In The Name Of Compassion

I was in my first year of medical school in Oregon when citizens here voted to legalize assisted suicide. I didn’t know how I felt about the issue until a patient I met helped me decide that I believe legalized physician­-assisted suicide is important.

The patient had been diagnosed with late-stage cancer and was going to die soon. She knew that cancer is often painful, and relief from pain is bought only with a high level of narcotics. She did not want to live in pain, nor did she want to live in a stupor. She tentatively asked the attending physician if he would help her with suicide if and when she wanted it. He told her that it would be an option. The woman was incredibly grateful for this knowledge and appeared to take a much more optimistic view of her disease. She lived several more months and, as far as I know, never requested help to end her life.

The option of physician-assisted suicide empowered this woman. She knew that, if she chose to die, she would have the support of her physician and community. She was now in control of her disease, and if she began experiencing intractable pain, she would not be forced to “transcend” it or live in a narcotic haze. I realized that it was incredibly selfish to take away a person’s control over her body in the name of higher ideals.

I do not know if I will assist patients with their deaths when I am a physician. I do know that I am grateful to live in a state where patients will be legally able to approach me and ask for an end to their suffering.

As I began reading Mark O’Brien’s interview with Wesley J. Smith [“In the Name of Compassion,” February 1999], I mounted my arguments against Smith’s opposition to assisted suicide. I have had firsthand, intimate experience with helping friends die. It is a profoundly moving, life-changing, affirmative, and reassuring experience. So I thought, How dare Smith show up here in one of my favorite journals to peddle his fears?

But then Smith caught me off guard. Like him, I have repeatedly seen our corporate culture co-opt the language of hope. And, as he observes, it will likely do so with “death with dignity” — offering a plausible, acceptable (and cost-efficient) alternative to the heroic extension of life. Already I have seen HMOs repeatedly choose cost efficiency over decent medical practice. I have known people who have looked to suicide as a way out of depression or ill-managed pain. And I’ve witnessed the increasing failure of our communities to affirm life, let alone deal with such “nonproductive” matters as thrown-away people or the dignified end of life.

As I grudgingly reread the interview, I began shamefully to recognize myself in Smith’s fretting. You see, I am recently divorced and have lost a great deal — land, home, an entire way of life. It’s costly to rebuild. Not long ago, my mother died of heart failure, leaving me a small amount of money. Her husband, in his mideighties with Alzheimer’s, is frail and quite unable to care for himself. One of his children now cares for him. Recently, he has suffered an array of health problems, any one of which could end his life. When he dies, another tidy sum will come my way.

A voice arises within me unbidden: He is mostly deranged, with little quality of life left. Let’s see, how much would the money add up to? I can barely stand these thoughts, common as they must be to many of us as we begin to think about a retirement for which we are mostly ill-prepared.

These thoughts go away, temporarily. As they scuttle off, they leave me sadder, but with a broader understanding of who I am — and of the complexity of the issues Smith addresses.

Maybe Wesley J. Smith cannot imagine himself ever wanting physician-assisted suicide, but I can, and I vehemently resent his effort to deny me that choice. To compare withholding it to keeping someone from enslaving himself is to say that anyone who wants to end his life acts out of self-abasement and unsound mind. There’s nothing as offensive as someone trying to dictate another person’s behavior. To claim the attempt is motivated by protectiveness is patronizing and denies the other person the full autonomy that is his or her birthright.

Smith says assisted suicide is wrong because someday it might be twisted around to kill someone who isn’t willing. This is too insubstantial and hypothetical to justify a restriction of personal liberty. In fact, Smith’s whole argument is built on hypothetical scenarios. We have to give doctors time to perfect pain relief, he says. But who’s to say they ever will? We shouldn’t have death with dignity until we have life with dignity, he says. But in this imperfect world, we won’t ever have it. Legalizing assisted suicide will make people feel less valued, he claims. But in this country, where lack of universal health care, child poverty, urban violence, and unemployment have already devalued people, that’s like shutting the barn door after the horse is gone. And Smith’s main point — that systematic euthanasia will be the inevitable outcome of legalization — is based only on his own fears, assumptions, and cynicism.

Smith seems bent on keeping everyone alive no matter what, and if people disagree with him it’s because they’re mentally incompetent — “clinically depressed,” he calls it. I say if someone wants to die, that is his or her business, and all Smith’s scare tactics and allusions to Nazi atrocities can’t disguise it.

In the world Smith would give us, where no one suffers needlessly, no one is lonely, neglected, humiliated, or shunned, and everyone is valued and welcomed, denying assisted suicide doesn’t seem all that cruel. But no one lives in that world. How can we value people on their deathbeds when we don’t value the child in the street? People live in the present and contend every day with staggeringly harsh realities. They don’t need to have their hands tied by the self-appointed guardian of some idealistic vision.

Although Mark O’Brien’s interview with Wesley J. Smith was compelling, I feel Smith is mistaken to equate painlessness with quality of life. I am a social worker with a reputable hospice program. We boast an exceptional ability to alleviate pain, and also offer chaplaincy and counseling services to alleviate emotional or spiritual suffering. What we cannot do, however, is make lying in bed and wasting away a comfortable status for patients who have always been active and independent.

Many patients have asked me if I can hurry things up for them. I can’t. These patients are not necessarily clinically depressed. They are often bright, humor-filled people who are all too aware of what lies ahead for themselves and the people they love.

My hospice work has made me sure of one thing: I want to die quickly. I hope for an accident, a fatal heart attack, or some other exit that doesn’t involve weeks of incapacity. I do not want to watch television for hours on end or have nursing assistants wash and put lotion on my weakening body. I do not want the people I love to change my diapers or give me suppositories when I can no longer swallow.

Who better to assist with a painless death than a trusted physician?

Wesley J. Smith’s international Anti-Euthanasia Task Force pretends to address physician-assisted suicide as a secular public-policy issue, but its real agenda is religious. This seeps out when Smith talks about the dying getting to “the other side.”

Rather than saying what he believes — that it’s morally wrong for people to receive assistance in dying — Smith insists that no terminally ill individual is capable of making that decision; be it for lack of pain medication or because of depression, the express wishes of the dying are never to be trusted. Smith delivers this insult without batting an eye, thus belying all of his talk about compassion.

I do not need for Smith to hover over me and take some of my pain onto his shoulders, as he so quaintly puts it. It’s enough to have Bill Clinton feeling everyone’s pain.

Prior to reading Mark O’Brien’s interview with Wesley J. Smith [“In the Name of Compassion,” February 1999], I would have said unequivocally that assisted suicide should be legalized. This piece turned me around completely.

When I read it, I had just spent eight agonizing months dealing with medical providers on behalf of my eighty-one-year-old mother (who, incidentally, was a member of the Hemlock Society). During the last year of her life, when the deterioration of her physical and mental functions accelerated, my mother began openly to express feelings of self-loathing. “I’m just a little old lady,” she would say despairingly. Toward the end, when she knew she was dying, she was prematurely discharged from the hospital. Within twenty-four hours of arriving back at the nursing facility where she lived, my mother began vomiting uncontrollably. Rather than give her medical attention, the head nurse put her alone in a room far from the nurses’ station. My mother continued to throw up and was too weak to use the call button, which wasn’t working anyway. If assisted suicide had been an option at that moment, she surely would have chosen it.

Though desperately ill, frightened, and alone, my mother found a way to summon me. When I arrived, she was heaving and covered in vomit. Emotion threatened to overwhelm me, but I took charge of the situation and made sure that my mother got the medical attention, pain relief, and emotional support she needed. My husband, my sister, and a dear friend helped out, and I arranged for a hospice aide to be with my mother around the clock. For the next ten days, we surrounded her with caring and love.

Once the staff realized that my mother had people who cared for her, their attitude toward her changed. Nurses, aides, security guards, and even janitors told us how kind, sweet, and funny my mother had been during previous stays there. Many told me that we were doing something wonderful, and they shared their own experiences of losing loved ones. Sick as she was, my mother created a sense of community around her deathbed.

She died peacefully just before Christmas, on the day it snowed in San Francisco.

I wonder if Wesley J. Smith has had a family member with Alzheimer’s disease. I suspect the experience might change his mind about assisted suicide.

I watched as Alzheimer’s transformed my father from a pleasant adult man into an infant needing twenty-four-hour care. My family wished desperately for a law enabling us to end his pathetic existence. For his last three years, my mother became a slave to his illness, spoon-feeding, bathing, and diapering him, and turning him every two hours, round-the-clock. He lay in a back bedroom, unable to speak or recognize anyone. The only thing he was able to do was open his mouth for food and swallow it. My father had never intended to punish my mother this way, but neither had he taken any steps to prevent it.

In the early stages of his disease, my mother had struggled to keep my dad at home. But after ten years, when he no longer knew who she was and began spitting and urinating in strange places, she placed him in a nearby nursing home. There, still able to walk but rarely uttering a sound and not knowing who or where he was, my dad shuffled up and down the corridors for three years. Finally, the chronic neglect he suffered (how could he complain?) forced my mother to take him back home or suffer high blood pressure and perhaps a stroke from worrying about him. So the round-the-clock saga in the back bedroom began.

Smith might wish to believe that this describes a loving wife making the ultimate sacrifice for her husband, but that just isn’t true. My real father had departed years before, leaving behind an empty husk requiring her slave labor to maintain it. We weren’t preserving his life, but we were destroying my mother’s health. Eventually, the strain affected her immune system, and she contracted a bad pulmonary infection, which she unwittingly passed on to my father. He died a short time later. (For a long time, I had been sure he would outlive her.)

Had there been a law in place in Washington State allowing euthanasia, I’m sure my father would have met all the criteria. Smith describes assisted suicide as “just getting rid of the person in one fell swoop.” I hardly believe that after sixteen years of dealing with my dad’s Alzheimer’s, my mother could have been accused of that. Smith worries about potential abuses of a law providing for assisted death. But what about the daily abuses occurring in nursing homes all over the country? Let’s do whatever it takes to preclude abuse of such a law, so we can stop keeping people like my dad in back bedrooms or awful nursing homes, forcing them to stay alive when they can no longer tell us they don’t want to live anymore. I would gladly have given my own father a lethal injection had it been legal, and I know my mother felt the same. And yes, it would have been in the name of compassion.

In your May 1999 Correspondence section, Wesley J. Smith smites his critics with unwarranted vehemence. The most egregious example is his response to hospice worker Margie Thompson’s letter, in which she offers a perspective on hospice life somewhat bleaker than his own. He counters with his version, which is sentimental to the point of smarminess, and concludes by saying, “I do hope that the patients Thompson works with do not perceive her personal disgust over the difficulties that dying people sometimes face.”

I read the same letter and thought it reflected concern for and empathy with her clients’ predicaments. Thompson speaks directly about some of the less-pleasant aspects of terminal illness, whereas Smith prefers euphemisms. She also speculates that she herself might prefer to opt out. Surely, that does not translate into “personal disgust.” Dying is not necessarily a Disney scenario.

Such moral condescension is one of Smith’s favorite rhetorical devices. In the interview in the February issue [“In the Name of Compassion”], he states that assisted-suicide advocates are, at the very least, “misguided,” and suggests that less-savory forces are really behind the movement: a culture that devalues anyone not young, beautiful, and athletic; a “radical individualism” that displaces communitarian ideals; HMO-inspired pressures for medical cost containment; and perhaps even neo-Nazi notions of eugenics. He warns that legalizing assisted suicide starts us down a slippery slope toward a world where the unfit are routinely euthanized. Without a doubt, Smith’s concerns are valid ones, but his response to criticism demonstrates that moral debates can themselves present a slippery slope. Characterizing those with opposing views as either deluded or morally deficient — without “true” compassion — is the first step downward.