Death with Dignity: Why I Don’t Want to Have to Starve Myself to Death

Dr. Ron Pies writes an eloquent defense of why physician-assisted suicide should not be made a legal right in Massachusetts. He compares it to a doctor helping one of his patients jump from a bridge — something most doctors would never do.

But in making this analogy, I believe we’re removing all context and logic from the decision behind wanting to end your own life because of a terminal illness. For the patient, it’s not about the act of suicide or ending their lives — it’s about alleviating suffering from the disease and choosing one’s own way of dying with a little dignity. It’s about patient empowerment, human dignity and choice.

That’s why in the two states where it is legal for doctors to help patients with a terminal illness, it’s referred to as the Death with Dignity law.

Because the alternative takes much of the dignity out of dying in today’s modern medical system.

“Physicians have no more business helping patients kill themselves with lethal drugs than they do helping patients jump off bridges,” says Dr. Pies.

Most would agree physicians have little business helping a person jump to their death. But it appears that Dr. Pies undermines his own argument when he suggests it is perfectly okay for a physician to let his or her patient die of willful starvation and dehydration. His rationale? Death this way is solely in the patient’s hands, and isn’t as painful as we imagine it to be. He points to the scientific evidence, because there have been studies assessing patients’ pain and suffering as they’re dying through starvation and dehydration. Well, no, not quite. The evidence he points to is a single study that surveyed — not patients — but hospice nurses.

Now while I have great respect for the work and opinions of hospice nurses, let’s not confuse their opinions with data that would be more helpful — from the patients themselves. But there is no such data. So we don’t honestly know — and can’t say — whether a patient whose doctor is okay with letting them starve themselves to death is in greater or lesser pain than one whose doctor has voluntarily prescribed a medication to hasten a terminal patient’s death.

Dr. Pies seems to be splitting hairs here. His objection appears to be that patients can end their lives if done solely on their own, because physicians shouldn’t help patients along to their death — especially with a prescription. Yet he’s okay with a patient starving themselves to death — something no physician would ever be okay with in any other situation (such as a patient who had anorexia).  ((Imagine someone presents to an ER severely dehydrated and emaciated. Would any physician stand idly by and let that person die of dehydration and starvation? ))

Physicians of such starving patients don’t just leave at that point. They too actively help the patient starve themselves by alleviating the discomfort associated with starving and dehydration. Physicians do this by prescribing a sedative, a practice known as terminal sedation or palliative sedation.

It’s not that starving to death isn’t a painful process (it is) — it’s because the patient has been prescribed drugs — by a physician — to make their “natural” death less painful.

Last, Dr. Pies argues it is not a right to die with dignity at the end of our lives, in the time and manner of our choosing. But nobody is coercing physicians to comply with the proposed law in Massachusetts. Just as most physicians do not perform abortions, I suspect many physicians will also not be interested in prescribing drugs to help a person at the end of their life hasten their own death.

We need such a law not to compel physicians or mess with their moral code, but because government has determined that the people cannot be trusted to have access to certain medications. Because government has restricted our access to such drugs, it is necessary to seek access to them through the government- and guild-defined methods imposed. ((In this case, that means gaining access to the drugs largely through a physician, because that’s the way the American Medical Association, the physician’s guild in the U.S., wants it. ))

If my liberty to purchase and administer such drugs wasn’t restricted in the first place, we wouldn’t need such laws. But since my liberty has been restricted, a law is needed. This law would not impose an obligation on physicians to prescribe such medications to any patient who asked, as it would be completely voluntary for physicians to participate:

(2) Participation in this chapter shall be voluntary. If a health care provider is unable or unwilling to carry out a patient’s request under this chapter, and the patient transfers his or her care to a new health care provider, the prior health care provider shall transfer, upon request, a copy of the patient’s relevant medical records to the new health care provider.

One of a physician’s primary purposes is to help alleviate suffering. Suggesting a patient starve themselves over a period of one to two weeks, while being prescribed and administered a sedative, hardly seems in the spirit of this purpose.

For me, it’s not about a physician’s rights — it’s about a human being’s inalienable rights and having the right to choose. So I will be voting “Yes” on Question 2 for the Death with Dignity Act in Massachusetts. Because I believe that people with a terminal illness have a right to die at a time and place of their own choosing — with the dignity deserving of a human life.

 

Further Reading

• Merciful Assistance or Physician-Assisted Killing?– Dr. Ron Pies
• The proposed Death with Dignity Act in Massachusetts (PDF)