When "Going Gentle Into That Good Night" May Be the Right Decision: The Case for Assisted Suicide
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Torch Magazine • Spring 2020
When “Going Gentle Into That Good
Night” May Be the Right Decision:
The Case for Assisted Suicide
By Leanne Wade Boern
Reprinted from The Torch, Fall at close of day;
1997, Vol. 71, No. 1. Rage, rage against the dying
of the light.
Preface And you, my father, there on
the sad height,
I bring to this topic familiarity Curse, bless, me now with
with the medical profession and your fierce tears,
professional views based on social I pray.
work experience. I also bring Do not go gentle into that
Leanne Wade Beorne has a B.A. in
English from the University of
something few avoid—personal good night.
Maryland and an M.A. in English experience with illnesses and dying. Rage, rage against the dying
from the University of Richmond. From a generalist’s perspective, I of the light.
She is presently pursuing a
masters degree in social work with
offer an overview of an issue with
specialization in gerontology at which we all must come to terms. Many of you will be familiar
Virginia Commonwealth University. As individuals and as a society, it is with this second poem, by Alfred
She has served as instructor in
vital that we reach some consensus, Lord Tennyson.
English at Virginia Tech and the since medical technology makes
University of Richmond. As a free- prolonged death increasingly “Crossing the Bar” by Alfred
lance writer, she won awards
for articles published in various
common. Lord Tennyson (1809-1892):
periodicals from the Virginia Press
Women, the National Press Women As a preface, I share with you Sunset and evening star,
and the Virginia Chapter ofthe
American Cancer Society. In
two favorite poems, opposing and And one clear call for me,
addition, she has served as editor of thought-provoking illuminations And may there be no
several publications. on the manner of our dying. moaning of the bar,
She is a member and the first female
When I put out to sea.
president of the Torch Club of I begin with the first stanza of
Richmond where she presented this Dylan Thomas’ haunting villanelle, But such a tide as moving
paper in November 1996.
in which he addresses his father. seems asleep,
Too full for sound and foam,
From “Do Not Go Gentle When that which drew from
Into That Good Night” by Dylan out the boundless deep
Thomas (1914-1953): Turns again home.
Do not go gentle into that Twilight and evening bell,
good night, And after that the dark!
Old age should burn and rave And may there be no sadness
34Torch Magazine • Spring 2020
of farewell, Tippy loved, mind and body healthy.
When I embark;
Years earlier, my husband Lona
For tho’ from out our bourne cradled our still-beautiful Shetland
of time and place Sheepdog, Tippy, in his arms and Before the tumor invaded her
The flood may bear me far, said “Tippy is going to die.” He brain, in her prime, she charted
I hope to see my Pilot face dealt with death and dying all the her own course, a woman who
to face time in his profession, but tears was known by her family and
When I have crossed the bar. cascaded down his face now. Tippy friends as intelligent, quick-
was our cherished "only” dog, witted, assertive, and independent.
I would now like to share with beloved from the early days of our Her two daughters grown, she
you three vignettes, which I hope marriage, loving, kind and always returned to nursing, at Chippenham
will reverberate in your minds with there. But now his kidneys were Hospital in Richmond, Virginia.
the poetry and with my remarks. failing; it was not easy for him to One winter day, Lona collapsed
run to us, jump up to sit on our while caring for a patient. A tumor
THREE VIGNETTES laps, follow us everywhere. He was had invaded her brain. Surgery
a little dog with a big spirit and a and chemotherapy kept her alive,
Helen big heart, who delighted all he met. but horrible drug side effects and
Although he was endearing and the tumor’s re-growth made this
She was once an energetic, charming, he was also a very self- once active tennis player able to
strongminded, loving mother, wife possessed little creature, with great get around only with assistance.
and grandmother. She almost never dignity. To surrender him to the Frightening seizures felled her at
sat still, loved pretty clothes and earth seemed unthinkable at first. unpredictable intervals. By spring
sunshine, and was always a woman His continuing absence, 12 years of 1996, Lona and her family knew
with great dignity. She was no later, still tugs at my heart. But he that although surgery could prolong
longer that woman by the time she trusted us completely all of his life. her life, she was dying and would
mercifully died at age 88. Instead, That trust demanded that we eventually die from her illness. And
she was blind, incontinent, allow him to die as he had lived, the surgery would almost certainly
uncommunicative and unaware still in functioning control, leave her paralyzed. Lona made
of her loved ones and her before uncomprehended pain and her own decision about death, as
surroundings. For over a year, she immobility overcame him. We she had about the rest of her life.
moved only from bed to chair, owed it to Tippy to let him “go She had “raged against the dying
never recognizing her devoted gentle into that good night,” and of the light” as long as it seemed
husband of 64 years, who cared for we did, whispering good-bye as she might defeat the disease that
her tenderly. Against her will, the he lay in our arms, his eyes on our stalked her; now she knew the
shell that had been Helen “raged faces. It was the hardest thing I had tumor would win. But she would
against the dying of the light.” ever done, but to have held onto not helplessly endure the final
Yet how often she had spoken him would have been supremely surrender; believing that in dying
of her mother’s last years, after a selfish, motivated by our own need she would indeed “turn again
devastating stroke; how she had and weakness, not by his need and home,” she chose to die peacefully,
feared the loss of her own mental best interests. Tippy is buried in her faculties and personhood still
and physical faculties. At last, she our pet cemetery, the wooden cross intact, not debilitated and supported
slipped out of the world she no marking his grave painted by our by machines. She indeed left this
longer knew, insensate in a nursing then-young son, with 3 images world on “such a tide as moving
home; “That wasn’t my mother," of things Tippy had loved in life. seems asleep,” thankful for the
her son, my husband, said. “I lost When we think of Tippy, we see peaceful means that carried her out
my mother two years ago. I won’t him running across the yard, silky of this “bourne of time and place.”
remember her this way; I won’t." fur brushed by the wind, happy and
35Torch Magazine • Spring 2020
Doctor Death the media, but a caring, sensitive are inextricably linked. Because
physician. Kevorkian, Jones said, of his media-spotlighted crusade,
They call him “Doctor “made it clear that his sole purpose state legislative responses, and the
Death”—Jack Kevorkian, M.D., was to help her prolong her life as Supreme Court’s consideration,
with his “suicide machine.” To long as she felt she could exist... a national debate on the issue is
some, he is a murderer, taking He never pressured her” to choose finally burgeoning. Physician-
what only God should give and death until she was ready. assisted death is now legal in 12
take, a human life. To others, he states. Given the dilemmas and
is a hero who helps terminally and Lona Jones looked for spiritual choices that medical technology
chronically ill adults, determined guidance in making her decision. has created, it is surprising that
to have control over their quality She had, according to her husband, discussion about the bioethics of
of life, die, sparing them and their “a strong faith," and she wanted prolonging life (many would say
families extended pain, suffering, to reconcile that faith with her prolonging dying) has remained
and debasement. From 1990 until feelings about death. She feared so muted. In thinking seriously
the time of writing this, Kevorkian ending her life helpless, without about assisted suicide, we must
has “helped” 44 people to slip out dignity, far more than she feared not think our choice vindicates
of life, most by inhaling carbon death. But Jones had to travel far or condemns Kevorkian. We may
monoxide gas (Adams, 1996, June from home to die. And her husband disagree with his tactics, we may be
20; Wolff, 1995, May 13). Juries had to leave her at an emergency uncomfortable with the man as the
have yet to convict him. room, with a fabricated cover story media and his lawyers portray him,
about her death, and then disappear but we may philosophically support
On June 8, 1996, Lona Jones for several days until reassured the individual rights he champions.
became Kevorkian’s “victim” that police and prosecutors would At least, he has spotlighted the issue
or “client,” depending on your not arrest him for helping her so that a national debate can begin
perspective. Lona Jones and her accomplish her last wish. and so that the medical profession
husband journeyed from Chester, must respond.
Virginia to Michigan so that she
could end her life with Kevorkian’s She feared Don’t automatically oppose
help (Adams, 1995, June 20, A7). assisted suicide because your
ending her reaction to Kevorkian is negative.
Last fall, in Richmond, Ralph Perhaps terming the act of helping
Jones spoke to the bioethics life helpless, someone to die “assisted death”
committees of Johnston-Willis instead of “assisted suicide,”
and Chippenham Hospitals. My without dignity, would keep our deliberations
husband chairs those committees, from being influenced by negative
and I heard Lona’s husband speak, far more than connotations of the word “suicide,"
taking spellbound listeners on a which ends a life that could be
remarkable odyssey, through his she feared continued and implies mental
wife's life before and after her irrationality that may be treated.
illness and through the decision- death. An assisted death is one where
making process that ended that those involved have explored
night in Michigan. Lona Jones had Jack Kevorkian is not the focus all treatment options and the
investigated all possible treatments of this paper—I am concerned ramifications, physical, social,
at several medical centers. Ralph about the right of adults to make emotional, moral, ethical and
Jones told us that the Kevorkian he autonomous decisions about the spiritual, of assisted dying. Such a
and his wife came to know in the way they will end their lives. But death “ends the life of a patient...
months before she died was not the in 1997, in America, Kevorkian whose hope for continued living
caricatured, loose cannon we see in and the issue of assisted suicide and cure is gone and who...[faces]
36Torch Magazine • Spring 2020
suffering until inevitable death” In June, the Supreme Court the need for firm guidelines and
(Jamison, 1996, p.l6). I use the ruled on two cases (from the safeguards. Concerns touch the
terms interchangeably in this paper. Second and Ninth Circuit Courts deepest core of our humanity.
of Appeals) involving the “Do our moral lives belong to
Aging Population constitutionality of assisted death us alone or do they belong to the
in April (Gianelli, 1995, November communities or families in which
Within 20 years, the number of 13; Wilkes, 1996). The Court we are embedded? Will this new
persons over age 65 is expected to said that there is no constitutional right give the dying a greater sense
double to 60 million, and the oldest- guarantee to assisted suicide. In of control over their circumstances,
old cohort are growing fastest their writings, the justices made or will it weaken our respect for
(Osgood, 1995). America spends it clear that they do not expect life?” (Carter, 1996 p.28) “To
vastly more than any other country or hope that the ruling will end whom does a death really belong?”
on intensive and chronic care, attempts to meet a consensus about (Jamison, 1996, p.15)
and for most people, more spent the issue. The Court has left it to the
in the last year of life prolonging state legislatures to deal with the
death, not improving quality of issue, an outcome that many legal America spends
life, often simply warding off “the commentators speculated (and
grim reaper” (ABC Nightly News, some hoped) would occur. Yale vastly more
March 5,1996). People in later years Law Professor Stephen A. Carter
are more likely to be confronted observed this summer in The New than any other
with life-ending and debilitating York Times Magazine: “Except in
diseases. People can now formulate emergencies, a court decision is country on
advanced directives, the written the worst way to resolve a moral
decision not to be maintained dilemma... The biggest problem is intensive and
after cognitive function ceases, that [a Supreme Court decision]
and can also execute medical would preempt a moral debate chronic care.
powers of attorney, empowering that is, for most Americans, just
representative to make end-of-life beginning” (Carter, 1996, p.28). Judges in the Ninth Circuit
decisions according to the patients' In an editorial, columnist Ellen Court case had ruled that “citizens
wishes. Still, only 1 /4 of Americans Goodman says that America should have a 'fundamental' right to” make
presently have these documents, import not the Netherlands’ process decisions about medical treatment,
and according to a 1995 JAMA of assisted suicide but “the Dutch including physician-assisted
study, 2/3 of doctors who received tolerance for ambiguity; for living suicide (Azevedo, 1997, p.140;
the documents did not look at them in the ethical gray zone, grappling “High Court Expands ... ,” 1996,
(Shute, 1997). If assisted death with complexity instead of denying p.54). Writing for the majority,
were legal, competent, still healthy it, staying open to change” until we Judge Stephen Reinhardt summed
people could execute advanced find “a way of dying that is both up eloquently the case, based on
directives that would allow merciful and careful” (Goodman, liberty and privacy issues, for
peaceful termination of their lives 1997, p.A 19). autonomous end-of-life decisions:
by doctors’ active intervention, “A competent, terminally ill adult,
as well as by non-action such as Strong and thoughtful voices having lived nearly the full measure
withholding respirators and feeding on both sides present plausible of his life, has a strong liberty
tubes, which is already being done. arguments. Certainly, the choice interest in choosing a dignified and
And the doctors would be legally to support or oppose assisted death humane death rather than being
bound to follow directives or find demands reasoned debate. Even reduced at the end of his existence
another physician who would. wholehearted proponents must to a childlike state of helplessness,
acknowledge potential dangers diapered, sedated, incompetent”
Legal Considerations to society and to individuals and (1996, p.54).
37Torch Magazine • Spring 2020
Muted Discussion bound wife, after repeated requests, the world’s only doctor-assisted
in an apparent mercy killing, and suicide law. Dent administered to
Until we could no longer ignore then shot himself. The wife had himself a lethal dose of barbituates
it, we, as a society, have been severe heart disease, was paralyzed, and muscle relaxants. He used a
steadfastly disinclined to consider on dialysis, and had a tracheotomy computerized portable intravenous
death and dying. American aversion (“Man, wife shot to death,” 1996). unit with its operation controlled
to discussing death is endemic. by a laptop computer (American
There is a reluctance to admit that Support for Assisted Death Medical News, 1996). Australia’s
we are all going to die and that law is again being contested in
there are, in fact, things worse than Across the country, many courts there.
death. It’s more reassuring to speak groups lobby for and educate
of “passing away,” of “expiring, about assisted death. The Seattle, Holland’s assisted suicide
going to join God, embarking on Washington-based group, climate has received great
the eternal sleep.” The medical Compassion for Dying, founded publicity for what supporters
profession, trained to “save life,” by Rev. Ralph Mero, offers see as its “humane” approach as
shares this reluctance, although counseling, emotional support, and well as great notoriety from its
increasing numbers of physicians legal advocacy to the terminally detractors. (See The Torch, Winter
are venturing into this ethical ill and their families. For patients 1995. The Editor). Although
arena, as are religious leaders. Polls who meet its guidelines, the assisted suicide is still technically
consistently show that about 70% organization provides someone to illegal in Holland, the informal
of the public believes individuals be present during “hastened death.” system of euthanasia (in which
should have control over their own The group’s acts are very private; doctors actually administer fatal
deaths—witness the unwillingness no names released, no police or injections), with fairly strict
of any jury to convict Kevorkian media called, but Mero indicates procedures and rules, operates
(Biggar, 1995; Gianelli, 1994, they have many cases. There has there with impunity (Hendin,
October 10; Girsh, 1992). In a been little public outcry or legal 1995). Seventy-one percent of the
“Quality of Life in Virginia” challenge to the low-profile group Dutch firmly support their system.
telephone survey last spring, 69% (Biggar, 1995). Oregon became Only 2.4% of deaths in Holland
of those surveyed agreed that the first state to legalize physician- actually happen with a physician’s
doctors should be allowed to help assisted suicide for the terminally assistance, and nine out of ten
the terminally ill end their lives. ill, passing the Death with Dignity requests are turned away, according
Referendum in November 1994. to the latest research, conducted by
Patients’ families should not While the act has not yet been medical school professor Gerrit van
have the burden, or opportunity, instituted, its passage marks a new der Wal (Goodman, 1995). Most
of ending another's life. The tragic era in the assisted suicide debate. of those patients were not nursing
story of a seventy-plus husband home residents but cancer patients
in Florida shows the unfairness What about assisted suicide in the 60s or 70s, who died in the
of placing such burdens on the in the rest of the world? A 1995 last days or weeks of their illness,
family: he went to jail after he shot British study found that 32% of at home, treated by a family doctor
his beloved wife, acceding to her British physicians had complied they had known for an average of
anguished pleas for death. This with requests for active euthanasia seven years (Goodman, 1997).
husband felt he had no choice. (“British doctors,” 1995). This The most troubling statistic is that
He loved his suffering wife, so he fall in Australia, Bob Dent, a nearly 1,000 patients die each year
killed her and went to jail. (After terminally ill cancer patient, from “non-voluntary” euthanasia.
the publicity died down, he was punched a button on a computer Many see this as proof of the
quietly released early.) Last spring, keyboard, said “yes,” he was “slippery slope” to euthanasia to
in Virginia, a retired lawyer from ready to die—and became the first which any relaxation of strictures
Lexington shot his wheelchair- person to kill himself legally under in this country would inevitably
38Torch Magazine • Spring 2020
lead (Hendin, 1995). Van der doctors to make a joint decision to remove themselves as “burdens
Wal’s study found, however, that to end life, while establishing firm to society,” but changing attitudes
more than half of that 1,000 had guidelines and penalties that would toward disabilities and the onrush
earlier expressed the desire to die, deter others (insurance companies, of the boomers into being plus-50
although not physically able to family members, government cost- give these groups increased status.
request it again at the time of death cutters) from committing greed- I work on the psychiatric unit
(Goodman, 1997). motivated euthanasia (without the of a local hospital, specializing
patient's sane-mind agreement). in gerontology; I have done
My sensitivities to such fears In addition, people must be research in adult nursing homes.
are deeply embedded. I understand educated about the issue and some I am committed to these special
them well. For 3 years, I lived in consensus achieved. Provisions populations. But today, options for
West Germany. I know Dachau such an act should contain many elderly and disabled are
and Mauthausen. Etched forever in include oral and written requests limited. As social outgroups, their
my memory is Dachau's stark iron for assistance, second opinions, minimal quality of life might lead
sculpture, human bodies impaled psychiatric evaluations, counseling them to prefer death to a tortured
on barbed wire. for patients and families, review by existence. Instead, America must
an overseeing agency. implement adequate health care for
Yet, consider this: By pretending all Americans, so that no one will
that assisted suicide never happens, choose death because they can’t
we are actually opening more doors Polls afford health care or because no
to involuntary euthanasia, Faye one cares about them. Currently,
Girsh, a psychologist, notes in consistently we are passing tacit death sentences
The Western Journal of Medicine on many, mostly poor people by
(1992). She points out that current show that about neglect, lack of funding (Girsh,
laws are being ignored, the police, 1992), and cost-saving intentions
district attorneys and grand juries 70% of the by government and insurance
are not punishing mercy killings, companies.
and in the rare cases brought to trial, public believes
juries are acquitting. She asks, “Is Already, some insurance
this better than having a law that individuals companies encourage AIDS
would provide regulations about a patients to cash in their policies,
practice that desperate people are should have thus accepting death, rather than
exercising surreptitiously?” (1992, seeking effective treatment. This
p.12) Assisted suicide proponents control over is different from choosing death
argue reasonably that “the best after exhausting possibilities of
defenses against the slippery their own a cure. Dr. William Regelson, a
slope” are clear guidelines as to Medical College of Virginia cancer
who is eligible. Restrictions like deaths. researcher, exposed a study at MCV,
“terminally ill, mentally competent authorized by a major insurance
and adult are enforceable” company, regarding cancer patients
(Azevedo, 1997, p.147). One safeguard would be the and treatment, survival, and quality
intense “watchdog” scrutiny of life issues. As postulated, patients
Assisted Death Legislation of the media, which would no who choose to forego treatment
Provisions doubt expose excesses, as would the insurance company considers
professionals involved in the “unsatisfactory” or “experimental”
Future death with dignity process. We would have to guard may receive an $18,000 cash
legislation should be carefully against societal, familial, and self- package (Style Weekly, 1996).
crafted to allow patients and their pressure on the elderly and disabled That “experimental” treatment
39Torch Magazine • Spring 2020
could save lives, but foregoing it of pain management and that a choosing death with dignity are not
saves money for the insurers. Isn't lot of these people who think they mutually exclusive; in fact, hospice
there a need to pass assisted suicide want to die just need to have their patients who could (and already
legislation offering firm guidelines depression treated” (telephone do) opt for death with dignity when
and safeguards since the intrusive interview, February 14,1996). their living becomes intolerable,
insurance providers already try to based on their own determination,
save money by denying treatment? The Pain and Depression are released to live those last weeks
Shouldn’t patients and their Arguments or months in a more rewarding, less
families make the decisions, rather stressful way. A social worker in
than third-party payers? The “if we controlled pain a Virginia hospice recently told
and depression, people wouldn’t me about a hospice patient who
As we are trying to come to a want to die” argument against planned to commit suicide when
moral consensus on assisted death, suicide at first glance seems to he reached his limits of living.
we must avoid knee-jerk reactions, appeal logically. However, as Were assisted death an option, he
such as those recently introduced in Dr. Timothy Quill, a plaintiff in could have died peacefully, rather
many state legislatures, including the New York case and a strong than going into the backyard and
the Virginia General Assembly. advocate of hospice, notes, even shooting himself, as he did.
Currently, Virginia is one of a hospice does not work 100% of the
handful of states with no laws time (The Internist, 1996, p.19).
governing assisted suicide, but a Like most physicians who support Shouldn't
proposed law, thrown together in assisted death, Quill is a respected,
light of recent focusing events, knowledgeable practitioner. He patients and
would limit debate and make future- believes that “physician assisted
attempts to legalize assisted death suicide is the last resort, to be used their families
doubly hard. Under current Virginia only when good palliative or
law, arrest and prosecution are up hospice care doesn’t work” (p.19). make the
to local police and prosecutors. He asserts that “hospice care is
Assisted suicide, remaining private wonderful and good, but the notion decisions, rather
between physicians and patients, that it can relieve 100% of the
certainly occurs, giving at least suffering of dying people is overly than third-party
some people who request it respite simplistic ... a romantic view ...
from unbearable conditions. As a people experience very hard deaths payers?
nation, we must allow laws against in the face of excellent palliative
assisted death to become “fait care ... when it does not work, we
accompli” before most people have still have to work creatively with Fear of pain, according to
made up their minds. people” (p.19). MCV professor numerous anecdotal studies, does
Sara Monroe agrees that “pain not cause most people to opt for
While the ACLU supports cannot [always] be relieved.” death. Psychologist Faye Girsh
“the personal right of autonomy” (Kelly, 1997, p.E6). Still upset over observes that “degradation and loss
and opposes all legislation against the recent painful death of a young of dignity ... because of
“humane terminations” (telephone AIDS patient, Monroe says, “We incontinence, inability to swallow,”
interview, February 16, 1996), the don’t allow our dogs to die such a lack of mobility and poor quality
National Society for Human Life wretched death.” (p.E6). of life are prime motives (Girsh,
puts opposing assisted death high 1992, p.II). High levels of pain
on its national agenda. Virginia’s What hospice workers do medications often lead to heavy
executive director Dave Murphy to help families and patients at sedation and negative side effects;
says, “We think euthanasia difficult and meaningful times is for many, existing only in a
advocates present a false picture wonderful. However, hospice and semicomatose state does not offer
40Torch Magazine • Spring 2020
an acceptable quality of life (Girsh, life is ending who exercises self- Medical Association (1996, p.588),
1992; Jamison 1996). determination about the end of life. physician William Hensel states his
Increasingly, we are seeing court plea for assisted suicide if “I suffer
Advances in medical cases, called “wrongful life suits,” irreversible central nervous system
technology have given mankind against doctors’ and hospitals’ damage to the point that I do not
the opportunity to usurp God’s refusal to carry out patients’ recognize my family.” Hensel
will—prolonging dying rather than requests not to institute respirators, believes that “if I am markedly
restoring sick people to wellness feeding tubes and other death neurologically impaired, I will have
and a satisfactory quality of life. prolonging measures. Frequently, already ceased to exist.” To those
Many of people fear that a final the reason behind the reluctance to who would object on religious
illness might condemn them to avoid these measures is fear, fear grounds, Hensel responds: “ ... my
“America’s longest death row”: the that family members or government understanding of God's will is
prison of life support that functions representatives will try to charge different from theirs, ... my final
simply to prolong dying (Simon, the doctors/hospitals with assisted request is an act of faith, based on
1993, March 18, 13 A). Laws suicide, even when the patient has my belief that there is a better life
allowing assisted suicide must requested death, even in writing. beyond this one” (1996, p.588).
provide for second opinions and Legalized assisted death would
psychiatric evaluations to deal with remove fear of repercussions A number of religious leaders
the depression issue. But in fact, and permit health care providers and groups do support death with
it is not unrealistic for people in who were ethically opposed to dignity. In a move to encourage
debilitated, dying conditions to be assisted suicide to withdraw so that national debate in the church, the
depressed—why wouldn’t they be? professionals committed to helping Episcopal Diocese of Newark,
Being depressed doesn't necessarily patients could step in. spearheaded by high-profile
mean a person is impaired to make Bishop John Spong, recently
rational decisions, but safeguards “Playing God?” adopted a resolution calling suicide
would eliminate depression as the a “moral choice” for the terminally
reason for requesting suicide, as Those opposed to assisted ill and those with persistent
would the requirement that patients death consistently charge right-to- pain (“Episcopal Diocese deems
be either terminally or chronically die advocates with “playing God.” suicide,” 1996). As for the claim of
ill, not simply emotionally or Such reasoning is sophistic. On suffering and pain as “redemptive”
mentally ill. Patients’ depression one hand, we have allowing or and the position that “people come
often lifts once they are reassured helping people to die. On the other to God” and grow spiritually from
that they will not face lingering, hand, we have them keeping them adversity, I believe that we humans
demeaning deaths. from dying through bio-medical do grow through adversity, not that
technology. What distinguishes we are made to suffer by a pedantic,
Abortion Equated with one from the other? If one action controlling God. Each person must
Assisted Death is “playing God,” isn’t the other? resolve the “When Bad Things
Supporters of the right to die Happen to Good People” issue as
As for the equation of abortion must not allow opponents to his/her faith leads. But my rights
and assisted suicide, they are wrap themselves in the Bible and to autonomous decision-making
simply not the same thing. One sanctimoniously pontificate about should not be abrogated in favor of
can be opposed to abortion and “God's will, redemptive suffering your position. No ultimate arbiter
still favor assisted suicide. Anti- and thou shalt not kill.” Deep faith in our human world can pronounce
abortion groups argue that abortion and belief that individuals should the final word on this as “Gospel.”
is the taking of another, innocent be allowed to die in a dignified
life, without that person’s (the and humane way are not opposite As debate on the issue opens
fetus’s) consent. In assisted death, extremes. In a thoughtful essay in up, it will be seen that numerous
it is precisely the person whose JAMA, the Journal of the American highly “religious” people—health
41Torch Magazine • Spring 2020
care professionals, clergy, families, Oregon State Medical Society’s and gently. A death with dignity
patients—advocate death with refusal to take a stand on assisted act, allowing them to legally satisfy
dignity and that such a stand is suicide helped to pass Oregon’s patients’ requests, would
completely compatible with strong physician-assisted suicide proposal forestall profit-oriented insurance
faith in God and the Judeo-Christian (Gianelli, February 10,1995); in companies insinuating their way
and other religious traditions. a 1996 New England Journal of into making end-of-life death
Medicine survey, 60% of Oregon decisions, based on economics.
Doctor’s Views doctors favored assisted suicide,
as did 56% of 7 Michigan Doctors Thomas Preston, a Seattle
For years, many doctors have (Azevedo, 1997). In an informal cardiologist, says that assisted
quietly turned off respirators, even survey by the American Society of suicide is not unethical: the “ethos
giving a bit “too much” of pain- Internal Medicine, one in of keeping people alive as long as
relieving, potentially lethal drugs five doctors reported having possible ... is not valid anymore.”
such as morphine, to dying patients deliberately taken action to cause a It’s ethical to “keep people alive
who request it. The AMA’s 1992 patient's death (Knox, 1992). as long as doing so gives good
Code of Ethics states that “Quality life. It’s unethical to keep terminal
of life is a factor to be considered Is physician aid-in-dying people alive .. .if it’s against their
... when the prolongation [of against tradition? Ethicist Stephen wishes” (Azevedo, 1997, p.143).
life] would be inhumane and Jamison says, “There is no such Doctors supporting assisted death
unconscionable. Under these thing as a linear medical 'tradition' see it as a “last resort, to be used
circumstances, withholding or handed down over 1,000s of years” only when good palliative care
removing life supporting means is (Jamison, 1996, p.13). Medicine's doesn’t work,” as Dr. Quill writes.
ethical provided that the normal ethos moved toward prolonging Whatever their personal opinion,
care given an individual who is ill life only in the 20th century, with health care professionals have the
is not discontinued” (1992 Code of advances in medical technology. obligation to listen to a patient
Medical Ethics Current Opinions, Since then, there have been who no longer wishes to live and
p.13). Those opposed to assisted numerous court cases and rulings to explore the reason behind that
suicide claim that patients will about keeping patients alive wish. Often, “by understanding the
not “trust” their doctor if they against their wills or in persistent impetus for the request, a physician
know he can, by law, end their vegetative states. In the last few can find alternatives: better pain
lives. However, patients may trust years, “do-not-resuscitate orders relief, meeting with the family,
physicians more if they know are becoming commonplace, ... etc.” (Quill, 1996, p.19).
doctors will not condemn them to and doctors frequently 'allow
existences lacking an acceptable patients to die' by withholding and Conclusion
quality of life. withdrawing ventilators, artificial
nutrition and hydration” (Jamison, More than 50% of Americans
While the American Medical 1996, p.17). Many believe the ethos die in the hospital, often alone,
Society publicly opposes assisted should evolve alleviating suffering tethered to a “frightening array of
death, the AMA has not recently quickly and gently (Jamison, high-tech equipment” (Shute, 1997,
polled members on the issue. 1996, p.13). Doctors increasingly p.61). Seventeen percent more die
Feelings against assisted death are find their ability to exercise in nursing homes. The picture of
far, far from unanimous among personal, professional judgement dying at home, in a “meaningful”
physicians across the country. circumscribed by insurers. They way, alert, with loving support
In a 1994 survey, nearly 30% further recognize that doctors is simply not a reality for most
of New Hampshire physicians may do more patients harm by people. However, there are ways to
suggested they might be involved permitting a slow, agonizing death put more dying people in this
in assisted suicide if it were legal than by doing what a patient asks picture.
(Gianelli, October 10, 1994). The and alleviating suffering quickly
42Torch Magazine • Spring 2020
Hospice care will expand now end-of-life choices. I believe that Gianelli, Diane M. (1995, November 13).
"New Hampshire considers physician-
that most health care plans pay for each person has the right to execute assisted suicide." AMA News, p.8.
it, thus offering it as a dying option a plan to choose how to enter that Gianelli, Diane M. (1995, March 27). "No
in more areas. Doctors will learn “good night” of death and to rely right to suicide help." AMA News, p.1O.
Gianelli, Diane M. (February 27). "States
to control patients’ pain. California on professional support if need be. weight assisted suicide" AMA News,
oncologist H. Rex Greene points to Some may choose to “rage” to the pp.32-34.
studies showing that two-thirds last minute. But should one hope Gianelli, Diane M. (1994, October 10).
"Survey yields admissions of doctor-
of physicians are incompetent at to “go gentle into that good night,” assisted suicide." AMA News, pp.6-8.
managing pain and that the “war one should have that option. As Girsh, Faye J. Ed.D. (1996, August).
on drugs” has led doctors and human beings, we have a right to "Physician aid-in-dying: What physicians
say, what patients say. Western Journal
patients to “irrational fears” of choose how we will live; we also of Medicine, pp.11-12.
addiction to morphine by a dying have the right to choose how we Goodman, Ellen. (1997, April 18). "Holland
patient (Azevedo, 1997, p.13 7). will die. tiptoes through tulips of strife." The
Richmond Times-Dispatch, p.A19.
Medical schools will continue Hendin, Herbert. (1995). Suicide in
to improve their training in pain America (2nd ed.). New York: W.W.
REFERENCES
management and in compassionate Norton.
Hensel, Wililam A. (1996). "My living will."
end-of-life care. Early this year, JAMA, 275 (8). p.588.
72 organizations, including the Adams, Stacy Hawkins. (1996, June 20).
"High court extends order blocking assisted
"Kevorkian Assists Chester Woman."
AMA, and the AARP, formed the The Richmond Times-Dispatch, p.A7.
suicide." (1996, June 24). American
Medical News, p.54.
Last Acts Coalition, to push for "Aid in-dying group appeals in assisted
Hoke, John. (1996, April 10, 1996). "Man,
sweeping reforms in the care of suicide ruling." (1995, April 4).
wife shot to death." The Richmond
AMA News, p.4.
the dying, including the issues I Alpers, Ann JD & Lo, Bernard, M.D. (1995,
Times-Dispatch, p.A1.
Jamison, Stephen. (1996, Summer). "Final
have just mentioned (Shute, 1997). August 9). "Physician Assisted Suicide
acts of life: Families, friends and
Some HMOs are offering hospice in Oregon." JAMA 274 (6), 483-487.
assisted dying." Noetic Sciences
Azevedo, David. (1997, January 13).
style home care to patients who still "Should you help patients die?" Medical
Review, pp.13-1S.
Jennings, Peter. (1996, March 3). ABC
want aggressive treatment and may Economics, pp.137-150.
Nightly News. New York: ABC News.
live for several years. A number Biggar , Joanna. (1995, March 20).
Kelly, Deborah. (1997, February 13).
"Choosing to Die." The Richmond
of hospitals are setting up nursing Times-Dispatch, p.E1.
"Escaping life." The Richmond Times-
Dispatch. pp.E1-6.
and team approaches to work with "British doctors help patients die, despite
Knox, Richard A. (1992, February 28). "1 in
patients’ and families’ end-of-life ban." (1995, July 2). AMA News, p.2
5 Doctors Say They Assisted a Patient's
Council on Ethical and Judicial Affairs of
issues (Shute, 1997). the American Medical Association.
Death, Survey Finds." Boston Globe, p.9.
"Kevorkian assists woman in her suicide."
(1992). 1992 Code of Medical Ethics:
(1996, January 28). The Richmond
But there will always be people Current Opinions of the Council on
Times-Dispatch, p.A2.
Ethical and Judicial Affairs of the
whose pain cannot be acceptably American Medical Association.
"Kevorkian: how could I have known?"
(1996, August 18). The Richmond
managed and whose quality of life Chicago: American Medical Association.
Times-Dispatch, p.A2.
leads them to prefer actual death to "Death and dying; Physician attitudes are
Osgood, Nancy J., Ph.D. (1995 , Spring).
changing." (1997, March 10). Medical
death-in-life. Death with dignity Economics, p.53.
"Assisted Suicide and Older People—A
Deadly Combination: Ethical Problems
is an issue from which none of us "Episcopal Diocese deems suicide a 'moral
in Permitting Assisted Suicide. Issues in
is exempt. Society must resolve it. choice.'" (1996, September 12). AMA
Law and Medicine, pp.A15-35.
News, p.5.
No one who approaches end-of- Ervin, Mike. "Disability-rights advocates
Quill, Timothy E., M.D. "A poignant look at
physician-assisted suicide." (1996,
life issues with deep and sincere fight assisted suicide." (1994,
May). The Internist, pp.16-19.
contemplation and study can come September 12). AMA News, p.5.
Regelson, William, M.D. (1996, September
"Family fights custody battle over father's
blithely away, opting for either side. suicide plan." (1996, January 1). The
17). "Choosing money over hope." Style
Weekly, p.51 .
I recognize troublesome concerns Richmond-Times Dispatch, p.12.
Shute, Nancy. (1997 , February 24). "Death
with assisted suicide even while I "First legal suicide reignites Australia
with more dignity." U.S. News and
euthanasia debate." (1996, October
remain fervently convinced that we 14). American Medical News, p.12.
World Report, pp.61-62.
"Survey probes 'quality of life.'" (1996,
are autonomous individuals who Gianelli, Diane M. (1995, March 20).
August 2). The Richmond Times-
must be allowed to make our own "Assisted-suicide measure fails in New
Dispatch, p.A2.
Mexico; AMA News, p.8.
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