Pondering Assisted Dying

Today’s Washington Post has an opinion piece by Archbishop Desmond Tutu in which he states, “When my time comes, I want the option of an assisted death.” It isn’t the first thing by Tutu that I have read on the subject. A couple of years ago he publicly reversed his opposition to assisted dying in an op-ed piece published in the Guardian. In that piece he eloquently argued that compassion for others demands that alongside palliative care, the choices should include assisted death. In this piece he directly addresses himself. Today is his 85th birthday. He wrote:

“Just as I have argued firmly for compassion and fairness in life, I believe that terminally ill people should be treated with the same compassion and fairness when it comes to their deaths. . . . Today, I myself am even closer to the departures hall than arrivals, so to speak, and my thoughts turn to how I would like to be treated when the time comes. No more than ever, I feel compelled to lend my voice to this cause.”

I have deep respect for Archbishop Tutu. He is a world leader, a man of peace, and a Christian whose theology and counsel I treasure. It would be totally out of place for me to ignore his words. But I must confess they have left me wondering and struggling with my own opinion on the subject.

One of the causes of my wondering may be the simple fact that I am more than twenty years younger. Although definitely in the second half of my life, and no one knows in advance the span of their living, I feel that my current state of health promises many more years. I probably do not spend as much of my time pondering my own death as will be the case when I am older.

My position on assisted dying, however, is not based on myself, but rather my desire to develop even more compassion for others.

I understand the fear of a lingering death. I have no desire for my own departure from this world to be prolonged by heroic, last ditch efforts. I have made my wishes clear to my family and established the necessary legal documentation that enables caregivers and family members to make practical decisions and avoid, to the extent possible, prolonging the process.

My direct observation of those who are dying, however, leads me to doubt the image of untreatable pain. Pain medication is, of course, a trade off. Too much medication and the person has less time awake for relationship. Too much alertness and there is more pain experienced. Each individual and their caregivers need to come up with what is appropriate. However, when I visit people in the hospital or hospice house I am impressed with the skill and compassion of palliative care givers in helping patients manage pain. When I think of my own time of dying, fear of uncontrolled pain is not one of the dominant emotions.

I think that the argument in favor of assisted death is based on the notion that uncontrollable pain might be present. My experience, however, leads me to believe that there is a large spectrum of pain medications available to treat suffering and ease pain.

I’ve often heard the argument that we treat our pets with compassion by assisting in their deaths, but that has not been the case in my personal experience. We have chosen to keep our pets at home when they near the ends of their lives and have experienced their deaths as peaceful times. I know that there are occasions where thoughtful, loving and caring people have felt that an assisted death was the best choice for their pets and I have no reason to doubt the choices they have made, but I have never had to face that particular choice.

I wonder more about the effects of assisted dying on those who provide the assistance. Although I am not a health care provider, when I try to imagine myself in that position, I wonder if I would be capable of such an action. And if I did submit and participate, would it change my personality and my values? Does it have an effect on society as a whole when we change our relationship to those who are dying by actively participating in speeding up the process?

My mother would have agreed with Archbishop Tutu. She favored laws that allowed for assisted dying and it was one of the things about the State of Oregon that attracted her. However, she lived with us in South Dakota at the end of her life and her brief final hospitalization never presented a desire or need for any assistance with the process. She was placed on comfort care orders and we did not witness undue suffering as we sat with her during her final days and hours.

I do not know what is the right policy for lawmakers. I think that I could be persuaded that making a dignified assisted death possible would be a reasonable law. I am not familiar with the law in Canada, but I know that it does allow for assisting dying for terminally ill people. Similar laws exist in some states in our country. I don’t however, feel compelled to go out and campaign for such laws at this point.

I imagine that even if legal, assisted dying would be extremely rare. The caregivers I know would be compelled to seek every alternative before suggesting such an action. And I can’t imagine the decision being anything other than gut-wrenching and leaving all kinds of doubt in its wake.

I have been with families as they made difficult decisions in the care of their loved ones. There are times when withdrawal of a respirator is an appropriate decision. There are times when switching from actively fighting disease to palliative care is the most loving choice. There are times when chemotherapy or radiation treatments or surgery is not the best choice. But these decisions are difficult to make and require care and compassion.

So I remain uncertain. I could not have written the clear and concise article that Archbishop Tutu has written. While I admire him personally and take his opinion seriously, I’m left pondering and wondering and thinking.

Fortunately, we seem to have time to think carefully.

Copyright (c) 2016 by Ted E. Huffman. I wrote this. If you would like to share it, please direct your friends to my web site. If you'd like permission to copy, please send me an email. Thanks!