This letter is in response the 2019 NAELA three-part webinar series titled, “End of Life Issues – Growing National Debate About Medical Aid in Dying (MAID).” The opinions expressed below are those of the author. Neither the webinar series nor the letter below reflect the views or opinions of NAELA or the NAELA Board of Directors. Webinar series moderator Peter Strauss responds below.
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I attended NAELA’s 2019 webinar series on medical aid in dying, and feel the series was not balanced in the presentation of the issues concerning the end of life.
Failure to Disclose Position and Choice of Language
The series had learned speakers, however, I feel they were stacked in favor of assisted suicide. The use of the term assisted suicide is deliberate. For millennia suicide was known as the taking of one’s own life. Participants in medical aid in dying (MAID) are assisted by physicians who make the diagnosis of terminal illness and competency, and a physician prescribes the appropriate drugs so that the patient may kill themselves. In my opinion, this is still suicide. Using the term MAID does not change the reality that the person is taking his or her own life.
Even if MAID is adopted, most states will retain their laws prohibiting assisted suicide. In these states, it will still be a criminal act for someone to assist a person to die by suicide unless the person has a qualifying condition. It will still be illegal for a physician or any other person to assist another to die by suicide even if the patient is greatly suffering from a non-terminal illness such as MS or ALS.
Language is important. When the proponents of assisted suicide insist on the term “medical assistance in dying” they are clearly trying to frame the debate to fit their objectives. This was illustrated by the program moderator, Peter Strauss, when he tried to bully one of the presenters, Kathryn Carroll, not to use the term assisted suicide during her presentation. Assisted suicide has been condemned by many for centuries. If the proponents of MAID are able to command the public forum with their choice of words, they know that they can shame most people who would object to assisted suicide.
The proponents of MAID should have the intellectual honesty to admit the importance of their choice of language in changing and framing the nature of the debate.
It was wrong for the moderator not to announce his advocacy of MAID (such as National Public Radio announcing that a major corporation is a sponsor when that corporation is mentioned in a story). The bias of the moderator was demonstrated in his exchange with Ms. Carroll in her use of the phrase assisted suicide. It was also demonstrated during the first session, when the moderator exclaimed to David Leven (another presenter) that it would be a violation of standards of practice for a physician to refuse to participate in any part of the assisted suicide (MAID) regime.
The bias of the moderator was also demonstrated in the very design of the seminars. The moderator allowed Mr. Leven, a proponent of MAID, to declare without challenge that the only consistent objectors to assisted suicide are the small percentage of citizens who happen to attend church regularly. The moderator also failed to include as speakers anyone who objects to the very concept of assisted suicide. On behalf of people with disabilities, Ms. Carroll raised genuine concerns concerning assisted suicide, but she was not given a full episode to present her views. In my opinion, the moderator minimized objections to assisted suicide by failing to include a presenter who objects to the very concept of assisted suicide, regardless of the disability of the patient.
The significance of the presentation was undermined by this failure to acknowledge bias.
Competence of Physicians
Proponents of MAID presume that all practitioners will be as careful as Lonny Shavelson, M.D. The presentation of Dr. Shavelson in describing how he acts with his patients to assist in their death, indicated that within this system he is ethical and careful in his work. I believe that it is unlikely that other physicians would be willing to deny “relief” to patients who were not physically or medically competent to engage in their own suicide. And that it is likely that many “unqualified” patients will be able to end their lives if assisted suicide becomes more prevalent and physicians are less diligent than Dr. Shavelson.
Changing Societal Norms
It is my belief that each human being has an essence or spark of life that ordinarily should not be terminated by unnatural means. As a general rule, society should promote the right of an individual to continue life or to permit life to end through natural means. These propositions seem to be accepted by the proponents of MAID.
For centuries, much of society has believed that mankind should not interfere with the natural processes of life and death, and thus homicide is not only wrong, but illegal. I believe suicide, taking one’s own life, was and is something that should be discouraged and prevented. Likewise, the action of one person to assist in the suicide of an another was and is seen as an interruption of that natural order such that it should prohibited and sanctioned by the civil and criminal law.
As human beings we do not and cannot fully understand the natural process that leads to death; we cannot fully understand why some people suffer. Our collective humility in recognizing our lack of understanding in death and dying is reflected in society’s unwillingness to accept death outside of the natural order.
The proponents of MAID wish to change these societal norms by declaring that self-determination in choosing how and when to die is the highest possible virtue; the proponents declare that a person should not be “required to suffer” just to satisfy some collective notion of justice. Logically, it seems that taking one’s own life, commonly known as suicide, to relieve suffering would be the ultimate exercise of self-determination. The proponents of MAID believe that suicide outside of a qualifying condition should be prevented. But the proponents of MAID want the “cover” of involving others in this unnatural process of dying. This is a huge change of societal norms.
MAID Harms All of Us
If assisted suicide is adopted under the label of “medical assistance in dying” others will be harmed.
As a society, we collectively recognize that some part of the very fabric of society is lost when someone dies by suicide. That rip in the fabric of society is more pronounced if one person assists another to die by suicide.
Approving assisted suicide will overturn societal values that have governed us legally and morally for many centuries. In my opinion, the proponents of MAID demand that the rest of society accept that the concept of self-determination and relief of suffering is so important to that individual that the rest of society is not entitled to feel any loss at the death of that person; the rest of society must “get over” its long-standing belief that suicide is wrong and is a loss for all of us.
With the widespread adoption of MAID, it is more likely for individual patients to believe that assisted suicide will relieve the emotional, time, and financial burden imposed on caretakers. Conversely, it is more likely that family members will be divided on assisted suicide, thus resulting in family fissures. It is likely that family members who object to assisted suicide will be excluded from the decision-making process on the grounds that they are interfering with the patients right of self-determination.
Simple economics could place pressure on patients to agree to assisted suicide instead of the more expensive choices of palliative care or other treatments. Persons with disabilities and other impaired persons do not have adequate medical and social care, and this is unlikely to change.
Opponents of assisted suicide have been, and will continue to be, “assaulted” by the proponents of MAID. These assaults occur when opponents of assisted suicide choose not to use the language of medical assistance in dying. The importance of language is further demonstrated by the term “physician assisted suicide,” which was abandoned when the proponents recognized that the public would not accept this more accurate use of language.
Physicians, pharmacists, and other medical professionals will be forced to participate in assisted suicide. As the moderator indicated, MAID will be the “standard of care” that must be followed. Any attempt to adopt meaningful conscience protection clauses will be seen by the proponents of assisted suicide as interference with the right of self-determination.
The role of physicians will change. In true Orwellian fashion, all physicians would have to accept that the oath to do no harm now includes the concept that helping the “qualified” patient to take his or her own life is not harmful. The concept of determining the conditions that qualify for the termination of life-sustaining treatment is fundamentally different than helping a patient take his or own life.
Coroners and other clerical personnel would be forced to lie when the law requires them to complete death certificates that only list the diagnosed terminal illness as the cause of death. Almost every other factor contributing to death is listed on a death certificate, but proponents of MAID refuse to agree to include this information.
Under the rubric of “standard of care” and “self-determination,” lawyers would be forced to draft documents and consul clients that conform to MAID principals. Increasingly, guardianships focus on preserving self-determination, and thus court orders for limited guardianships are carefully crafted to take away decision-making authority only to the extant necessary to protect the individual. If MAID is adopted, then attorneys and the courts could be required to violate their own conscience and follow the “standard of care” to draft documents to preserve the right to assisted suicide.
A surrogate decision maker, such as an agent under a health care power of attorney, has the right to make health care decisions. The MAID proposals seem to exclude the authority of a surrogate to make these decisions, but I believe the proponents of MAID will seek that change in the future; if so, attorneys would then be required to be involved in the MAID process by counseling the client in choosing the appropriate agent, and crafting documents that address the concept of substituted judgment as compared to the best-interest standard within the documents.
All citizens would be forced to contribute to the payment of the costs associated with assisted suicide through insurance premiums or government programs such as Medicare, Medicaid, or the Department of Veterans Affairs. Yes, the incremental cost to any citizen will be small, and yes citizens are forced to pay for other medical care that some consider objectionable; that does not make the loss any less real.
The MAID series had helpful information. But if it remains as a resource in the NAELA archives, its status as a tool for advocacy should be acknowledged.
Leonard F. Berg
1013 Richard Drive
Godfrey, IL 62035