KNOW THINE OPPONENT

On the political right there’s a popular saying that "A conserva- tive is just a liberal who’s been mugged," and in some cases it’s probably true. Also true is that Death With Dignity (DWD) advo- cates, whatever their prior view of the subject, have often had exposure to tending a loved one through a lingering and intrac- tably pain-ridden departure from life.

DWD’s staunchest opponents, for the most part, are those lucky enough not to have witnessed such a thing and who don’t them- selves suffer from ALS, bone cancer or similar conditions likely to leave them in an uncomfortable, hopeless and helpless state for a prolonged period. In a culture so assiduously death-denying as ours, few, especially from the younger, healthier cohorts, give any thought to what could befall them as their lives end. It’s just not the sort of thing you want to dwell on. Besides, the kinds of truly bad deaths I refer to are a small minority among the many thousands of deaths that occur on any given day.

At the opposite end of the spectrum, deaths which might be cal- led good—i.e. peaceful, relatively expeditious and with family and friends having a chance to say goodbye—are rare as well. The great majority of deaths are merely deaths, no better or worse than the norm. Ah, you say, "’Twas ever such." But actually, it wasn’t. Modern medicine not only works cures and promotes recoveries that previous generations couldn’t have imagined, it can and does greatly extend the lives of hopeless cases where quality of life isn’t meaningfully taken into account. And one of those cases might be you.

Yet who’s to decide if or when enough is enough? That, pure and simple, is the crux of the DWD issue. My answer is the ill person him- or herself; never the government, never insurance compan- ies or healthcare providers, and never family members unless expressly designated by the ill person to make that decision. I see it as one of the absolute rights of person-hood, which medical practitioners should be as bound to follow as they are other direct instructions from a mentally competent patient.

DWD opponents, meanwhile, believe the decision is solely God’s, or in the case of nonbelievers, that it’s best left to chance. After all, miraculous recoveries have been known to occur. Nor do I doubt the sincerity of people holding that view. I accept that many of them fully intend to, and do, endure as a matter of faith or principle, whatever suffering may come their way. It’s a brave choice, and not easy to carry out, though it barely qualifies as choice, since the alternative possibilities—jumping off the hos- pital roof if you’re ambulatory or securing assistance if you’re not—are either heavily stigmatized or legally foreclosed.

Another popular saying, "God never gives you more than you can stand," sums up that view. My problem is in finding that view, when it is forced on others as a matter of law, to be immoral, and on the very basis it stakes for itself—the sanctity of human life. If there is sanctity to human life, and I believe there is, then respec- ting the wishes of the person whose life is involved follows from that sanctity.

Placing a higher value on human life in the abstract than one does on individual instances of it seems a very odd business. More- over, the notion that God never gives you more than you can stand is palpably untrue. What is death but God’s having finally given a particular human entity more than it can stand?

In addition, DWD opponents argue that the imperfections of hu- man nature mean no safeguards can ever be devised that will prevent government agencies, insurance companies, healthcare providers and unauthorized family members from seizing the opportunity and putting terminally ill and mentally or physically handicapped people to death. However, the Oregon record over ten years of DWD shows no such occurrences nor have any, to my knowledge, been documented in other countries with DWD laws. In fact, opponents who make this slippery-slope argument often contradict themselves by supporting the death penalty, despite its enabling statutes having been devised by imperfect human beings and despite its proven risks of executing innocent persons.

So what we have in regard to DWD is essentially a religious dis- pute, although anti side has so far been more successful in legislating and enforcing its view through government inter- vention. The same, of course, can be said of the pro side on legalized abortion, though I support that, because it expands individual autonomy in deciding whether or not to have a child without compelling any particular decision. Nonetheless, it’s a tougher call. While a fetus gestated less than 100 days can’t exist in any real way separate from the mother, it is still a human entity. Even so, within that timeframe I’m willing to weigh the mother’s autonomy, privacy and dignity as superior to the fetus’s not- withstanding that the fetus itself isn’t requesting abortion or giving informed consent.

While the two issues are frequently equated, DWD is altogether different. The human entity making the request and giving con- sent is the human entity whose life is offered up. What is free will, be it derived from God or not, if it doesn’t include the moral right to end one’s life or order it ended? But that’s not how things are in the US of A, or not yet.

Still, I understand why many people regard DWD as immoral and respect them for that. It’s a principled view. But like me, they’ve chosen to live in, and support with their patriotism, a country that has a bedrock constitutional prohibition against established religion. Where we part ways is that they want our government to behave as though it does have such a religion and I don’t. Under our system, blanket limits on individual choice in an area as fundamental as determining the circumstances of one’s last days aren’t properly a government matter.

But trying to put yourself in the other guy’s shoes usually helps in any disagreement. Let’s hope everybody now knows everybody else a little better.

LIFE AND DEATH IN THE GREAT NORTHWEST - PART II

Picking up where my last post (Life and Death in the Great Northwest – Part I) left off, Montana’s foray into Death With Dignity isn’t via legislation, as in Oregon and Washington, but via a court case known as Baxter et al v. Montana, filed in October 2007. In it, two severely ill men claim a right under the Montana constitution to physician assistance in ending their lives when their situations become unbearable.

Robert Baxter, 75, has advanced leukemia, and Steven Stoelb, 53, suffers from Ehlers-Danlos Syndrome. The kicker is the Montana constitution. In 1972 the state adopted a new document con- taining express guarantees of privacy, and in a second pro- vision, dignity. Wow! Anyone putting a high stake on personal autonomy has to love that. Also, since privacy and dignity are fundamental to the view that individuals should be able to end their own lives on their own terms, it’s readily believable that Baxter and Stoelb could win. Even so, judicial outcomes are tough to predict and groundbreaking outcomes harder yet. The Cali- fornia Supreme Court’s recent decision finding a constitutional right to gay marriage—i.e. no compelling state interest to forbid it—caught almost everyone by surprise.

So, what would a Death With Dignity court victory in Montana mean? The Montana legislature could pass a law, presumably like Oregon’s, regulating how that right should be exercised. In the interim, or if political opposition prevented the passage of a regulating statute, Montana physicians would seemingly be free to prescribe life-ending medications without fear of prosecution if, in their medical judgement, the patient’s request was war- ranted. Similarly, family members would likely be free to witness or perhaps even hand the lethal dose to a willing but enfeebled person.

One nearly certain result would be fierce backlash from religious conservatives, who would try by initiative to delete the operative sections from Montana’s constitution. Otherwise, broad latitude for pregnant women in that state to choose abortion would seem to follow the same logic as a right to Death With Dignity. But the fact that those two sections were included to begin with is evi- dence of how libertarian Montana is, so predicting the success or failure of such an initiative is a roll of the dice. It makes one wonder, however, about the wording that might be in the con- stitutions of two other famously libertarian places, Idaho and Alaska.

That question I’ll research for a future blog. Still, Idaho, which constitutes a buffer zone of sorts between Oregon/Washington and Montana, may be less ripe a field for Death With Dignity. Religious conservatives wield greater power there, reinforced by a fairly large Mormon population in the south along the Utah border. And Utah, well forget it.

Early this decade, when the issue was being debated and defeated at the Federal level, Utah Senator Orin Hatch said such a law was simply unnecessary. "We already have the Second Amendment. Anyone who’s that concerned about ending their life can just buy a gun." Which suggests that a Death With Dignity program in Utah or Idaho might consist of a voucher to pay someone to save your family from having to clean up your house after you’d done the deed. Or would that be deemed a needless state expense?