Earlier this year, just before the COVID lockdowns started, I gave a presentation about Final Exit Network (FEN) at a weekly gathering of humanists. As usual, the presentation included information about physician-aided death (PAD), such as the list of states where it is legal and the fact that some people come to FEN because they do not meet the strict requirements of PAD. During the Q&A session after the presentation, I was asked if I think PAD might become available through universal health care. My immediate response was something like, “I don’t see that happening.” I would typically move on to the next question at that point because universal health care is a politically charged topic. Until that moment, I had generally avoided discussing anything political at FEN events.
A slight detour is needed here. Some FEN speakers include specific information based on the speakers’ expertise. I have two such areas. First, as an ordained chaplain, I am often asked how to respond to people who object to the right to die because of their religious beliefs. For example, many Christians claim the right to die violates the sixth commandment of the Hebrew bible (the Christian Old Testament). The commandment is correctly translated as thou shall not murder. Unfortunately, it is incorrectly translated in the more widely used King James bible as thou shall not kill. When correctly translated and understood in the context of the original Hebrew, neither suicide nor assisted suicide qualify as murder and therefore do not violate the sixth commandment. I will write more about that and other religious objections in a future post.
My other area of expertise is of a political nature and, when considering the apparent polarization in our country today, that’s a dangerous door to open.
One might be tempted to assume that most FEN members and supporters are politically liberal. The key word is “most.” I saw hints of FEN’s political diversity when I was developing an online course on the right to die for the American Humanist Association. For that project, FEN sent surveys to its members, asking why they care about the right to die in general and why they joined FEN in particular. A common theme was that most people had witnessed the needless suffering of a loved one and did not want that for themselves, but some interesting differences emerged in their stories.
Many survey respondents blamed religious authorities for denying us the right of self-deliverance. A few blamed politicians, usually focusing on conservatives with ties to the religious right. Several of the respondents said they like FEN because it’s a better option than a gun. Some of those respondents prefer FEN specifically because they want nothing to do with guns and openly advocated for more gun control. Others had no objections to guns in general but for various reasons did not want to use a gun to end their lives. One noted that his only gun was a prized possession that he hoped to pass on to a grandchild. He didn’t want to risk having the gun confiscated by law enforcement and he didn’t want its value tainted with the likely stigma.
I mention the differences of opinion on guns because it shows that people who may strongly disagree about a politically divisive issue can unite behind a common cause. And that brings me to the rest of my answer about PAD being covered by universal health care. The rest of my answer was that I’m not a big fan of universal health care because it ultimately gives politicians, bureaucrats, and lobbyists for the pharmaceutical and healthcare industries undue influence over my health and therefore over my death. I don’t want them to have that power.
Another slight detour is helpful here. FEN hosted a conference in early 2018 entitled Dying in the Americas, with speakers invited from throughout North and South America to discuss the right to die in their respective countries. Several speakers were doctors or lawyers who naturally talked about medical and legal issues. I gave a brief presentation and participated in a panel discussion with some of those doctors and lawyers. During that panel discussion, I challenged the premise that I should care what doctors and lawyers say about the time and manner of my death. Speaking to the audience, I said something like this: “It is not a legal decision for lawyers or judges to make. It is not a medical decision for doctors or nurses to make. It is a personal decision for you alone to make.” Seeing many heads nodding in approval assured me that I was not alone in my opinion.
In last week’s post, I mentioned that I attended a Minnesota Senate meeting on death with dignity and that I was a hospice chaplain at the time. I was also the Executive Director of the Libertarian Party of Minnesota (LPMN). It was actually the combination of both jobs that prompted me to attend that event and ultimately led me to FEN. As part of FEN’s outreach, I eventually arranged for or gave FEN presentations at three consecutive annual meetings of the LPMN and one for the Libertarian Party of South Dakota. Recognizing the right to die as the ultimate civil liberty, I have yet to meet a libertarian who does not fully support FEN’s mission.
Earlier, I intentionally referred to the apparent polarization of the country because I suspect it is largely just the appearance of division, mostly driven by the media. There are protests and even riots going on in select places, but the vast majority of people are just living their lives and trying to get through a crazy year. Whether you consider yourself a liberal, progressive, conservative, libertarian, anarchist, or something else, everyone reading this is an ally in the fight for the right to decide. We are better served by focusing on things that unite us than on what divides us.
Kevin, I welcome you to my early Monday mornings. I look forward to these posts as a way to get me thinking as I kick off the week ahead. I appreciate your bringing in your experience and background as you craft your blogs….a libertarian, hospice chaplain. There is a lot to like there!
As you and Lamar know well…language matters. Many of us in the movement are working hard to solidify our language and I believe that “medical aid in dying” has gained considerable traction across the country. Many states are proposing to enable advance practice nurses and physician assistants to participate in assessing and prescribing for eligible patients who request compassionate end of life assistance. Thus, to limit our practice to “physicians” does not seem appropriate. So, please consider a language change and join us as we legislate and implement this important end of life option. Thanks for considering and best of luck with your blogging. We appreciate it.
As some followers of this blog know, I follow it as part of fierce opposition to any sort of assisted suicide or euthanasia, even for the terminally ill. Thanks to our gracious hosts for allowing spirited, but respectful, discussion on these matters.
Just what does one mean by “medical assistance in dying” or “medical aid in dying”? Hospices, with a stated mission to neither hasten death or prolong life, provide “medical aid in dying”. So do palliative care specialists (physicians, nurses, and other members of the palliative health care team) and palliative care units. They just do so without providing lethal medications (usally intravenously) or lethal doses of medication that patients self-administer. One could even make a case that family physicians, nurse practitioners, and physician assistants who deal with the medically vulnerable near the end of their of their lives at any age provide medical aid in dying…whether they would ever write a legal prescription of lethal medication. They help their patients to die well.
Just because the Canadians have hijacked this term to provide (mostly) euthanasia and assisted suicide by physicians and nurse practitioners for an increasing number of Canandians every year does not mean that we must.
If one is a proponent of instantaneous (or nearly instaneous) death by lethal intravenous medication or a lethal dose of pills or capsules, call a spade, a spade for heaven’s sake. Or perhaps call it medically-hastened death or health care professional-hastened death, if you will.
I personally would welcome a hastened death if it got me out of my misery. I’m not afraid of death and actually look forward to where I’m going afterwards, so any help to get there is exceedingly welcome. I don’t have the right to tell you when or how you have to die, and you don’t have the right to tell me when or how I have to die, either. I continue to be baffled by those who think they have that right. My death, my choice; your death, your choice. If you don’t want MAID or its equivalent, don’t use it. If I had read previous comments of yours or knew where you were coming from, I probably wouldn’t bother to reply because I suspect I’m yelling into the abyss.
Mystic Tuba,
Whatever misery you are undergoing, my sympathies. Do not want to sound glib, frivolous, or minimize what you are going through in any way, of course.
1) Suicide is *not* illegal, nor should it be. It is always tragic, of course. Anyone can take her or his own life; no one can stop a determined person from doing so. It’s when we turn our health care professionals into facilitating it where the problems lie.
2) No person is an island. What you, I, and everyone else *does* affect others. In The Netherlands and Belgium, euthanasia is now becoming normalized. There are documented cases in the New England Journal of Medicine of it being done *without* explicit patient consent. I will provide the reference upon request.
3) I do not know how old you are and that *is* none of my business. I am 66 years young and thank God, very healthy. According to acturial tables, my expected life span is 86 or 87. Our US Medicare system is going broke. If euthanasia is normalized, do you really think that health care professionals will really go the extra mile to keep those of us who *want* to stay alive with a broken Medicare system?
4) Have you ever wondered why in the states where physician-assisted suicide is legal for terminally ill people with < 6 months to life, how few people actually choose this manner of shortening their lives? In some cases, it could be because they cannot find the two doctors willing to provide the assessments necesaary to proceed, of course. It could be because the lethal dose of medication is rather costly and not covered by health insurance. Some may have philosophical or religious objections. It might also be because some reside in assisted-living centers or nursing homes where it is not allowed on site. Most can obtain adequate pain control if this is an issue. But these factors cannot account for the very, very low percentage. Many, many people want the option in *theory*, but few really use it.
__________
*About 30% of Democrats (like myself) identify as pro-life, according to a 2019 Gallup poll.
Thank you, Sue, for contributing to thought-provoking discussion rather than polarizing debate.
Part of the challenge as I see it is the issue with using a short phrase consisting of only a few words to stand in place of (or point to) something complex. Beyond the personal (individual) associations with particular words and phrases, some can be very emotionally and/or politically charged. Also, the vast majority of words seem to have multiple meanings. So what meaning is intended when selecting a particular word? In addition, social taboos and stigmas are often uncovered by running into the relative dearth of words and language to describe and discuss the taboo and stigmatized issues. We run directly into the issues of taboo and stigma when attempting to discuss death, including suicide.
I regularly run into the hurdles described above when simply using the word suicide. Wikipedia’s first sentence in their entry is, “Suicide is the act of intentionally causing one’s own death.” While this is a technical definition, I find that many working definitions and uses of the word can vary substantially. Even with a specific individual or group. That might depend upon the context of its use. Many times language is used casually and not precisely, which can add to the confusion of interpretation and understanding intent and meaning.
I see an example of variation in the interpretation of word meanings in Sue McKeown’s response to this blog post. What ought “medical aid in dying” to mean? If I had my druthers, I’d rather we have multiple phrases that describe multiple different things. I would like to have compassionate medical support in the *process* of dying. Yet how does one define that? How long (or short) must that process be to come under a meaning of that phrase? There is already one term for such support: palliative care, which Wikipedia says is “an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex illness.”
Okay, yes, that definition of palliative care doesn’t cover all cases of why/how people die. In particular, that definition does not include the word “fatal.” So one might infer it means “non-fatal” or “non-terminal.” Yet the definition also does not specifically (overtly) exclude fatality or terminality. We are already into one layer of variations of understanding just with those two words. If we add the third word (fatal or terminal), we end up getting into a next layer of deepening complexity.
If one were to be bold, perhaps I’d declare that one thing I want available is “medical help to die” — to achieve the state of death, not simply (only) care with the process of dying, and to have professional medical “help” with that goal. Now I’d only be left with the quandary of explaining what I meant by “help.” If we are calling a spade a spade, I would prefer language that is more clear and to the point. Unfortunately, using such relatively clear and perhaps blatant language often ends up being a barrier to communication rather than an enhancement of understanding and clarity.
In practice and using a pragmatic approach, I find it can come down to a matter of integrity and self-definition at the most basic level, followed by a need to consider clarity in communication at the next level. First, know what I mean and why. Select candidate words that can stand for (in the place of) those meanings. If I’m only talking with myself, I don’t need to go any further. However, as soon as (interpersonal) communication comes into play, the need to consider the social environment becomes important. Otherwise, clear communication is going to be hit-or-miss, and meaningful discussion is likely to be difficult or impossible.
This very thought provoking idea of the desire for freedom of choice transcending political differences reminds me of a quote from Ronald Reagan: “Government exists to protect us from each other. Where government has gone beyond its limits is in deciding to protect us from ourselves.”
I recently found out that in North Carolina, assisted suicide is not illegal (or was not when the video was made.) While the methods available may not be as easy an exit as MAID or some of the methods discussed in the PP handbook, at least a person assisting will not (if the law has not changed) be arrested for helping to ease the way. I don’t know what other states laws are in this category, but if I could find one that has a cool and dry climate, I would move there. I’m afraid I’ll screw it up by myself, when the time comes, and I will never meet FEN criteria because I will not subject myself to the “allopathetic” system of “medical” care. I would very much like to see FEN change its criteria to “my life my choice” instead of “the medical system’s life and the medical system’s choice.” I realize they need to stay out of jail but it would be nice to have that real freedom.
My Life is my own, my death is my own. No one has the right to change that or desperately try to change my mind. Not surprisingly the Dutch/Belgian legal model, opinions and law are the most sane. If I determine that life is not worth living any longer, that is my business.
Well said, Kevin. Thank you.