GOOD STRATEGIES & BAD : Opposing Physician-Assisted Suicide

By Callahan, Daniel | Commonweal, December 3, 1999 | Go to article overview

GOOD STRATEGIES & BAD : Opposing Physician-Assisted Suicide


Callahan, Daniel, Commonweal


The state of Oregon has been notable in recent years for some policy innovations, not all of which please people in other parts of the country. The two that are most striking are its Medicaid program and its law on physician-assisted suicide (PAS). Its Medicaid program, which prioritizes some 734 medical treatments, is dependent on its annual state budget to determine how far down the list it can go to provide those treatments. Attacked by many at the outset-a way of picking on the poor, it was said- the policy has worked exceedingly well, becoming a model for consideration by a number of countries (though, oddly, by no other states). But that program has faded from attention at the moment, overshadowed by Oregon's PAS law.

According to its supporters, Oregon's PAS legislation is no less successful, showing that a responsibly administered law can avoid the pitfalls and calamities its critics have predicted. Since only fifteen people officially availed themselves of the right of PAS in its first year, 1998, that claim does not mean much. More important will be the evolution of PAS as a practice in Oregon over a number of years, particularly when-and if-it loses public and media attention and the number of patients wanting to avail themselves to it increases, as is generally expected.

Earlier this fall, the House of Representatives passed Bill H.R. 2260, the "Pain Relief Act of 1999." Its purpose is two-fold: to thwart Oregon's attempt to allow physicians to use controlled substances, ordinarily opioids, to assist patients in committing suicide, and to advance palliative-care research and education. As someone who has spent fifteen years or so actively opposing euthanasia and physician-assisted suicide, and working to advance palliative care, this is the kind of bill I wish I could like. I can't. It strikes me as flawed, unwise legislation that will do more harm than good in the struggle against PAS.

I am not happy to be saying this. I know that some groups, and many of my friends and other opponents of PAS, have worked hard to get the bill passed. But I have come to think that, if PAS (and euthanasia) are to be effectively combated over the long run, great care must be taken with the arguments used and the strategies chosen. The combination of the American love of self-determination, a rapid rise in the number of elderly, and the kind of long, drawn-out deaths that are the mark of the regnant chronic diseases, is likely to make PAS ever more attractive as time goes on.

Right now, with the exception of Oregon, the struggle against PAS is being won. Other bills in state legislatures do not even make it out of committee, and no other state seems on the verge of following Oregon. In short, opposition to PAS seems to be prevailing nationally. All the more reason to be careful in choosing how to press the case against it.

There are two popular but mistaken arguments against PAS, one drawn upon by the Left, the other by the Right. Liberal opponents of PAS, of which there are many, believe the strongest case against it is the danger it poses to the poor and the weak, those unable to defend themselves from coercion and social rejection. Surely abuse could happen, but it is far more likely that it is members of the educated middle and upper classes who are most at risk. They are the ones who think control of one's body is the greatest value in life, and that dependence and bodily decay are a threat to their dignity. But the greatest danger of PAS is the social legitimation of suicide as a way of dealing with the suffering and sorrows of life. That most of the first cases of PAS in Oregon came from people who feared a loss of control, not pain and suffering-similar to the pattern in Holland-lends some credibility to my hypothesis. …

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