End-of-life decisions

The movement that exalts “choice” in all matters of life has long been after more control over death. The stories are piling up out there of the consequences.

Imagine visiting your 75-year-old mother in the hospital after she has had a disabling stroke. She is unable to speak or swallow. Her immediate needs include artificially provided food and fluids (tube-feeding) and antibiotics to fight an infection. If she survives, nursing home care as well as physical and speech therapy will be required to help her recover. Your mother chose you to be her health care decision-maker (agent) and told you that, no matter what, she wants to live. Nevertheless, her attending physician refuses to provide further “life-sustaining treatment”—including tube-feeding. When you object, the doctor explains that this is what he thinks is best for your mother. You are stunned.

Sound far-fetched? It’s not. Similar scenes are playing out all over the country in hospitals which have quietly adopted “futile care policies.” These policies are based on the theory that a physician is entitled to refuse life-sustaining treatment when he/she believes the quality of a patient’s life is too low or the cost is too high to justify further treatment. Such policies permit so-called “futile care” to be stopped, not because the care or treatment won’t sustain the patient’s life, but precisely because it will. If the patient, family or agent objects, the case is referred to the hospital ethics committee for the final decision. 

A hard question needs to be asked. Is it advisable, or even legal, for doctors and hospital ethics committees to have this kind of power?

Did we learn anything as a society from the court-ordered death of Terri Schiavo? Didn’t we see how it would morph into the euthanasia argument?

If the law allows a patient to decline treatment, it will have to allow him to decline treatment even when he is declining it solely for the purpose of hastening or causing his own death. In the case of incapacitated patients, it will have to allow the decision-maker to decline treatment even if the decision-maker’s intent is to bring about the patient’s death…

For those who favor euthanasia, then, the next step is clear. The Schiavo controversy has revealed widespread support for the notion that some lives are so terrible that they should be ended. It would not be surprising if in the next few months and years there were moves for other states to follow Oregon’s lead and legalize assisted suicide.

That has happened, all over the place, and it not only not surprising, it is alarming.

And while we’re looking at life and death decisions, here’s another question. Are right-to-die activists getting around laws and changing the rules by changing the language about life and death?

Yes.

The term “assisted suicide” was originally coined in the ’90s by doctors looking to distance the practice from Dr. Jack Kevorkian and his creepy euthanasia machines, or, as Kevorkian called them, the “Thanatron” — the death machine — and later the “Mercitron,” which entailed hooking up patients to a gas mask and bombarding them with carbon monoxide. But as the debate evolved, and right-to-die bills were shot down in legislatures across the country, it soon became apparent that something wasn’t working. Nowhere was this more obvious than in California, where 70 percent of poll respondents supported the right to die, yet year after year these measures failed in the Legislature.

After the defeat of AB 654 in 2005, Compassion and Choices members were dumbfounded. How could a measure with such popular support be such a political failure? Even among Catholics, 64 percent favored allowing patients to end their own lives if they were suffering from a terminal illness. Yet Catholics were the most adamant foes of assisted suicide. The numbers didn’t add up.

The answer, it turned out, was a study in public relations. In most denominations of Christianity, and especially Catholicism, suicide is considered among the most grievous of sins. Could it be that one simple word was hijacking the debate?

It made perfect sense. Associating with euthanasia and Dr. Kevorkian may be the political equivalent of bringing a known child molester to Chuck E. Cheese, but there aren’t too many politicians who want to be linked to suicide (assisted or otherwise) either — particularly Catholic politicians.

A Gallup Poll was commissioned, and the results were remarkable. Fifty-eight percent of respondents supported “doctor-assisted suicide,” yet after replacing the phrase with “physician aid in dying,” that number jumped to 75 percent.

“The majority of Californians support this bill no matter what you call it,” says Hopcraft, “but when the word ‘suicide’ is removed from the equation, that majority becomes overwhelming.”

After the poll results were published, Compassion and Choices began building a nationwide campaign to expunge the word “suicide” from the right-to-die debate. Its efforts have finally started to pay off.

They’re hoping ‘you can fool all of the people some of the time’, at least long enough to change the rules. Don’t be duped.

If it takes false advertising to sell a law, you can bet your life there’s something wrong with it.

Thanks to the tireless efforts of moral biomedical experts, like nurse Nancy Valko who assembles an exhaustive bioethics news list with stories like these, we have gained vital information….and lost our excuse to be unconcerned. Everyone is potentially a heartbeat away from a critical condition that needs true compassionate care.