Independence Day

“I would rather be exposed to the inconveniences attending too much liberty than to those attending too small a degree of it.”
Thomas Jefferson

Yesterday, the Seattle Times printed an op-ed from Booth Gardner, the former Governor and supporter of the Death with Dignity Initiative. Curiously, though, this was the picture that ran alongside it online:

I don’t think I really need to describe the image any more than what’s obvious about it. It shows a doctor preparing a needle with an elderly woman (with a concerned look on her face) next to it. There’s one obvious problems with this – with I-1000, the medication is orally self-administered. Right within the column, Gardner lists out the safeguards:

The basic provisions of the Oregon Death with Dignity Act that have been included in Washington’s Initiative 1000 include:

• The patient must be diagnosed by two physicians as being terminally ill with less than six months to live

• The patient must repeat the request in writing twice with at least two weeks between requests

• If either physician suspects the person is not mentally competent to make the decision, a mental-health evaluation is required.

• The patient must be provided with information about and access to palliative (hospice) care.

• A prescription may not be written if there is any indication of coercion. Coercion is punishable as a felony.

• The patient must self-administer the medication.

All of these rules are meant to make it impossible for the slippery slope scenarios of this initiative’s opponents to come true. This is copied from Oregon, where the law has worked just fine, allowing for only a few hundred patients to make this choice about the end of their life, and with no stories of doctors forcing elderly patients to end their lives against their will.

The Seattle Times has long been the beacon of nanny statism within Washington. It’s probably not as bad today as it was back when Lou Guzzo was there, but it still carries the torch for just about any cause that is meant to protect the citizens of this state from themselves and their own decision-making ability. And if you’re not clear on whether or not the Times is carrying water for I-1000 opposition, check out the title they put on this article.

The ideals of liberty that people like Thomas Jefferson fought for are illustrated quite well by the quote above. He knew that the risks of having too much liberty were far more appealing that the risks of having too little. But the Seattle Times reminds us again that they seem to always arrive at the opposite formulation, that any time people are demanding greater liberty to make choices about their own lives, it’s equated with an unforeseen (and in this case, unfounded) danger. It’s the nanny state mindset, one that constantly seeks to equate choice with peril and freedom with disaster.

Comments

  1. 1

    anne spews:

    the self administration element knocks out a large group of people who may wish to end their lives: those with progressive neurological impairment which affects their ability to manipulate their hands or limits their swallowing.

  2. 2

    spews:

    This is a subject that recently came up as a resolution of support from the Pacific Northwest Conference of the United Methodists, and I was on the committee that put the matter to the vote.

    While I, and many of my bretheren were initially supportive of the measure, it turned out that like so many other issues, the devil was in the details.

    It turns out that the Oregon measure has had some problems with the implementation, and the safeguards aren’t as safe as many (myself included) were led to believe.

    There have been cases where doctors have refused to prescribe the life-ending medication, not because of an opposition to the concept, but because the doctor was convinced that the patient was suffering untreated clinical depression.

    So they found another doctor.

    There was a case of an Alzheimer’s patient where the attending doctor stated that there was coercion from the children.

    So they found another doctor.

    There has also been the case of a cancer patient that was told by her insurance company that the insurance would not cover ongoing cancer treatments, but would cover assisted suicide.

    Fortunately, she also found another doctor.

    Medical professionals tell me that they cannot reliably tell when someone has six months left to live. Days, yes, weeks, maybe, months, no.

    And this bill has yet another problem. Since it must be self-administered, someone with a degenerative disease will have to choose to end their life before they lose the ability. This may (my opinion – almost certainly will) have the patient end their life before it is necessary for comfort or dignity.

    I agree that noone should be forced to endure a lingering, painful death, enduring long after all hope of recovery is gone. Put forward a proposition that adresses that problem, and it will have my support.

    Or, if the argument is that anyone should have the right to choose to end their own life, put forward that proposition, and let’s have that debate.

    But the current proposition is neither of those things. For its stated purpose, the safeguards are inadequate.

    There is no requirement for an impartial psychological exam to ensure that neither clinical depression nor coercion is the reason for the request.

    There is simply too much room for abuse of this system, and it doesn’t address the problem of many terminally ill patients that are not able to self-administer the drugs.

    Sometimes a poor bill that is a step in the right direction is acceptable, but not in this case. This is an issue we need to get right the first time, and this bill isn’t it.

  3. 4

    michael spews:

    I’m very supportive of things like death with dignity, but the initiative process and the legislative process are two very different things and something like this needs to be done through the legislative process. There needs to be town meetings, there needs to be legislative hearings in Olympia and the final law needs to be written by legislation writers (Can’t remember their real name) working for the public.

    Sometimes it takes a few trips to the legislature to get a bill passes, but if it’s a good bill it will pass eventually.

  4. 5

    YLB spews:

    Something to think about on Independence Day:

    The New York Times reported Wednesday that military trainers at Guantanamo Bay in 2002 taught a class on interrogation using a chart that detailed the effects of sleep deprivation, etc.

    The chart, it turns out, was copied verbatim from a 1957 Air Force article titled “Communist Attempts to Elicit False Confessions from the Air Force Prisoners of War.” It’s possible that the trainers didn’t know this; the chart might simply have been floating around the Pentagon.

    In effect, interrogators at Guantanamo were being taught to use precisely the same methods as the Chinese communists did during the Korean War – to extort false confessions. The Chinese employed these techniques primarily to turn Amerian POWs into propaganda tools. After being subjected to cold or sleeplessness or muscle cramping long enough, most human beings will sign anything just to end their torment.

    The Chinese didn’t invent these techniques. They were perfected by the NKVD – the predecessor of the KGB – in the Soviet Union after the Russian Revolution. The NKVD turned torture and the coercion of confessions into a fine art; it mass-produced hundreds of thousands of “enemies of the state” who had done nothing worse than, say, travel abroad or fall into the cross-hairs of a malicious secret accuser.

    The Gestapo as well as the Chinese communists studied the NKVD’s practices closely. And somehow – with the benefit of historical amnesia, rationalization and skewed moral compasses – people at high levels of the Bush administration came to view some of these methods of coercion as perfectly legal.

    There is something worse than losing to your enemy: It is becoming your enemy.

    http://www.thenewstribune.com/.....03867.html

    The kind of freedom I value is freedom from a bunch of REPUBLICANS who are responsible for this bullshit. Nov 2008, please get here quicker.

  5. 6

    michael spews:

    Typo @4

    That last sentence should read:
    Sometimes it takes a few trips to the legislature to get a bill past, but if it’s a good bill it will pass eventually.

  6. 8

    ratcityreprobate spews:

    Actually, Lou Guzzo was an editor at the PI, in another era, not the Seattle Times. I know he sounds like a protoge of Blethen, but he was the PI’s mistake.

  7. 9

    Reformed republican spews:

    @5: Thank you YLB

    True patriotism is using the knowledge of the people who founded this contry to promote liberty and justice today.

    Liberty and justice are antithetical to torture, illegal spying and unnecessary wars.

    I like the Ben Franklin quote better:

    “Those who would give up Essential Liberty to purchase a little Temporary Safety, deserve neither Liberty nor Safety.”

    Or maybe this one:
    “We have met the enemy and they are us”.

  8. 11

    Marvin Stamn spews:

    Death with dignity under free or government paid healthcare? HAHAHAHA
      
    That picture tells the whole story of the future. You’re old, you gotta go. And we’ll make it painful! Anyone notice the needle is above the liquid in the bottle?

  9. 12

    spews:

    @2
    John,
    I appreciate the feedback, but I’m not convinced that those are reasons to vote against this initiative. Elderly people who are that eager to end their life are going to do it regardless of whether a doctor allows them. It’s just that the method they choose will be less “dignified” than if it was sanctioned by a doctor. What this initiative does is allow for a family to have a regulated and legal option for a narrow circumstance.

    What many people are trying to do with this measure is to look at it to solve all the problems of older people being coerced into ending their own lives by family members or insurance companies. This bill cannot do that. Nothing can do that. And it’s unfair to expect this bill to solve problems that it’s not meant to solve. It will not expand upon the amount of problems that occur in end-of-life scenarios today.

  10. 14

    Richard Pope spews:

    If this initiative is such a good idea, why hasn’t the state legislature passed something like this already? There is almost a 2-1 Democratic majority, and the initiative seems to have considerably greater support from Democrats than Republicans. I would trust the legislature to carefully consider and deliberate this issue, but I have to agree with John Barrelli’s observations.

  11. 15

    YellowPup spews:

    @11:

    Anyone notice the needle is above the liquid in the bottle?

    Ha, I noticed that too.

    “Hmm, this syringe will help get the air out of the bottle!”

  12. 16

    Marvin Stamn spews:

    13. Lee spews:
    @11
    How did I know that a plea to nanny statism would resonate so strongly with you, Marvin?

      
    I’m all for suicide clinics. I’m against the mental health evaluation. Mental health evaluations aren’t required for abortions are they?
      
    Let the depressed kill themselves. Hell, you’re in the suicide capital of the country. You know what I’m talking about.

  13. 17

    Daddy Love spews:

    Why not change the intiative so that the doctor has to hack the patient to death with a hatchet or axe? That would ensure that neither the doctor nor the patient will take this too lightly or resort to the remedy as anything but their last resort. Consider it a modest proposal.

  14. 18

    spews:

    @14
    If this initiative is such a good idea, why hasn’t the state legislature passed something like this already?

    Because governments tend to find ways to restrict freedom as opposed to ways to expand it. That’s why we have the initiative process here, so that the people have a way to more directly petition for expanded rights that the government is naturally reluctant to do on its own.

    I would trust the legislature to carefully consider and deliberate this issue, but I have to agree with John Barrelli’s observations.

    I respect both you and John a lot, so I want to leave this with a challenge to either of you. Please outline a scenario that cannot already happen today where an elderly or ill person will be coerced into committing suicide because of the terms of this measure. Feel free to email me directly if you’d like. I think both of you are making the same mistake that SeattleJew has been making, in believing that the way that these cases are handled now (in a legal gray area) will somehow become more treacherous. That hasn’t been the case in Oregon, and there’s no reason to believe it will be the case here.

  15. 19

    ratcityreprobate spews:

    @10
    You are correct. His years as a music and art critic at the Times were before mine in Seattle. I only remember his time as managing editor of the PI. Just thinking about music and art criticism by that asshat makes me shudder.

  16. 20

    spews:

    @2
    And this bill has yet another problem. Since it must be self-administered, someone with a degenerative disease will have to choose to end their life before they lose the ability. This may (my opinion – almost certainly will) have the patient end their life before it is necessary for comfort or dignity.

    John, this is a conceivable case to me. Do you have any examples of this from Oregon?

  17. 21

    Jane Balough's Dog spews:

    Guvmint health care and death with dignity is a match. Made in hell, but it’s definitely logical.

  18. 22

    Roger Rabbit spews:

    What’s novel about Times editorialists lying, sensationalizing, misrepresenting, and manipulating readers’ emotions? They’ve been doing that for as long as I can remember.

    It must be nice to own a newspaper so you can shove your opinions down everyone else’s throats, huh Frank?

    You’d never catch a Seymour Hirsch or a Dave Horsey working for such a rag.

  19. 23

    Seattle Jew spews:

    John Barelli @2
    Lee

    If we may pause for a minute on this wonderful anniversary, I would like to say that the current thread of civilized debate epitomizes the revolutionary ideals of the American revolution. I am grateful to the mone and women who fought to overthrow oligarchy in 1776.

    Back to the fray.

    My concerns are somewhat similar to Johns’s. I am concerned that legislation, where not needed almost always does more harm than good.

    In this case, the first question should be “how often do individuals who need the surcease of death fail to find it?” Unfortunately, that question is likely not to be easily answered. Under our current laws, anyone with enough self control to complete the process in Oregon would also be likely to conduct their efforts to end life in a quiet manner. They might go to their attending physician and ask for help and, if they did not get that help, seek another doctor.

    we do not know whether I-1000 addresses a real problem

    My second concern is a principle of medical ethics that says in considering therapies, fir do no harm. This idea is actually part of of medical law. When developing a new drug, the first phase of a trial is designed to determine whether the drug may do harm .. even if it also does good! So, WADR to the intent of the law, as a physician I am concerned that the existence of this law may decrease the freedoms that patients and doctors now have.

    John’s concerns are well stated. For example, under current law, a patient may instruct a physician that, in case of a coma, no “extraordinary” measures be taken to maintain life. The physician must exercise very good judgment with a comatose patient. That judgment includes deciding whether the patient is in pain and, therefore, whether to treat the pain in ways that might shorten life. The balance between how far to go in maintaining life and what to do to maintain comfort of patient and family is a very difficult one.

    To be very honest, I do not know how I will vote on this bill. Like Lee, and John, I tend to side with anything that increases our freedoms. One thing I do at such times is ask myself “what would Jefferson do?” I am sure he would support assited suicide, but I am not sure he would have felt we needed a law to do that.

  20. 25

    Jane Balough's Dog spews:

    It must be nice to own a newspaper so you can shove your opinions down everyone else’s throats, huh Frank?

    This coming from a liberal…. pot meet kettle.

  21. 27

    Jane Balough's Dog spews:

    You’d never catch a Seymour Hirsch or a Dave Horsey working for such a rag.

    Yeah, they work for even a bigger loser the PI. Just another subsidized liberal rag.

  22. 28

    Roger Rabbit spews:

    I’m for euthanizing dogs, whether they want to be, or not! Dogs are worthless. They’re a waste of oxygen.

  23. 29

    ByeByeGOP spews:

    Hey dog as someone in favor of suicide why don’t you do the world a favor and rid it of one more traitor – put yourself to sleep!

  24. 30

    spews:

    @23
    Steve, just to clarify something…you do know that if a doctor prescribes a lethal dose (like the medication in this initiative) to a dying patient, that the doctor can be sent to jail, right? From some of your posts, I keep getting the impression that you think that this is already legal and that all this is doing is establishing better regulations for it. That’s not the case.

  25. 31

    spews:

    @23
    In this case, the first question should be “how often do individuals who need the surcease of death fail to find it?” Unfortunately, that question is likely not to be easily answered. Under our current laws, anyone with enough self control to complete the process in Oregon would also be likely to conduct their efforts to end life in a quiet manner. They might go to their attending physician and ask for help and, if they did not get that help, seek another doctor.

    Sure, and they’ll have to find a doctor willing to break the law in order to do so. What this initiative does is allow for a dying patient to seek this option without putting the doctor in legal limbo.

  26. 32

    Jane Balough's Dog spews:

    Hey dog as someone in favor of suicide why don’t you do the world a favor and rid it of one more traitor – put yourself to sleep!

    07/04/2008 at 3:43 pm

    Wait wait wait. I am in favor of suicide for liberals. Get it straight. Killing two birds with one stone.

  27. 33

    Jane Balough's Dog spews:

    As everyone knows liberals can not do anything right. The exception though may be suicide. We all know their policies are suicidal. hehehe

  28. 34

    FricknFrack spews:

    I thought one poster on one of the PI’s comment threads said it best:

    “My sister said it well when she said “no matter how difficult a situation you always feel better knowing that you have a bus ticket home.”

    As an Agnostic, I don’t feel other peoples’ churches or religious beliefs should decide how much pain or indignity I should be forced to endure when my time comes.

    The requirements are VERY stringent, not that many people in Oregon were even able to qualify. Many didn’t use the drugs in the end, after they did qualify. But, like an insurance policy, they knew they were covered if things got to the point that they could no longer handle.

    The problem with the State Legislature is that they are always looking over their shoulders, endlessly worrying about covering their backsides in case of losing votes (particularly the Catholic votes). That’s one reason, I would imagine, for this being a CITIZEN’S Initiative. Our lives – Our choice to make. People that don’t wish to request aid in dying are NOT required to seek assistance.

    There’s BIG money to be made from the healthcare industry in keeping people alive beyond the point of having any quality of life. So I would expect that puts further pressure, adding to resistance to this initiative. MANY of the volunteers running around getting these petitions signed had heart rending stories, which is why they were so adamant about volunteering to make this choice available to all citizens (not merely folks that struck the lotto, getting lucky with a sympathetic doctor).

  29. 35

    spews:

    Lee (and others)

    We’ve got one of those “people of good will can disagree” issues here. As I mentioned, my church’s governing body rejected the motion to endorse I-1000, but it was a close vote, with empassioned arguments on both sides. I actually voted in favor of it at the committee stage, but finally voted no on the floor vote, after listening to the arguments for and against, and doing a bit of research.

    But a number of people that I respect voted in favor.

    Many of the stories that were told during our debate on this issue were intense and moving, but in most of the cases, one point stood out, at least for me.

    Most of these people would not have been helped by this law.

    An ALS or MS patent? By the time they have less than six months to live, they are often unable to self-administer. Alzheimer’s patents? By the time they have less than six months, they lack the cognitive ability to make the decision.

    To say that the current bill is just “a first step” is to say that it is a dishonest way of getting voters to go along on a path that leads to a spot that the proponents know would be unacceptable to many, if not most.

    Some potential safeguards that would help:

    1. A person desiring aid in dying to be assigned an impartial advocate.

    2. The person desiring aid would be examined by a trained psychologist for signs of untreated depression. If the psycologist does not have an ongoing doctor/patient relationship with the patient, several interviews, over a reasonable period (not less than two weeks) must be performed.

    3. The determinative factor should be the mental ability to make the decision, not the physical ability to administer the drugs.

    There are those that say that this is the most personal decision that someone can make, and that they should have the right to make it. While I have serious reservations, I do not disagree.

    But it is a permanent decision. Once made, it cannot be undone. We need to ensure that it is made deliberately, without coercion and by someone with the cognitive ability to make the decision clearly.

    We should also ensure that it is not made prematurely, by someone in fear of losing the ability to control their own destiny. (Example – the MS or ALS patient)

    The current bill does not adequately address these issues and the safeguards (as enforced in Oregon) have been inadequate, so I cannot support it as written. It is not simply a bill stating that anyone should be able to determine the time and manner of their own death, so we cannot debate it on those terms.

    The stakes are too high, and the results of getting this wrong are that some people will die, while the stated purpose is not carried out.

    Most of the time, we settle for something adequate, because we cannot get something good. The saying is “don’t let best be the enemy of good”. But not this time. This one is just not good enough.

  30. 36

    ByeByeGOP spews:

    I think that all republicans should be forced to live out lives of terrible pain and agony – that their kids should watch them die slow and painful deaths – that they should in no case be allowed even so much as pain meds – nor should they be admitted to hospice or given any other opportunity to have their end of life suffering mitigated in any way. This is their debt for being such asswipes on this and all other issues.

  31. 38

    FricknFrack spews:

    @ 2 John Barelli

    “There is no requirement for an impartial psychological exam to ensure that neither clinical depression nor coercion is the reason for the request.”

    If you read the actual text of I-1000, it states:

    “NEW SECTION. Sec. 6. COUNSELING REFERRAL. If, in the opinion of
    the attending physician or the consulting physician, a patient may be suffering
    from a psychiatric or psychological disorder or depression causing impaired judgment, either physician shall refer the patient for counseling. Medication to
    end a patient’s life in a humane and dignified manner shall not be prescribed
    until the person performing the counseling determines that the patient is not
    suffering from a psychiatric or psychological disorder or depression causing
    impaired judgment.

  32. 39

    FricknFrack spews:

    One thing that I’m hopeful for is that this November there will be a MUCH larger voter turnout, with a much larger diversity in the voting public. More younger people, more of the educated people, more people in general, eager to vote for Obama.

    In 1991, Initiative 119, a similar (but broader) measure, failed with 46% of the vote. Hardly a landslide. But since that time two major things have occurred.

    1) The Oregon measure went into place and later (in spite of Ashcroft’s hammering against it) has been upheld in the courts.

    2) The unfortunate Terri Shiavo situation. Now obviously, Mrs. Shiavo would not have fallen into these circumstances outlined by I-1000, BUT something important happened with her case. Remember GWBush practically flying back to DC in his pajamas – along with the rest of the Republicans – attempting to interfere with the final court decision to let her rest in peace? All of the posturing?

    MANY Americans were outraged by all the attacks on what was perceived to be a private and personal situation. Her husband was even receiving death threats. Also with the Republicans siding with the Catholic church, messing with the separation between church & state, just trying to grab some votes and publicity at Mrs. Shiavo’s expense.

    From what I read during the Shiavo case, it opened the way for a HUGE amount of discussion among the public; especially with the younger people realizing that they were not immortal. No longer a subject that was taboo or impolite & not to be discussed.

    An immense number of people went running to get their POA and End of Life Medical Directives issued & signed. Those who couldn’t afford an attorney were downloading forms from the Internet. But people were actively thinking ‘what if it happened to me?’

    As I said, there’s going to be a whole new dynamic of voters this November because of Obama. And I hope that bodes well for the I-1000 Death with Dignity Initiative. People that don’t CHOOSE for assistance in dying with dignity are free not to request it.

  33. 40

    Seattle Jew spews:

    @30 Lee

    Lee,
    Of curse I know the law and yes, giving a lethal dose is illegal.

    However, physicians make many decisions that ride the rails between saving lives and making people compfortable.

    To change the focus a bit, bone marrow transplantation for cancer or immune diseases, requires making patients very sick, in fact the treatment itself is lethal. But, we have learned to treat the irradiated patient and save their lives while, hopefully, being able to kill the cancer. Deciding to ask a patient to risk his life in return for some chance of a prolonged ife is very hard.

    As another example, a patient in pain may need to choose between insufferable pain or a weakened ability to breath. The atter certainly can lead to death. Again, these are not simple, binary decisions.

    Let me give you one last idea. Angioplasty has NOT been shown to lengthen people’s lives. It does male people feel better. Since angioplasty does carry risks, against death must be balanced vs. well being.

    So, I support the intent of I-1000 but I am not sure how to vote. I am especially concerned with the imposition of a counselor. The idea that a psychologist is able to help with moral decisions disturbs me.

  34. 41

    Seattle Jew spews:

    Is suicide a first amendment issue?

    It seems to me that I-1000 ought to be seen as a religious issue. Not all religions accept the implicit idea that life itself is a necessity.

    The Buddha considered life a choice. Part of his teaching was that a person might no longer be attached to life and the loss of that attachment would remove fear of the suffering associated with life.

    Much of the debate amongst the good guys (libruls) here is over whether the addition of a psychology is a dood protection in I-1000. The stated reason is that the patient might be depressed. This is certainly a valid concern, but depression is NOT a crime. There is no mandatory treatment for depression. If a person is depressed and chooses death, should we force them to take Prozac before making a final decision?

    Why do we assume tha the choice to die is wrong?

  35. 42

    spews:

    Here’s a slippery slope to think about. What are we going to do with those physicians who take a stand that they refuse to write the prescription that will end their patient’s life? Do we treat them as we deal with pharmacists who refuse to carry emergency contraception? If we are saying this is a right, isn’t it a right then? This initiative should not be one that progressives matter of factly add to their agenda without some real thought and soul searching. (countrydocreport.blogspot.com)

  36. 43

    spews:

    FricknFrack:

    There is a similar clause in the Oregon law. The problem with that clause is that there is an unstated, but obvious loophole.

    If the attending/consulting physician thinks that a psychological consultation is apparopriate, the patient can solve it in two ways.

    1. Get the consult (and risk being turned down).

    2. Find another doctor that isn’t so picky.

    It’s impossible to know what percentage chooses either option, as Oregon’s system of record-keeping for this has been described as “designed to hide problems”.

    There have, however, been several documented cases where attending doctors were convinced that the patient was clinically depressed, and the patient (or family, it’s impossible to know) chose the second option.

    As for Countrydoc’s issue, that is more easily dealt with. One of the big issues with the “morning after” pills is the time frame. The patient often doesn’t have several days to find a cooperative pharmacy.

    There is also the point that pharmacists are not strictly decision-makers in patient care. Doctors and patients decide on a course of treatment. Pharmacists use great care and skill in carrying out that treatment, and warn both doctors and patients of potential problems, but do not exercise independent judgement in the course of the treatment.

    But back to the topic at hand.

    You’ll notice that the first change I see as needed in this law is the assignment of an impartial advocate.

    The idea is to have someone outside the immediate family monitoring the situation and (in part) making sure that “doctor shopping” isn’t done in an effort to skirt the law. (It may be necessary to change doctors if the family physician has personal qualms about prescribing lethal medication.)

    Don’t get me wrong here. While I have qualms about it, my objection is not to the concept. My objection is that the restrictions in this proposed law (as in Oregon) have been written in a way that seem almost deliberately ineffective. They seem to be designed to appease voters, rather than to protect patients.

    Additionally, the law does not address the most serious problems, and seems designed in some cases to hasten the decision. Again, I’ll point to the patient with a degenerative disease, that (assuming that they qualify at all under the “six months” rule) must decide to exercise the option while they are still physically able.

    (Yes, I presume that an MS or ALS patient with severe motor skill imparement, but several years to live could probably get a doctor to claim they had less than six months, but what does that say about the proposed law?)

    If the question is whether or not physician assisted suicide should be made available to anyone, regardless of mental or physical state, dependent only on the patient’s ability to pay for a doctor, then we should have that debate and write the law that way.

    If we’re really concerned with dignity at the end of a person’s life, when the alternative is a slow, painful death, then the law needs to be written that way.

    This is a poorly written law, with obvious loopholes that does not even address the most serious issues. It seems more to be a “foot in the door” rather than an actual attempt to deal with a real problem.

    Sometimes, that’s just what you have to do in order to deal with an issue. But not this time. The stakes are too high.

  37. 44

    spews:

    @43
    John, a few more things…

    There is a similar clause in the Oregon law. The problem with that clause is that there is an unstated, but obvious loophole.

    If the attending/consulting physician thinks that a psychological consultation is apparopriate, the patient can solve it in two ways.

    1. Get the consult (and risk being turned down).

    2. Find another doctor that isn’t so picky.

    That’s certainly true. Doctors will obviously have varying standards of what constitutes “mentally competent.” But in the current system now, people in this situation are not prevented from ending their lives. It’s just that with I-1000 (and with the law in Oregon), they may explore the legal path first. As you point out, and I agree with, I-1000 does not deal with some of the more serious issues of mental illness and the desire to end one’s life.

    This is a poorly written law, with obvious loopholes that does not even address the most serious issues. It seems more to be a “foot in the door” rather than an actual attempt to deal with a real problem.

    But no initiative in the world could deal with some of these issues, and I think it’s unfair to expect it to. This law can’t protect all patients in end of life scenarios. It can protect doctors who know that a patient of theirs has a valid desire to end their own life on their own terms. You’re right that even with this law passed, you’ll still have a number of difficult issues and corner cases that leave people in the lurch. You’ll just have less than there are today.

    As a parallel to your “foot in the door” description, look at medical marijuana. Prohibition of marijuana is a complete disaster of a federal policy in this country. Medical marijuana laws can’t fix that larger problem, and many people have noted that they are simply a “foot in the door”.

    Opponents of medical marijuana have constantly tried to claim that, by legalizing one aspect of marijuana use, it opens up a host of other issues. For instance, people who grow marijuana legally as medicine could secretly sell off part of their supply. This does happen, but it has absolutely no real effect on the overall status of marijuana prohibition. The people who got their marijuana from medical growers would get it from someone else if medical growers weren’t around. But the medical marijuana laws do protect a narrow slice of the population who most greatly benefit from it (and in some cases, their lives depend on it).

    In some ways, you’re looking at this issue the same way. You imagine that the instances where people are coerced into ending their lives prematurely or who make rash decisions about the end of their lives are going to be introduced by this legislation. That’s not the case. They’ll just manifest in different ways because some will think that there might be a legal avenue for them to do something that society (even with I-1000) still deems that they are not allowed to do. A more hardcore libertarian would dismiss these concerns out-of-hand. I don’t, but I also don’t agree that we make anything worse by having this law.

    As for the scenario with MS or ALS, I don’t find this to be a potentially troublesome scenario, but I still don’t know of any cases from Oregon where this has been an issue. Are you aware of any?

  38. 45

    spews:

    Lee

    The problem with comparing the assisted suicide laws with medical marijuana laws is that when the medical marijuana laws are abused (and let’s face it, they are) someone gets stoned.

    They’ll get over it.

    When this law gets abused, someone dies. It’s permanent.

    As for the MS/ALS cases, the problem comes from the nature of the diseases. While I’ve read of some cases, I’m also aware that those reports come through some rather biased sources, and the patients are no longer available for consultation.

    Once someone has exercised this option, it’s pretty tough to ask them if they felt pressured to act now, while they still had the physical ability.

    Much of the information out there is from groups that were formed with the immediate purpose of either promoting or opposing these laws, but there is one group currently opposing them that is a wider advocacy group, the Disability Rights Education and Defense Fund (DREDF).

    While my own view is rather different from theirs, in that I could support assisted suicide with appropriate safeguards, their observation of the actual application of the Oregon law seems valid, they site references, and their opposition does not seem to stem from a desire to control other people, but from honest concern.

    Rather than repeat their work, I’ll simply refer you to them.

    http://www.dredf.org

  39. 46

    Stephen Schwartz spews:

    Lee and John

    Kudoes for one of the few really useful discussions on HA!

    Lee

    “It’s just that with I-1000 (and with the law in Oregon), they may explore the legal path first. “

    I think this is a very important point. Moreover, presumably, physicians willing to assist in death would become know and patients could choose.

    reefrring to John’s comment that legislation is not well written

    I think it’s unfair to expect it to. This law can’t protect all patients in end of life scenarios. It can protect doctors who know that a patient of theirs has a valid desire to end their own life on their own terms. You’re right that even with this law passed, you’ll still have a number of difficult issues and corner cases that leave people in the lurch. You’ll just have less than there are today.

    Lee, this comes close to my concern. You and John both assume that the major issue in writing such a law is to protect physicians who are willing to assist in death from litigation and protect patients from inappropriate use of death.

    First, we all know that, in practice, something much like this does happen now. Other than Jack Kevorkian, who provoked a court case, is there any evidence that the existing process is leading to litigation?

    Second, the Oregon law is, as John describes, limited to a somewhat artificial class … people with terminal illnesses who are not depressed and do have a rational attitude toward accelerating their own deaths. Given the flexibility of our current system, does anyone know how many patients would benefit from this law?

    John. Lee.

    Third, am I wrong that this rules out people with non life threatening conditions even if they want to die? In my limited clinical experience, the numbers of such people may be much higher than those who simply want to accelerate an inevitable death. Examples may include quadriplegics, surviving spouse, severe rheumatoid arthritis, severe emphysema, advanced MS, chronic pain, ….

    Under current law, I suspect that many people in this class hasten death perhaps by ODing on a medicine they use to minimize pain or failing to use an inhaler, or ??? Would this law, by specifying when a physician can assist in death, open doctors (and patients) to litigation?

  40. 47

    Stephen Schwartz spews:

    John

    Lee

    John thanks for the link (http://dredf.org/assisted_suic.....icide.html)! Very worthwhile reading.

    I would like to quote from some very powerful words:

    It is legal in every U.S. state for an individual to create an advance directive that requires the withdrawal of treatment under any conditions the person wishes. It is legal for a patient to refuse any treatment or to require any treatment to be withdrawn. It is legal to receive sufficient painkillers to be comfortable, even if they might hasten death. And if someone who is imminently dying is in significant discomfort, it is legal for the individual to be sedated to the point that the discomfort is relieved. Moreover, if someone has a chronic illness that is not terminal, that individual is not eligible for assisted suicide under any proposal in the U.S., nor under the Oregon Death with Dignity Act (Oregon is the only state where assisted suicide is legal). Furthermore, any individual whose illness has brought about depression that affects the individual’s judgment is also ineligible, according to every U.S. proposal as well as Oregon’s law. Consequently, the number of people whose situations would actually be eligible for assisted suicide is extremely low.

    The very small number of people who may benefit from legalizing assisted suicide will tend to be affluent, white, and in possession of good health insurance coverage. At the same time, large numbers of people, particularly among those less privileged in society, would be at significant risk of harm.

    This is very much consistent with the points I have tried to bring to Lee’s attention.

    The article goes on to discuss some other very difficult issues arsing from the American system of health care. At the very top, Americans still receive traditional health care, usually administered by a personal physician working with selected specialists. The law, as written, fits this model very well. However, as one proceeds lower on the feeding chain, medical care is increasingly controlled by rue making bodies whose concerns range from profit to, meeting statistical norms, to conforming to ethical rules set wither by the physicians or by the patients acting as a cooperative. The worst example may be the HMOs we all read about.

    If you combine I-1000 with such HMO rules, the outcome is going t vary depending on the HMO. I would guess that a fairly liberal HMO, like our own Group Health, might authorize assisted suicide. On the other hand, I am not so sure that the UW, given its extreme concern for litigation, would do the same thing. Aetana, Human, Providence, Swedish … these are anyone’s guesses.

    The DREDF also raises worrisome concerns about the lowest wrungs of our “system.” Given the huge differences in standards of health care for impverishyged groups in the US, not just race, but geographical location, is almost certain to lead to huge differences in who can and who cannot partake of this privilige. Even here in Wastate. healthcare among the chrinically unemployed of the Olympic peninsula is governed by very different rules than healthcare at, say, Swedish.

    There is much more worth discussing in this piece.

  41. 48

    Stephen Schwartz spews:

    An alternative?

    I am not sure how to realize this, but it seems to me that the issue of I-1000 is very much akin to the issue in Roe vs. Wade. The issue is the right to privacy.

    WADR to Madison and Jefferson, the Bill of Rights was a Compromise wrung from the Constitutional Convention because Jefferson threatened to oppose the Constitution unless these guarantees were included. Even more than his authorship of the Declaration of Independence, his intransigence on this issue shaped our history.

    Underlying the Bill of Rights weretwo issues, but only one of these is explicit. The tenth amendment clearly reserves powers for the states .. an issue we still fight over. There is, however, no simialr amendment that states the principle of the right of privacy. I*n other words, whether it is abortion or suicide, the Constitution does not explicitly limit the government’s right to make laws that limit our rights unless those laws conflict with the limited set of statements already included in the Bill of Rights.

    As I understand Roe vs. Wade, the Court based its decision on an implied right, if you will, they created a right that Madison would have included if he had understood the future reading of the Constitution. look at the text of the tenth amedment:

    The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

    Couldn’t that be read to support BOTH abortion and suicide .. at least at the federal level? In other words, since the Constitution does not specify any limitations on our rights to decide to live or die, doesn’t the tenth state that no federal law can restrict those rights?

    Of ocurse this would leave the possibility of creating such laws open to the states. However, if Roe vs Wade is a legitimate interpretation of the Bill, then how could it be that a woman has right to terminate a pregnancy but a suffering person does not have the freedom to choose death?

  42. 49

    spews:

    Professor Schwartz:

    Actually, at both state and federal level, it could be argued that the Fourth Amendment applies.

    I have always believed that the right of privacy, which the neo-cons cannot seem to find in the Constitution is clearly spelled out there.

    “The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported by Oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized.”

    Certainly the founding fathers considered that when the government took control of something or someone, they had “seized” it/them.

    Many court cases have ruled that the fact that a function was now done differently due to advances in technology (for example – the “press” now includes radio, television and even blogs like this one) did not change the basic right involved.

    That being the case, it seems obvious that the writers of the Fourth Amendment were describing “privacy” and the right to control your person and property.

    But not even the pro-life proponents seem to take that view. I’m really not sure why.

    All of this seems to underscore the argument that was made by opponents of the Bill of Rights, that once you start spelling out specific rights, no matter how broadly, that readers will take that as implying that only those rights specifically spelled out are guaranteed, and those only in the narrowest possible form.

    The Tenth Amendment notwithstanding.

    The neo-cons and their ilk are not alone in this. Witness the Second Amendment, where the framers spelled out their reasoning within the wording of the amendment, and so we have folks that make claims that:

    1. It only applies to people in an organized, state-sponsored militia

    2. It only applies to weapons in use in 1789

    (Don’t get me wrong. I think that the warfare on our city streets has become intolerable, and reasonable gun control is needed. I just think that a Constitutional Amendment is needed to enact it.)

    But back to the original topic.

    Yes, a reasonable person could make the claim that the Constitution protects a person’s right to take their own life, or even direct another to help.

    Only laws designed to protect the person from undue influence and ensure that the person had the mental capacity and capability to make that decision would be Constitutional under that interpretation.

    It would be a very interesting court case.

  43. 50

    Stephen Schwartz spews:

    John,

    As a fervent Jeffersonian , I am concinced he and Madison would have been outraged by the intrusiveness of much current law.

    The only basis I can see for limiting the right to die is the concept of natural law. Jefferson believed that the underpinning of law was a natural law that was a sreal as physical law. Of course discovering the law of gravity is a lot easier than discovering the natural law governing I-1000.

    Since Jeferson and his colleagues were Christians, I wonder if they might not have appealed to Jesus’s own voluntary death? WWJD, in this case meaning Jefferson do based on his reading of Jesus, would seem to me to lead to the idea that the government has no compelling interest in a person’s choice to live or die.
    ****************************************

    While we are at it, I wonder if Lee’s stand on this sissue may not illustrate a unifying issue of the Repricans and the Dems that I do NOT agree with. Both parties seem to me to believe that resort to legislation is always the first solution to any problem. In this light, Repricans and Democrats are both antiJeffersonian.

    It seems to me there are many issues where the govt could do a lot of good by decreasing the amount of law. For example, No Child Left Behind might work a lot better without all the mandates.

  44. 51

    Stephen Schwartz spews:

    Second Amednment

    I agree wiht Johnm here too. There is no question what the founders meant and that any attmpt to disarm the public would havfe struck them as horrible.

    OTOH, it is also true that modern weaponry is qualitatively and quantitatively different from the weapons of the 1780s. I have no trouble imagining that Jefferson would have banned assault weapons but the key word here is “imagining.”

    It seems to me that there are many ways of controlling guns that do not infringe on the original intent. Registration of guns and AMMO seem within the intent of the second amendment. So would be civil laws affixing major responsibility on anyone choosing to own a gun.

    I know little of our current law but what does the law say about possession of a gub with intent to use it in an illegal enterprise?