Assisted Suicide in New York and the Physician's Temptation
"A life not worthy of living. Well, I’ve heard that before. From peers, from rivals, sometimes from myself."
Dovie Eisner, 34, was born with a recessive genetic neuromuscular condition called nemaline myopathy, which requires him to use a portable ventilator to breathe and a motorized wheelchair to get around. He often needs assistance with basic tasks.
Writing in Unherd this week, Eisner reflected on his frequent near-death experiences and his belief that New York’s proposed Medical Aid in Dying (MAID) Act threatens the “presumption of lifesaving care” that is baked into medicine and that has repeatedly kept him alive. In his words, “If the Empire State joins the 10 states (and the nation’s capital) that have made assisted suicide legal, it will be adding killing to the options available in doctors’ toolkits.”
New York’s bill recently passed in a vote of 81 to 67 in the assembly and is now on its way to a vote in the state senate. Other states with similar laws include California, Colorado, Hawaii, Maine, New Jersey, New Mexico, Oregon, Vermont, and Washington. Canada’s MAID program has drawn global attention for years. The dark underbelly of euthanasia adoption seems to be the perverse financial incentives driving health systems toward it. Much of the debate around these programs, though, has focused on the experiences of patients—how we ought to measure patient suffering, or how to determine meaningful consent among those with mental-health or cognitive challenges. A 44-year-old woman in the Netherlands, for example, was euthanized after being diagnosed with chronic anorexia—and apparently no other conditions. Was this an empowering exercise of her autonomy and right to self-determination, or the consequence of a system that is misguided at best, abusive or coercive to the vulnerable at worst? The category of people approved for suicide-by-doctor in places like Canada, Eisner notes, has steadily expanded to include the mentally ill, those with autism and ADHD, even teenagers.
Eisner reflects on his “moments of staring into the suicidal abyss as a result of depression associated with [his] condition.” These “existential moments can tip into a yearning not to exist — to escape it all.” He admits this is, of course, partly why there is a demand for euthanasia: “If no one wanted physician-assisted suicide, there’d be no reason to make or keep it illegal.”
Eisner also notes that all the world is destined for death, making it all the more strange that doctors—those charged with safeguarding life—are being authorized to determine expiration dates for those under their care:
Simply put, we don’t know when our time is. If that’s the case, then the logic of assisted suicide leads inevitably to the conclusion that those with doctor-approved expiration dates are living lives not worth living. Lives unworthy of life, as the Nazis referred to people with disabilities when they set out to exterminate us with their Aktion T4 program.
While he acknowledges that no one wants to be left to “wilt and fade while still breathing,” he also fears a world in which life is cheap.
Eisner notes the constant vigilance he had to maintain during a recent hospital stay, without which, he says, “I’d have been administered several painful antibiotics I didn’t need, received precious little nutrition, and ended up with a tracheostomy in my windpipe. And that’s with doctors having no right to kill any patient.” I’ve written about the chaotic and damaging hospitalist system before and will again—this kind of experience is tragically typical. Such ordeals do not solely harm patients, but doctors’ own competency, along with their sense of responsibility and mission.
So what does euthanasia do to doctors? Again in Eisner’s words, “Legalized euthanasia and assisted suicide twist and distort the medical profession’s oldest commitment, turning physicians into angels of death.” In a 2015 report by the Heritage Foundation, Ryan Anderson quotes the physician and bioethics scholar Leon Kass, who noted in testimony before Congress that “the legalization of physician-assisted suicide will pervert the medical profession by transforming the healer of human beings into a technical dispenser of death. For over two millennia the medical ethic, mindful that power to cure is also power to kill, has held as an inviolable rule, ‘Doctors must not kill.’”
Elsewhere, Kass wrote:
Won’t it be tempting to think that death is the best treatment for the little old lady “dumped” again on the emergency room by the nearby nursing home? Even the most humane and conscientious physician psychologically needs protection against himself and his weaknesses, if he is to care fully for those who entrust themselves to him. A physician friend who worked many years in a hospice caring for dying patients explained it to me most convincingly: “Only because I knew that I could not and would not kill my patients was I able to enter most fully and intimately into caring for them as they lay dying.”
Protecting this boundary in the conscience of a physician is vital to the integrity of medicine itself. Of course, removing that boundary affect the patient too, in innumerable ways. Kass considers the experience of a hypothetical patient, which in some ways mirrors Eisner’s account of his recent hospital stay, when he did not sleep for two days in a state of agitated vigilance. In Kass’s words,
Imagine the scene: you are old, poor, in failing health, and alone in the world; you are brought to the city hospital with fractured ribs and pneumonia. The nurse or intern enters late at night with a syringe full of yellow stuff for your intravenous drip. How soundly will you sleep? It will not matter that your doctor has never yet put anyone to death; that he is legally entitled to do so—even if only in some well-circumscribed areas—will make a world of difference.
The subtle, corrosive effects of widespread euthanasia may not be measured in a strictly quantifiable way, but they are nonetheless real. The practice of medicine can never be a “morally neutral act,” as Anderson writes, “Physicians do not practice medicine simply to fulfil the desires of consumer-patients, whatever those desires may be. Rather, medicine is a profession governed by its core commitment to healing patients.” That commitment ought not slip away, even incrementally. The availability of euthanasia transforms the relationship between the well and the sick, the old and the young, the caretaker and those in need of care.
Thank you for this post, working in the emergency room I appreciate hearing the patient perspective of their experience there.