Pro Choice To The End Of Life

(Dr. Susan Celina Robinson, M.D. is a retired gynecologist in Paso Robles, CA She graduated from University of California, San Diego (UCSD), School of Medicine in 1978 and did her residency at Tufts Medical Center. She is certified by the American Board of Obstetrics and Gynecology. Dr. Robinson has been a leader in the reproductive rights movement, and has also provided tips and advice on Dementia and Advance Directives.)

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For the last 15 years of my 35-year career in OB GYN I specialized in abortion care, eventually sub-specializing in abortion care of people with later pregnancies. I loved this field because I could help every patient who came through the door, and I could surprise them by being nonjudgmental and kind. (I shudder to think what they expected.)

Many people think that an abortion is harmful to the patient unless the circumstances are really extraordinary. But who gets to decide what circumstances are extraordinary enough? Some random anti-abortion activist? The local priest?  Or the expert on that patient’s life — the patient herself? I believe that the patient’s decisions should be followed, not those of unrelated people or institutions which have no connection to the adult patient of sound mind.

There are four major principles of medical ethics that guide doctors in their decision making: 1) to be fair in the allocation of medical care, 2) to do no harm, 3) to be of benefit to the patient, and 4) to respect the personal autonomy of the patient.

In this country we fall horribly short of allocating medical care fairly. People with money or power get the best care. People with neither get the scraps.

To do no harm and to be of benefit to the patient are not straightforward. Who gets to decide what is benefit and what is harm? For example, the patient might be desperate to have the benefit of an abortion, whereas an anti-abortion activist might think that an abortion is harmful. Another example might be the case of a patient with severe dementia; if he got pneumonia, would giving him antibiotics be beneficial because they would extend his life? Or would antibiotics be harmful because they would extend his life?

Respect for the patient’s autonomy is clearer. Autonomy means that if the patient is of sound mind (has ‘capacity’), she can make her own independent medical decisions. The doctors and medical institution should respect and follow the patient’s wishes if possible or unless they have a conscientious objection, in which case they should refer to someone who will respect and follow them.

Now I am retired, and I find myself interested in end-of-life care choices including Medical Aid in Dying (MAiD). Once again, I find myself disagreeing again with the Catholic Church and now with anti-MAiD activists.

“Opposed to abortion? Don’t have one.” is a slick bumper sticker but it misses a central point about the anti-abortion position. It’s reasonable that someone who believes that the embryo or fetus is already a human being is going to be opposed to abortion. They may feel that it is their job to prevent the destruction of that helpless and vulnerable human being. I disagree, but I get it.

On the other hand, who are the people opposed to MAiD protecting? To receive a prescription for MAiD, the patient must be 18, have “capacity” to make medical decisions, and have 2 physicians agree that they are within 6 months of death. There is no helpless embryo or fetus to protect. There is an adult person who is of sound mind, who is expecting or experiencing a protracted, painful, or otherwise miserable death, who would prefer to choose a more peaceful death. That adult person doesn’t need protection and her decision in no way affects or impinges on any aspect of the lives of the anti-MAiD activists, the Catholic Church, or people of any other faith for that matter.

Anti-MAiD activists are concerned that the disabled and the elderly will be coerced to request MAiD. Since one must have capacity to get MAiD, this assumes that old people or people with disabilities are incapable of making their own decisions even though they meet the criterion of having capacity. MAiD, called “Death with Dignity” in Oregon, has been legal there since 1992 and it is now legally used in California, Colorado, the District of Columbia, Hawaii, Maine, Montana, New Jersey, New Mexico, Oregon, Vermont, and Washington. At least 5200 prescriptions for MAiD have been written and there has never been an accusation or report of patient coercion.

Why would an anti-MAiD activist try to force a patient about whom they know nothing, to live by the activist’s personal values rather than the patient’s own? The activist has no skin in the game, no dog in the fight. The anti-MAiD activist thinks that everyone should follow the rules he thinks are “right” and he wants his opinion to override the autonomy of everyone else. By contrast, the patient seeking MAiD may disagree with the anti-MAiD activist, but that disagreement affects no one. Each can go her own way without interfering with the autonomy of the other.

So that pro-choice bumper sticker applies very well to end-of-life choices: “Don’t approve of MAiD? Then Don’t Request It.”

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Final Exit Network (FEN) is a network of dedicated professionals and caring, trained volunteers who support mentally competent adults as they navigate their end-of-life journey. Established in 2004, FEN seeks to educate qualified individuals in practical, peaceful ways to end their lives, offer a compassionate bedside presence and defend a person’s right to choose. For more information, go to www.finalexitnetwork.org.

Payments and donations are tax deductible to the full extent allowed by law. Final Exit Network is a 501(c)3 nonprofit organization.