Live and let die?
Let’s hope the Bush administration got the hint last week.
Finally someone — the Supreme Court, specifically — took it to task for
overstepping its bounds. The Court, in a 6-3 ruling, pulled the plug on the
administration’s program of siccing the Drug Enforcement Agency on Oregon
doctors who help terminally ill patients die. Since Oregon
voters approved the Death with Dignity Act a decade ago, 208 people have used
the law to die. Religious conservatives, ignoring both individual and states’
rights, have been gunning for the law ever since.
In 2001, in a sneaky workaround, former attorney general
John Ashcroft applied the federal Controlled Substances Act (designed to reign
in drug traffickers) to docs who prescribe pain medication to terminally ill
patients. Surely the DEA has something better to do than charge into hospices
shackling weary physicians and confiscating their little white prescription
pads. Then again, it’s probably a lot easier and safer than actually fighting
the illegal drug trade, where drug dealers carry Glocks and the only lives they
value are their own.
Last week’s rather narrow ruling was about an overstepping
administration meddling in state law. The larger debate about assisted suicide,
however, touches on many factors such as pain management and, for disability
rights activists, the fear that society could use the law for sinister ends.
To assisted-suicide
advocates like Timothy Quill, director of the Palliative Care Program at
the University of Rochester Medical Center, the ruling was a relief.
“The most important thing,” he says, “is if the decision had
gone the other way, it would have empowered the Drug Enforcement Agency to get
involved in end-of-life decisions, and that would have been terrible.” Quill
says the DEA’s job is important, but it’s not their business to be
second-guessing doctors.
Oregon’s assisted-suicide law — the only one of its kind
in the country — is considered “open,” meaning decisions are made with the
knowledge of two doctors who must agree that the seriously ill patient is of
sound mind, not depressed, and has fewer than six months to live.
But for Quill, this case is not just about the right to die.
It’s also about pain management. A ruling in the federal government’s favor
might have stopped some of the practices of assisted suicide, Quill says. “But
it would have had huge unintended consequences in terms of under-managing
pain.”
If you’ve ever been to a doctor (or are just married to
one), you know they’re notoriously chintzy with pain medications. In addition,
they tend to underestimate the pain you’ll experience during a procedure. When
I hear a doctor — or my husband — say, “you may experience some mild
discomfort,” I start popping Tylenol with codeine.
But I never knew the doctors’ side of the story until Quill
explained that when dealing with painkillers, doctors are very cautious,
fearful of being investigated for over-prescribing. This fear has a chilling
effect on pain management.
At the end of life, however, abuse of painkillers is
typically not a major concern, Quill says. Comforting the dying person is.
Because excruciating pain can compound the fear and anguish of a dying person,
it’s important that doctors feel safe prescribing strong pain killers.
Quill offers an example. “Some people at the end of life
require large amounts of pain medication as part of their care,” he says. “Some
medications may even prolong life. Imagine an inexperienced DEA agent who sees
a patient on increased amounts of pain medication and that patient dies. There
may be a misinterpretation that the pain medication caused the death.”
For Chris
Hilderbrant, director of advocacy at Rochester’s
Center for Disability Rights, and for many disability rights groups, the idea
of assisted suicide is terrifying in a society which they see as valuing money
over human lives.
“What’s particularly dangerous now is there’s already a
blame put on our community for the cost of Medicaid,” Hilderbrant says. He
worries that there is already a perception that, as he puts it, “‘you people
are a burden on the taxpayer.'”
“Take that and expand it, and see that people who are a
burden and who are also suffering can choose to end their suffering and reduce
the burden on society,” he says.
And Hilderbrant recalls a letter to the editor in the Democrat and Chronicle a few years ago
that said once people turn 75, they should receive no life-sustaining care.
“There is an attitude out there that doesn’t value our lives very
highly,” says Hilderbrant.
If you’ve ever fought to get coverage for a procedure or
medication, you know our health-care system is all about profit. What if
society opted for the $35-$50 lethal medication used in assisted suicides
rather than pay thousands of dollars for long-term medical care? This dark view
is put forth by Marilyn Golden, policy analyst for the Disability Rights
Education and Defense Fund, who cites studies drawing correlations between
for-profit managed care and pressure on physicians to offer assisted suicide.
For his part, U of R physician Timothy Quill says it’s all
about having sympathy for patients who, at the end of life, are not just in
terrible pain but are “tired of dying, of feeling out of control.” It’s hard to
imagine him supporting a system that administered lethal drugs to people who
really don’t want to die. But then, in a country where the federal government
freely removes hard-fought individual and state rights, someone else might.
This article appears in Jan 25-31, 2006.
