“A belief in assisted-dying is by no means a fringe view in western society.
There is broad agreement, associated with notions of modernity and evolved thinking,
that assisted-dying is an appropriate action to take in certain cases and should be allowed by law”
Discussing this concept of assisted-dying, which is a choice at the end of the day, with anyone can be difficult and challenging, not just because of differences in religious/spiritual beliefs, moral values, legislation and medical-ethical considerations, but for the multiplicity of terms used to describe it. Terms I think are relevant to this discussion are active and passive, voluntary and involuntary assisted-dying and physician-assisted-dying. Many other terms such as suicide and euthanasia (active/passive, voluntary/involuntary, by omission/action) and are also used but carries social stigma and negative religious connotations.
This week’s theme of assisted-dying and end-of-life decision-making, has been difficult for me as a physiotherapist and a Buddhist, trying to see both sides of the coin… The individual right to life and to be treated with dignity and respect versus the bigger picture of the society and the impact of such legislation. Buddhists are not unanimous in their view of physician-assisted dying, and the teachings of the Buddhadharma don’t explicitly deal with it. In Buddhism, the way life ends has a profound impact on the way the new life will begin. So a person’s state of mind at the time of death is important – their thoughts should be selfless and enlightened, free of anger, hate or fear. This suggests that suicide, albeit assisted or not, is only “approved” for people who have achieved enlightenment and are at peace with themselves and the life they had.
Personally I do not believe in artificial means of prolonging life. I believe in the “do not resuscitate” order, also known as the “No Code”, which may be seen as a passive assisted-dying by some. Dying does not scare me as it’s part of life, the natural progression of life, or if your life is cut short, it’s part of the path you had to or need to walk. Perhaps my perspective will change once I have children. Then the thought of leaving them behind will make me reconsider. But at this stage in my life, I believe that your time is your time and letting nature takes it’s course after you’ve exhausted all your options in medicinal and therapeutic terms. But science has made it possible to cure disease, recover from disability, reduce perceived pain and suffering and improve quality of life, so I do believe that you should make use of what is available. Therefore I am not pro assisted-dying for myself, but I am not against it for others.
The potential negative consequences or effects after resuscitation and prolonging life artificially is a reality, so too are the life saving chances. I have seen this with some of the kids I have treated. One is a little boy who was brain dead after a car accident and his parents instructed the doctors to save him and keep him on life support as long as possible. They had to resuscitate him 3 times and after 5 months of living on machines, he only recovered enough to sustain breathing through a trachi (tracheotomy), with a “Glasgow Coma Scale” of 3 (Eye 1 (no reaction or movement), Verbal 1 (no expression, sound, attempt), Motor 2 (reacts to painful stimuli)), which hasn’t improved or deteriorated in the last 2 years. But he needs 24h care, therapy and constant medical attention and intervention. Is this a life worth having or living, or is it selfishness to have forced life despite the package it comes in?
Then there’s the question of physician-assisted-dying. This really hit home in 2012, when Sean Davison, a physician, professor and head of the Forensic DNA Analysis Lab at The University of Western Cape in South African, returned home after five months’ house arrest in New Zealand for helping his terminally ill mother die. He was found guilty of the lesser charge of counselling and procuring the suicide of his mother, by giving her, as requested and consented, a lethal dose of morphine after she tried to starve herself to death. He has formed a non-profit organisation, Dignity SA and hopes to educate people and champion a law change in South Africa.
I agree with the slogan of Dignitas, “To live with dignity, to die with dignity” and that this is the last human right, or it should be. But unfortunately the mastermind behind the Dignitas organisation (an international centre for assisted-dying), Ludwig Minelli (a self-described humanitarian and lawyer), who might have had the best intentions to start with, has become something of a side show and with his toxic reputation, has resorted to shocking the public and forcing his opinions on others. Under Switzerland’s permissive and unique legal environment, assisted-dying has developed into suicide-tourism.
The problem we have is that every human being has the right to life and a quality life at that, but quality is subjective and each person has their own perspective on what living a quality, full life means. Two people with terminal cancer will not consider assisted-dying the same, they will not consider medical management and intervention the same… but is their suffering the same, as pain, stress, discomfort and fear are all perceived emotions, reactions and sensory processing which varies from person to person? So why does one person choose to fight to the end, whilst another lets nature takes it course? And what about people who are choosing to “give up” or end the suffering and requires assistance? Should they have the choice? Tony Nicklinson who suffers from Locked-in Syndrome has been fighting against the legal system for “Death with Dignity” laws. These laws allow a terminally ill patient to hasten an inevitable, insufferable and unavoidable death. It’s not suicide or euthanasia; rather, a possible option if the physical or emotional pain from the underlying illness gets to be too much or quality of life too degraded. If one is of the opinion to agree with legal active and passive assisted-dying for compos mentis, suffering, living, human beings, what would be the criteria? Should this be a right to all suffering human beings, a choice of how they want to live and die? But what about a person who has lost the will to live? Should they have this right or is this only for people who have exhausted all medical or health/healing interventions and therapies in trying to recover, reduce or manage the pain and disability? And then, is emotional and physical pain the same? Are we to say that such people are weak? Are we to say that everyone should endure?
If we think about it, compared to abortion, it makes the moral question a bit more simple. In South African it is legal to have an abortion, even from the age of 13, as shocking as it may be for some. Medically speaking in terms of anatomy and physiology, the embryo as a blastocyst has living cells after implantation on day 8-10 and then the embryo develops into a fetus at 8 weeks gestation when heart cells start beating. Furthermore, from 10-13 weeks gestation, the fetus’s nervous system sensitizes and develops integration of pain/noxious stimuli which cannot be termed a mere reflex. The fetus also bears all human traits at this stage including the basic/core structure of cardiac-circulatory and nervous system cells, which are reactive. But abortion is legal up to and including at 13 weeks gestation. Thus it can be seen as involuntary assisted-dying of the unborn fetus (although the mom is the active participant and decision maker). Others might call this murder. Just because the baby is inside the womb, once it has a heart beat, it is considered alive, a living human being. So what makes a born living human being’s life more important or special than a unborn human being’s life? Thus scientifically speaking within morality and ethics, the answer to involuntary and passive assisted dying is quite straight forward, it’s wrong. I believe that voluntary assisted-dying is a choice as you alone are responsible for your own life, and the choices you make.
A great video on the assisted-dying debate: