Monday, January 19, 2004

Euthanasia, Part 1: The General Argument

(See the prologue to this series here.)

I've struggled a little bit with how to put this series together, because my argument seems to me to be a vast edifice with a lot of intricate components. My current position has evolved over several years, through my psychological education, my political and social experience in the disability rights movement, my clinical work with incurably ill patients, and my personal experiences. It's hard to see how to convey all of those ideas and perspectives at once, in the short attention span theater that is the blogosphere. So I've decided to lay out my general thesis here, and to address the supporting framework of arguments and evidence in subsequent posts, as outlined below.

My argument is that euthanasia and physician-assisted suicide (PAS) seem to be good ideas only because society offers grossly inadequate care and resources to people who are severely disabled or terminally ill. Most people underestimate the degree to which it is possible to relieve pain, distress, and suffering in persons who are disabled or dying. Instead, people tend to see depression, despair, futility, and intolerable suffering as rightful and unchangeable elements of the end of life, rather than seeing them as reasons for intervention or as appalling failures of care.

I further argue that many people in western cultures are so personally afraid of disability and dependency that they see suicide as a rational response to incurable illness, but to no other human problem. As a result, evidence of depression is often overlooked in ill or disabled persons who are suicidal, and some incurably ill or disabled persons experience pressure to refuse life-prolonging medical treatment. Considering all of these factors, I believe that PAS cannot be safely administered.

Future posts in this series:
Part 2: Prospects at the end of life.
Part 3: Prospects for the lives of people with incurable illnesses or disabilities.
Part 4: Case study: PAS and euthanasia in the Netherlands.
Part 5: Screening PAS candidates for depression: what's a psychologist to do?
Part 6: I'd rather die: Fears of disability.
Part 7: "Mercy killings" in the courts and in the press.
Part 8: Another definition of death with dignity.

But first, before we continue, a few definitions:

Euthanasia is when a physician actively administers lethal drugs to a patient. PAS is when a physician prescribes a lethal dose of drugs for a patient to self-administer. PAS is legal in the state of Oregon, although contested by the federal government; euthanasia is legal only in Belgium and the Netherlands.

PAS is not the same as stopping medical treatment or refusing medical care, both of which are legal everywhere in the United States and Canada. Ill persons always have the right to request "no heroic measures" or a "do not resuscitate" order, and to refuse or stop life support or lifesaving treatments. (You can pro-actively spell out your preferences in an advance directive, so that your family and doctors know what you want. I recommend it.)