that human beings ought to be trusted with the right to manage their own dying.
PHIL PONCE: Bishop McHugh, afraid of death in all of its forms?
BISHOP JAMES McHUGH: No. The process of dying is also a salutary time in a person's life. It's a time in which a person can really examine his or her past life; it's a time in which he or she can grow closer to family members and family members can become very supportive, especially if there's been some estrangement in the past. The dying process allows a great deal of human dignity to surface to the top. We should not look at death as a terrible enemy.
Dying is part of living, but for us in the religious way dying is also part of that transferal to eternal life. Our whole concept of dying is linked with our belief in redemption, of our belief in eternal life, our belief in the fact that what we have done well on earth entitles to us a reward in heaven, and that the final moments of life allow us the opportunity to repent of our failures, to re-establish bonds of love and bonds of closeness with family members, and to be appreciative. And I think that's very often a common situation, to be appreciative of doctors and the nurses and the health care workers who have made the transition from life and very often from disease to a happy death and to an eternal reward.
What is the public's opinion on assisted suicide?
PHIL PONCE: Ms. Lee, you are a health care worker. Do you believe that the passage in Oregon by this wide margin, relatively wide margin of 60 to 40 percent, I believe it was--do you think it's going to make doctor-assisted suicide more acceptable in the public's mind across the country?
BARBARA COOMBS LEE: Well, assisted dying is always enormously acceptable in the public's mind. It's just an enormous disconnect between the minds of the public who know their minds quite well and the organizations, the institutions, and the politicians, who believe that they represent them. And I think that the discussion between Bishop McHugh and Bishop Spong sort of reveals where the difference lies, and I see the difference as a difference in believing who should be in control of the end-of-life process. Right now--control--physicians are responsible for acts and omissions of which the inevitable and the certain and foreseeable result is--you're right. Physicians do manage death. The question is: Can patients? And should patients have the choice and control to do the managing for themselves?
PHIL PONCE: By the way, Ms. Lee, do you have any idea--are there any studies or surveys that might reflect how much of a demand there is at this point, how many people in Oregon who want to take advantage of this?
BARBARA COOMBS LEE: Well, we think relatively few people will actually take advantage--take advantage--if by take advantage you mean exercise the option and take the lethal dose of medication. However, the beneficiary effect extends to essentially every dying person because it's enormously comforting to know that should one find oneself in the worst nightmare facing the--dying process, that there is a way out, and so we believe that even if you never avail yourself of that option, that option is of benefit to you.
PHIL PONCE: Dr. Hendin, do you believe that it is--do you believe it will continue to be a rarity if Ms. Lee is correct?
DR. HERBERT HENDIN: No. I think over time it increases. But the danger, from my perspective, is that what happens over time is that what Ms. Lee hopes for is kind of theoretical and academic; that patients will have more control over their death. If you watch this in operation in the Netherlands, what you see is that as doctors whose power increases and whose control increases when you have a legal sanction, the doctor can suggest euthanasia or assisted suicide, which has a powerful effect on patients. They often don't hear that patients are ambivalent about dying. They want to die in the morning and live in the afternoon. They don't present alternatives to patients that might make them feel better. And, in addition, they end up over time feeling they know best who should live and who should die, and they end up putting patients to death who have not requested it, so the motivation for it, which I can understand and sympathize with it, the patient should have more say over what happens to them, is not what happens--it can happen in somebody's theoretical frame work but not in the reality of how it's actually practiced.
"We're going into an experiment blind in which every patient is a guinea pig."
BARBARA COOMBS LEE: Yes, they do. There is a dose of medication that is universally fatal, and there's plenty of data from both the Netherlands and from the United States to demonstrate that, plus information about the pharmacology. That was sort of the big lie of the campaign, was the assertion that pills don't work and that patients will awaken and be suffering in their awakening. That was never, ever substantiated. In the 50,000 medically-assisted deaths in the Netherlands there was not one case of that kind dire prediction, and we have no reason to believe that they will come true here. If I could just say here--
DR. HERBERT HENDIN: Ms. Lee is wrong about that. I spent hours talking to Pietro Admirale, who did that study. He tells you that between 20 and 25 percent of people who take pills don't die in a reasonable three, four hours, and doctors intervene and give them lethal injections.
BARBARA COOMBS LEE: And that--
DR. HERBERT HENDIN: I've spent--I've spent a lifetime working with suicidal people who take four and five times the lethal dose and don't die. Part of the problem is that Oregon is going into this blind. If you and I can disagree about this, or have this discussion, it's because we don't know the doses; we don't know the complications; we don't know how effective it is and how it isn't, and Oregon is not going to make that possible because they don't even ask doctors to report the cases.
PHIL PONCE: And I'm afraid--
DR. HERBERT HENDIN: If we're going into an experiment blind in which every patient is a guinea pig that a doctor experiments on, we won't learn from it.
PHIL PONCE: And I'm afraid that's going to have to be the final thought for this discussion. I thank you all for joining me.
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