Three former Washington State Governors have endorsed the Death with Dignity Initiative I-1000, Republican Dan Evans and Democrats Booth Gardner and Gary Locke. A fourth, Republican John Spellman, is opposing the measure. I’d been planning to write a final post about all of the myths and lies being spread by the I-1000 opposition, but Spellman’s recent editorial in the Seattle PI contains enough of them that it serves as the perfect springboard for this post anyway.
It is not often I publicly disagree with my former gubernatorial colleagues, Booth Gardner and Daniel Evans. While I respect them both, I must firmly disagree with their support of the assisted suicide initiative, I-1000.
Both frame the issue as one of strictly personal choice. But what’s at stake is actually much broader. Derek Humphrey, co-founder of the Hemlock Society, has asserted repeatedly that euthanasia and assisted suicide will inevitably prevail in our society because they make economic sense.
Think about that for a second. What on Earth is he saying? Obviously it’s cheaper to have people with serious illnesses die sooner rather than later. But when economics enters the picture, it’s no longer a matter of strictly personal choice. Do you really think that, once implemented, assisted suicide will remain merely a “personal choice,” isolated from not-so-subtle coercions of everyday life and magically protected from health care rationing?
Yes, I do, and we can look at Oregon for the proof. Oregon’s law has been on the books for 10 years now, and there’s absolutely no evidence that it’s moving any closer to being anything other than a personal choice. No one anywhere wants coercions, and no one anywhere is talking about coercions. As in Oregon, only the terminally ill individual makes the choice under I-1000, not doctors, not health care providers, not family members, not the government. The belief that I-1000 will lead to an end where people have less choices has no basis in reality.
When Gardner says I-1000 is a good “first step,” I think we have to take that claim very seriously.
The first step we’re taking here is one towards having greater say over our own medical decisions, something that has gradually been taken away from us for the past few decades. This is a first step towards more autonomy, more privacy, and more dignity.
This week, a judge in Kitsap County sent a medical marijuana patient to jail because the judge disagreed with the patient’s decision to use medical marijuana over far-more addictive opiates, even though his doctor approved of it. Is this is the kind of intrusive government nannyism that Governor Spellman and others want? How is this any different from what I-1000 opponents want in end-of-life scenarios?
This initiative is just one way we can start fighting back. Government officials should never be in a position to impose any kind of moral litmus test on our medical choices, especially when they overrule the advice and consent of doctors.
Our choices affect the common good. As a state we don’t allow people to exercise the “personal choice” of driving a motorcycle without a helmet, because the social costs are too high and we all bear those costs. Legalizing assisted suicide will change the whole fabric of medical care, and it will radically alter the doctor-patient relationship. That’s one reason why the American and Washington medical associations actively oppose assisted suicide.
For starters, one can once again easily look towards Oregon to see if their law “changed the whole fabric of medical care.” It did not. In fact, there’s evidence that palliative care (caring for someone with chronic pain) has actually improved since Oregon’s law was passed. And second, a majority of Washington doctors surveyed support this law, even if some of their umbrella organizations do not.
Only one state, Oregon, allows assisted suicide, and it provides the template for I-1000. In Oregon, things have not turned out as proponents claim. For one thing, the economic effects of that law have reared their ugly head. The Oregon Health Plan recently sent out letters informing some patients that although it would not cover their cancer treatments because they were too expensive, it would be happy to pay for their assisted suicide.
This situation has nothing to do with Oregon’s law. Health care plans across the country deny people life-saving treatments and force people to explore alternatives. Just because Oregon has a death with dignity law has not made it any more likely that health care providers in that state will deny treatment. The same thing will be true in Washington. There’s no evidence whatsoever that health care providers will find it easier or more convenient to avoid giving people real care.
In addition, Oregon’s alleged safeguards don’t appear to be working. A study this month found that one of four people requesting assisted suicide suffered from untreated depression. Not one resident requesting assisted suicide last year was referred for depression, even though one of the law’s alleged safeguards requires people requesting assisted suicide to be referred to a mental health professional if they exhibit signs of depression.
Depression is a long-term clinical condition. Most people who are at the end of their lives are going to be sad about it. But to say that doctors across Oregon are misdiagnosing people who come in and request the prescription is insulting to doctors. If this law is commonly ensnaring the depressed, where are the living relatives who feel that their now-deceased relative was taken advantage of? They don’t exist. The bottom line is that this is a narrow statute that generally only appeals to strong-willed individuals. No chronically depressed person would ever make it through the safeguards and there’s zero evidence anywhere that any have.
Our choices also affect those closest to us. Yet I-1000 allows a loved one to be given a lethal overdose without a family member ever being notified.
This is because of doctor-patient confidentiality laws. Again, I-1000 opponents reveal what they’re all about, making more of your personal medical decisions subject to state regulation.
Oregon’s program is shrouded in secrecy. That’s one reason why the Oregonian in Portland has come out against I-1000, saying, “Essentially, a coterie of insiders run the program, with a handful of doctors and others deciding what the public may know.” I-1000 goes even further than Oregon’s law; it requires doctors to falsify the death certificates, and there will be no way to discover abuse.
This is the most blatant lie in the editorial, and one of the most blatant lies I’ve seen in this entire campaign. I-1000 is no different than Oregon’s law when it comes to death certificates. When a person requests, receives, and uses the death with dignity prescription, their cause of death is listed as their underlying illness. This is exactly how it should be. The underlying terminal illness is the cause of their death. Just because they chose to die on their own terms does not change what brought about the particular outcome. Putting suicide on their death certificate would technically be inaccurate. This is how I-1000 will work, and that’s the right way to do it.
The past president of the King County Bar Association concludes that I-1000 “would subject poor, disabled and other vulnerable patients to dangerous outside pressures to end their lives prematurely, could not effectively be monitored or policed and is deeply contrary to the role of health care providers as healers.”
He’s absolutely wrong, and we already know this for a fact because of the experience in Oregon. No one who is poor, disabled, or otherwise vulnerable has been unfairly coerced into a premature death. Absolutely none. Not a single one in ten years. Why? Because the law requires that the person involved explicitly expresses their desire for death with dignity to two separate doctors at two separate times. Anyone with an interest in coercing another person to commit suicide will have no interest or ability to corrupt this process. And if there are corrupt doctors out there, well, they don’t need I-1000 to do this in the first place. They can already prescribe lethal doses of opiates and other drugs as long as it’s under the auspices of palliative care. I-1000 simply does not put people at risk of being coerced into suicide. Anyone who tells you otherwise is lying.
Throughout this campaign, I’ve often compared this debate to the debate over abortion. Both issues involve a matter of choice for a controversial medical decision. They both involve an individual’s value judgments over life and death. They both involve a very vocal minority whose religious views or moral inclinations compel them to take away people’s choices in an attempt to protect them from themselves (or as they often try to claim, to protect society as a whole). And the arguments on both sides can get very emotional. But this is one issue where putting aside the emotion and using reason is an absolute must.
Governor Spellman asserted above that one reason to vote against I-1000 is because health care providers might cover that instead of the far more expensive cancer treatments. But is the possibility that a health care provider might cover abortion, but not the costs of bringing a child to term, a reason to take away a woman’s right to choice? Of course not, that would be silly. It’s the same thing here. We shouldn’t be limiting our choices because of what an unscrupulous health care provider might do to us if we demand more freedom. We should demand both our choices, and for our health care providers not to screw us over. I-1000 can not fix our health care mess. But it’s a lie when opponents claim that it will make it worse.
It’s true I’ve written a lot about this initiative (some of you think too much), but I really can’t overstate how important I feel it is to pass this. I was new to the Pacific Northwest when Oregon passed their law and was excited to be in a region that was at the forefront of valuing individual liberty. But it seems like since then, the mood of the entire nation had been going in the opposite direction. Part of this had to do with our response to terrorism and part of it was the nadir of the radical “pro-life” movement, which thankfully began to die down after the Terri Schiavo fiasco.
Government has a role to play in protecting people from the unexpected – from tragedies that one can’t possibly avoid on their own. But government should not be in the business of trying to protect us from ourselves. Giving government that right is the real slippery slope here. Please vote yes on I-1000.
Lee
This is the first time I have been impressed with your posts on the issue. Well written!
That said, and in many fewer words, let me rebut your key claims. I will do so in a series of posts so it is easier, if you wish to do so, for you or others to respond.
1., as you point out, a health care provider in Oregon has ALREADY gotten in trouble for advising patients that the patient and the provider can save money by choosing the suicide option.
As long as we practice terminal impoverishment by charging patients for their terminal care, I-1000 .. and Oregon’s law, DO put patients in a terrible dilemma. As I have told you before, I have already seen just this happen in my own and several other families.
Finally, while Oregon’s law has not been widely used, it is naive to imagine that healt6h care providers will nto choose to save the $50,000
cost of terminal care.
Response to Lee, ctd ..
2. Oregon’s law has not failed BUT it has also not worked.
Very few people are using it and only a small cadre of Oregon physicians, apparently those associated with the pro-campaign, are siging these prescriptions.
Why is this “freedom” so unpopular? Obviously I do not know but a few likely issues do suggest themselves.
First, there is the issue of privacy. I-1000 (and the Oregon law) are not clear about this but in one form or another, at least in the medical record, I-1000 will require a formal. legal record of a patient’s decision to commit suicide.
Second, the laws require that a physician make a differential diagnosis between clinical depression and depression in reaction to the prognosis of death. If you talk with a psychiatrist she will tell you this is a very difficult distinction.
Third, as I have pointed out many times, in practice physicians and patients ALREADY have the ability to use these drugs, as long as the INTENT is relief from pain and suffering. Apparently a vastly larger number of physicians and patients choose this option, done in the privacy of the usual doctor-patient relationship, than choose to undergo the formal proceedings required by this law.
3. Next of Kin SHOULD HAVE RIGHTS!
Under I-1000, the decision to die is made by the patient requesting a prescription. A large portion of these cocktails are not used, meaning that your husband, lover, or mother might well be carrying her death cocktail around without her family knowing this.
Isn’t it at least fair to ask whether ones most dear relation, including (I hope) gay partners, should be informed?
Finally, given the very real legal implications of suicide, it seems to me that affected people, e.g. heirs, lenders, and even employers may have legitimate legal concerns. None of these apply when a similar cocktail is used to relieve pain and suffering.
SJ speculates: “Third, as I have pointed out many times, in practice physicians and patients ALREADY have the ability to use these drugs, as long as the INTENT is relief from pain and suffering. Apparently a vastly larger number of physicians and patients choose this option, done in the privacy of the usual doctor-patient relationship, than choose to undergo the formal proceedings required by this law.”
How absurd. Even if true, then these people are breaking the law and leaving the patient exposed to all the abuses you argue so forcefully will result from the passage of this measure. You insist on shooting yourself in the foot. Why not just go for a medical discharge?
4. Death certificates DO matter
Your idea abut how cause of death is or should be determined is FAR off the track.
Terminal patients may dies of many causes. For example, I am diabetic. I am likely to die of a myocardial infarction, stroke, gangrene, etc.
Assisted suicide is as much a cause of death for me as any of these and certainly should be recorded if science is to use death data to improve patient care!
So where to next?
I expect I-1000 to pass. If we are very lucky, by that time Obamacare will have solved the terminal impoverishment issue.
At the same time, and at the risk of being seen as switching sides, I do support a better written law, especially if the law can deal with four things:
1. Preserving the right of privacy.
2. Keeping this process OUT of the public domain.
3. Addressing the far more serious issue of the severely disabled who may literally undergo years of torture watching their own deaths!.
4. Assuring that this decision is never coerced b y financial threats.
@4 Proud to be an ass.
Of course such abuses could occur, but .. unlike I-1000, there are extensive protections of patient rights and medical ethics built into the current procedure.
All deaths are reviewed carefully ans any misuse of drugs, e.g. for the purpose of hastening death as opposed to relieving suffering, would bring
serious forces to bear lon the physician involved.
As for your quesition of legality, that has already been tested in the Supreme Court.
The distinction here is, I admit, not simple. Current law permits the use of lethal drugs not not with the intent to kill. As long as the intent is to relieve pain and suffering and patients are informed of the effects of these treatments, use of lethal drugs is legal.
What in the heck is the problem with Martin Sheen? Those ads have made me lose any and all respect I might have had for him..permanently.
Lee and SeattleJew:
Good points on both sides. I’ve come out against I-1000 for some of the same reasons that SeattleJew has mentioned, but want to emphasize a couple.
First. “Cause of Death” recording. Some proponents have pointed to the lack of problems with the Oregon law. They have pointed out (truthfully) that most of the evidence of problems is anecdotal.
But the law is written in such a way as to prevent gathering of any other sort of data. Short of conducting an intrusive interview of next-of-kin (and even they might not know) we have no way of knowing how well or poorly this law is working.
Next, there is no provision to prevent “doctor shopping”, and some (yes, anecdotal) evidence that this is a problem with the Oregon law.
Certainly, just because the family doctor may be opposed (for whatever reason) to assisted suicide, the option shouldn’t be completely closed, but if a doctor suspects clinical depression or coercion and says “no”, there are apparently doctors ready and willing to step in and write the prescriptions anyway, with only brief interviews with the patient.
And while their judgement (or professional ethics) may be questioned if confronted, under the Oregon law, we may never actually know who they were or what they did.
Oh, and one last problem with I-1000. In one way, it doesn’t go far enough. Many of the patients that would want to end their suffering are not in a position to administer their own medication.
This puts people in the position of having to decide to take the lethal medication before they are actually at the crisis point.
I have less sympathy for the “next of kin notification” argument. If the relationship is not close enough that the patient feels comfortable telling the next-of-kin, then neither the state nor the doctors should.
Yes, assuming that accurate cause of death record keeping is required, the next-of-kin will eventually find out, that is another problem, and could be worked out. Sealed records (much like sealed birth certificates for adopted children) or some such.
As to insurance issues, that could easily be addressed in the law.
I’m not opposed to the concept of a person being able to choose a painless death over lingering suffering. But this initiative just doesn’t seem the way to deal with that.
I-1000 requires doctors to falsify death certificates.
In a sane society, this would be enough to kill it.
Od course, Spellman opposes I1000. As a Republican, he believes that government should not intrude into citizen’s personal lives. And this inconsistency, this hypocrisy, is what makes him a real Republican.
PS: Fuck You Mr. Cynical
“I-1000 requires doctors to falsify death certificates.”
Although the points is a strawman argument to find fault…it would be easily fixed. A checkbox can easily be added to the death certificate that indicates whether they chose to die.
Matty, as before, you do not know what a “straw man” is, and we are not voting on your hypothetical bill, we are voting on I-1000.
I get a chuckle every time I hear the audio for this measure. They insist it is SAFE!-LOL! Safe until they kill you. How safe is that?
You’re right on me using strawman incorrectly. My apologies. Your argument is still fallacious. I-1000 is a fine initiative and those opposing it are often because of personal religious beliefs they want to impose on others.
Matty:
When you (and others) talk of personal religious beliefs, and imply that somehow those of us that have them should leave them outside the ballot box, it puzzles me.
It is true that my “personal religious beliefs” help shape my opinions. I oppose the death penalty based on them, for example, and rarely hear that I should ignore them in that area (even from the right).
My “personal religious beliefs” tell me that life is sacred, and decisions make regarding the end of life should be taken carefully and with consideration.
The “falsified death certificate” argument is, indeed, a reasonable one. In Oregon, it has prevented data gathering on their “death with dignity” law. The proponents say that there is little evidence that there are problems, and they are correct.
“There is no evidence of a problem” is a vastly different statement from “there is no problem”, especially when the law is written to prevent the gathering of that evidence.
Matty:
Your argument is still fallacious.
No, in fact, it’s not. At least, no one has pointed out a single fallacy in my arguments, including you.
I-1000 is a fine initiative
No, it’s not.
and those opposing it are often because of personal religious beliefs they want to impose on others.
See, now THAT is a great example of a fallacy: since you are directing it at me, it’s a straw man fallacy, as it has nothing to do with anything I’ve said, and even if not directed at me, it’s an ad hominem fallacy, since it is an argument directed at the people, rather than their arguments.
“My “personal religious beliefs” tell me that life is sacred, and decisions make regarding the end of life should be taken carefully and with consideration.”
And when your personal beliefs then try and trump somebody own and tell them they can’t off themselves…you’re telling them what they can do. That’s when you should look to tolerance that not everybody thinks like you and that they should be able to consult with their own doctor and do what they want.
I-1000 really is about personal choice and removing what already is a government intrusion in people’s lives. You don’t have to agree with it or want to do it yourself, but would you deny another person the choice?
Some of us Republicans rant and rave that they want government to leave us alone…until it’s on a point that their own God tells them they should get in other people’s business. This is one of those times. It’s hypocrisy.
I, for one, just think less government is best. I-1000 puts it closer to a citizen’s choice with consultation of their doctor.
Matty:
And when your personal beliefs then try and trump somebody own and tell them they can’t off themselves…you’re telling them what they can do.
He wasn’t saying he would oppose any “death with dignity” bill: you’re misrepresenting him. He is saying that his personal beliefs are so important that he will not support a BAD bill, which is what this is.
Matty:
Try reading the entire comment again. You might even go to my earlier post and read that one too.
What I wrote was “life is sacred, and decisions made regarding the end of life must be taken carefully and with consideration“.
You have a problem with that?
My “personal religious beliefs” also tell me that random killing is wrong, that decisions about going to war must be “taken carefully and with consideration” and any number of other positions that I’m willing to bet that you have no issue with.
Here, I’m simply saying that this law has enough problems that I cannot support it.
Yes, my religious beliefs tell me that clinically depressed people should get treatment and counseling, even if they only have six months to live.
My religious beliefs tell me that people vulnurable to coercion should be protected, even if they only have six months to live.
And my religious beliefs also tell me that sworn statements on official documents should be true and complete.
Finally, my religious beliefs tell me that none of us know how long we have to live, but that life is to be cherished.
And while I’m not going to require a person to suffer through the last days of a life that has, for all intents and purposes, already ended, I will insist that the decision be made carefully, with appropriate checks to prevent abuse.
After all, this is not a decision that can be reversed.
@21 and 14 Matty
Whatever and however I-1000 is advertised, as written it is NOT about the patient’s choice but about a major change in what we expect of physicians. If you want to commit suicide now, you can do it. What I-1000 is intended to do is to facilitate your decision by allowing doctors to help.
This makes no sense to me. If the proponenets want death cocktails available, there are mnay ways that could be done without creating such an obvious conflict of interest on the part of heralth vare providers.
Also, as omeone who believes that the choice to edn life is very personal, I see I-1000 as intrusive in my business. Both of may parents made conscious decisions about exactly this issue, with their family, physicians and rabbi. I fail to see what purpose would have been served by adding a mechanisms that would require state registration, commitment by two physicians to prescribe medicine for the purpose of death, not to mention the bizarre idea of involving a psychologist in the impossible decision as to what is and is not clinical depression.
Look, while I find Lee’s rhetoric offensive, I have a high respect for his intent. The issue is NOT with some Hemlock Society conspiracy to promote a soylent green view of the world and more than it is with the Pope meddling in my affairs.
The issue is whether I-1000 makes sense. It does not:
The law in Oregon has not worked. … if so few people use the program after ten years, one needs to ask why?
The potential for provider abuse is real and the issue of encouraging people to die has already reared its frightening head in Oregon.
I-1000 may actually interfere with the current practices of offering patients relief while doing nothing for the much larger issue of people with long term severe disabilities.
@12 John
I find it ironic that the same people who defend free speech and oppose the Rovian tactics of McCain, are all to willing to support the same tactics when it comes to denigrating people who oppose I-1000.
Like you, I am opposed to the death penalty. I do nto do this out of some wonderful ability to sense morality but oput of my own traditions. Some of those are religious, some not.
@7, SJ: “The distinction here is, I admit, not simple.”
Ya’ don’t say? Now please re-read your sentence in post #2 above that begins with the word “Apparently”. Subject sentence asserts an unsubstantiated fact that, if true, undermines your entire argument and indeed argues strongly for the passage of this measure.
@24 Proud Ass
I am not sure what you mean. There is plenty of data on the number of folks getting the prescription ,, that is very small and not all use it. The number of folks in terminal care is much bigger.
I do not see a contradiction.
What I wrote was “life is sacred, and decisions made regarding the end of life must be taken carefully and with consideration“.
You have a problem with that?
Possibly because you appear to have dogmatic baggage, but let’s try:
If I wasn’t clinically depressed, If I was suffering from an incurable and painful disease with only a few months to live and I decided after careful consideration to end my life…and was free of coercion….would you allow me to end it?
@26 .. Matty ..
I do not know if this was meant for me, but FWIW, you asked:
My answer would be yes and more that it would be none of ,y business. I would support an initiative that assured this right, provided that it did not use doctors in this way, threaten patienjts with impoverishment, and force a private decision into the public sphere.
I urge readers not to vote for I-1000. I am severely disabled and 20 years ago I wanted to die. At that time doctors thought – wrongly as it turned out, that i was terminally ill.
I attempted suicide several times and was saved only by friends who got me taken to the hospital where I was treated against my will.
I still have extreme spinal pain which isn’t well controlled even with morphine. What has changed is not my pain and suffering but my outlook on life. What suffering people like me most need is not assisted death, but help and support to LIVE with dignity, until we die naturally.
I urge readers not to vote for I-1000. I am severely disabled and 20 years ago I wanted to die. At that time doctors thought – wrongly as it turned out, that i was terminally ill.
I attempted suicide several times and was saved only by friends who got me taken to the hospital where I was treated against my will.
I still have extreme spinal pain which isn’t well controlled even with morphine. What has changed is not my pain and suffering but my outlook on life. What suffering people like me most need is not assisted death, but help and support to LIVE with dignity, until we die naturally.
If I-1000 passes, I propose a follow-up measure: Publicly funded Snuff Stamps for the HA Happy Hooligans.
At a minimal cost to the taxpayer, the Happy Hooligans could gleefully show their support for the I-1000 concept by getting subsidized suicide – instead of food stamps, let’s give ’em Snuff Stamps.
But only if they’re immediately used.
What a boon to humanity! Not only will the Happy Hooligans be all the more happy, but, over time and with their propensity not to reproduce naturally, they’ll eventually I-1000 themselves out of existence.
Won’t that make reasonable people of all political persuasions all the more happy themselves? And alleviate the massive depression caused by the moonbat madness of most who post here?
Talk about a tautology!
Dulce et Decorum est, pro Goldy mori…
The Piper
@30 I had forgotten just how shallow and insipid you are. Thanks for the reminder.
@31…Steve…
On your level?
I’m rubber, you’re glue…
The Piper
@32 Like I said, shallow and insipid. Thanks for confirming.