Will Coloradans approve the ballot measure to allow physician assisted death in Colorado?
This is an update to previous posts about (unsuccessful) proposed legislation concerning physician-assisted death in Colorado and the ballot initiative which will be put in front of Colorado voters this November. Click here to read the Colorado Secretary of State’s final version of the initiative. Today’s post is a further conversation about this highly-charged topic. I enjoyed reading this recent Denver Post piece by Jennifer Brown about use of language and terminology in this initiative and the wider debate.
The first observation is that I’m using the term I have previously employed – physician assisted death. When I typed in the term to my search engine, what appeared in the results was “physician-assisted suicide” defined here as
The voluntary termination of one’s own life by administration of a lethal substance with the direct or indirect assistance of a physician. Physician-assisted suicide is the practice of providing a competent patient with a prescription for medication for the patient to use with the primary intention of ending his or her own life.
I use the term death because it is less inflammatory, but it is – by the very nature of the procedure – suicide. Assisted death can incorporate both physician assisted suicide and voluntary euthanasia, and I note this is important. While we’re talking about terms to describe the life-ending process which is facilitated by a physician, let’s look at a few important terms to help keep the terminology straight.
Euthanasia comes from the Greek meaning “good death” and the Merriam Webster online dictionary defines it as:
the act or practice of killing or permitting the death of hopelessly sick or injured individuals (as persons or domestic animals) in a relatively painless way for reasons of mercy.
Within the definition of euthanasia are different types of euthanasia, including: voluntary, non-voluntary and involuntary. Today I consider only voluntary euthanasia which consists of two kinds – active and passive.
Passive voluntary euthanasia: When someone executes a living will to direct that no life-sustaining procedures or artificial nutrition and hydration be offered in the event a person (known as the “declarant” for purposes of a living will) is determined to be unable to provide informed consent and suffers from a persistent vegetative state or terminal condition. This practice (with important controls promulgated by state laws) was made legal by the U.S. Supreme Court decision in Cruzan v. Director, Missouri Dept. of Health, 497 U.S. 261 (1990). It was the first “right to die” case heard by the U.S. Supreme Court, and discussed important aspects of self-determination, liberty interests and due process in the context of Cruzan’s family’s attempts to have Nancy Cruzan’s previously expressed wishes (orally expressed, not in writing) upheld.
Active voluntary euthanasia: This differs from the widely accepted passive form in that passive euthanasia involves a refusal or withholding of treatment and active euthanasia involves an intervention to give something – a lethal prescription from a doctor – to provide the means to end a life. Herein lies the distinction between refusal to provide or continue to provide treatment (recognized in our living wills) and the active choice of one’s own death, or suicide.
Can there be any middle ground here? Perhaps. If you consider the arguments for wider acceptance and use of hospice and palliative care – these focus on the treatment of the whole person to manage pain, a terminal condition or end of life medical care, and not just from the more mainstream exclusive perspective of medicine’s focus exclusively on a patient’s medical problems, often to the detriment of the patient’s quality of life. So here is the question – if patients have access to good quality palliative and/or hospice care at the end of life, then is assisted death really necessary? One way of looking at this is to consider that the rights-focused physician assisted death doesn’t adequately take into account the scope and range of palliative and hospice care which is presently available.
As we continue to age and live with (read: have our lives prolonged by) more drugs and medical devices, how we choose to remove those supports (like a pacemaker or similar devices) is part and parcel of our choice of living as much as it is how we choose for ourselves (and others) how we manage the end of our lives. Here there is a distinction between the legal terrain (like a medical POA or a living will) and the medical terrain (a do not resuscitate is a medical order requiring a doctor), but this is longevity in the U.S. and most people don’t live their lives consciously regarding these distinctions. Maybe it’s time to broaden the conversation . . .
© 2016 Barbara Cashman www.DenverElderLaw.org
I’ve been following this topic on your blog with keen interest as it strikes close to home of late.
I’m going to disagree with you to the extent that I don’t believe personally that I would opt for the hospice alternative in my case.On the surface, it would seem to be a caring, kind way to ease one’s passage, but in fact ( in my all too personal experience), it is not. Any way you dice it, it entails a prolonged period of suffering for the loved one as well as the care givers. It is all too sad and I believe that any individual in hospice, should he or she have the choice, would opt for a quick and merciful end. That’s what I plan for myself.
Hi Peter, thank you for your insightful comment on this discussion. What your comment illustrates is the paradox between the two types of voluntary euthanasia: active and passive euthanasia. I have written a bit further about that in today’s post. As you so eloquently illustrate, this is not just a matter of choosing a way through a difficult situation – both for the individual going through the end-of-life twist and turn passages and for the loved ones who provide care and support for the individual – but must involve the provision of compassion in the form of mercy. Mercy depends upon the involvement and support of others to allow one to make good on one’s own choice. Few of us make this choice alone.