Peaceful dying vs Doctor Knows Best

credit acpinternist.org

Barbara Coombs Lee, the sharp and articulate president of Compassion & Choices, spoke to the issue of death with dignity on PBS NewsHour tonight, with opposing views presented by Ira Byock, noted physician, author and advocate for palliative care. Neither really won; the time was too short and the issue is too complex. The Death With Dignity movement though, is not going away, and we the people will only win when the movement wins.

Lee spent 25 years as a nurse and physician’s assistant before becoming an attorney and devoting her life to personal choice and autonomy at life’s end. She believes a terminally ill, mentally competent adult should have the right to end his or her life when and how he or she chooses. Byock, chief medical officer of the Providence Institute for Human Caring, believes that if doctors were properly trained in pain management and end-of-life care – which he readily admits is far from the case – no one would ever want, or choose, to hasten one’s end. Lee appreciates the grace with which Brittany Maynard is facing her own very premature death; Byock says the active, well-educated 29-year-old is “being exploited” by Compassion and Choices.

A few caveats:

Barbara Coombs Lee is a good friend whom I admire and respect. I have worked with Compassion & Choices for well over a decade as a volunteer, Northern CA member and board chair, and now member of the Leadership Council. I strongly support physician aid-in-dying and individual autonomy.

“Hospice and palliative care,” Lee said on the NewsHour segment, “are the gold standard” for end-of-life care. But no amount of hospice care, or palliative care, can alter “the relentless, dehumanizing, unending” progression of a disease such as Maynard has and many of us will also face. For many of us, as for Maynard, there will be loss of every bodily function, one by one, quite likely accompanied by excruciating pain and possibly things like the seizures Maynard would like to minimize for her own sake as well as the sake of her loved ones who would be forced to watch.Stethoscope

Perhaps doctors will eventually all be adequately trained in pain management and palliative care. But even then – and “then” is a very long way off – must the doctor always know best? Why can’t I, the patient, the person facing my own dying, be the one in control?

Byock is dismissive of the pain involved with watching a loved one suffer agonies of prolonged dying. Maynard’s inevitably increasing seizures, for example, would be helped by palliative care, he suggested, so she wouldn’t suffer terribly. If I chose – as Maynard is choosing – to have my loved ones remember me as a woman at peace while holding their hands rather than a disintegrating person gripped with terrible spasms – why is that not an honorable choice?

Byock – who in this NewsHour fan’s humble opinion got the better time and treatment – slipped in words like “suicide” and “slippery slope” and “euthanasia,” and phrases like “euthanized in the Netherlands” too far along in the program for Lee to answer in the brief time given her. Byock ignores the fact that no one choosing to hasten death under the existing laws (four states now have the law, two others allow aid-in-dying) is committing suicide; they are being killed by their disease. No one has been, or will be, “euthanized.” The United States is not the Netherlands. He also ignores the fact that in the long years of Oregon’s successful law – it was first enacted in 1997 – there has been not one report of abuse. Not one.

There is no slippery slope. There is only compassion. Self-determination. Autonomy. Dignity. Grace. Peace. Why should they not be legal?

I respect the medical and literary achievements of Ira Byock. But I’m sorry: the doctor does not always know best.

7 responses

    • Glad I was not just imagining that. I felt that Byock, who is indeed a fine writer and probably does great good work in palliative care, deliberately threw in every possible trigger phrase and innuendo when he knew they could not be countered. Dirty pool-playing is inappropriate in these discussions and the issues deserve honest debate.

  1. Dear Ms. Johns, Thank you so much for supporting death with dignity. It seems that there are always those people – whether they come from a religious or political milieu – who are uncomfortable with individuals wanting control over their own lives – and deaths. Whether it be abortion, religion, voting rights, racial and marriage equality, or a myriad of other choices, these would-be dictators have long been doing their best to curtail an individual’s control over his or her own life. Here, without question, is one of the most important decisions a human will ever make, and we still have those who think they know what’s right for everyone and wish to foist their decisions on the culture as a whole. We who support death with dignity are not saying that everyone must adhere to our way of thinking; only that everyone can have a choice at the end of life. Dr. Byock’s statements show a need to curtail the population’s ability to decide which choice to make, and force us all to swallow his own ideas about what is right.

    • Thanks so much for those comments. I share your concerns that so many — politicians, preachers, power-brokers of all stripes — want to curtail our right to control our individual destinies.

  2. Well said, Fran! I can’t recall whether Ms. Lee had a chance to point out that, simply by
    having those capsules in her bedside drawer, thanks to Oregon’s progressive law, Ms. Maynard/Diaz has already gained a great deal of the peace she was seeking by moving up to Oregon. About a third of Oregon patients who qualify for and get prescriptions never use the medication. But having a key to the exit allows them to shift their focus from anxiety about the potentially ruinous manner of their impending death to focus, instead, upon the short-term goals that make their remaining time as tranquil and satisfying as possible. As for the effect upon her family, I give thanks to retired Supreme Court Justice John Paul Stevens for noting that allowing a terminally ill person to choose how to die “…gives proper recognition to the individual’s interest in choosing a final chapter that accords with her life story instead of one that demeans her values and poisons memories of her.” Robert Liner, M.D.

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