Saturday, September 29, 2012

Prescription Dignity

I received the state's "Information For Voters" pamphlet in my mail the other day. By this I mean the actual mail and an actual pamphlet —made of paper —the pulp matter of fallen trees: pages and pages of information on voter registration, how to obtain an absentee ballot, a statement of the "Massachusetts Voters' Bill of Rights" and —most importantly— full text and detail on the three ballot questions we'll all be answering in November. It was nice to receive the reminder that there is more to this fall's ballot than the matter of who will be our next president or senator or congressman. Aside from the personas to pick from, we are presented with a couple of very direct questions. To be more precise these "questions" aren't simply polls to gauge opinion or set the direction for future policy or law making. These are law proposed by initiative petition. We vote 'yes' and we make them law.

One that has me wondering is Question 2, referred to in the voter information pamphlet as "Prescribing Medication to End Life." That's the more careful prosaic name for the proposal that tries to avoid taking sides in the question, yes or no. It's not referred to as physician prescribed suicide as some might call it. That is too blunt. The folks advocating the proposed law will tell you it is all about Dignity. They entitle their law as drafted the "Massachusetts Death With Dignity Act" —and this is where I become skeptical.

Dignity... Who could be against Dignity? Right?

A 'yes' vote on Question 2 would enact proposed law allowing a physician licensed in Massachusetts to prescribe medication at the request of a terminally ill patient "meeting certain conditions" to end that person's life. To put it plain, the law codifies authority for a physician to prescribe the medicine one would use to commit suicide.

The actual word 'suicide' only appears twice in the full text of the law, which is reprinted in whole in the state pamphlet. The word only appears where we are told this is not what we are about here with this law, we are told "[a]ctions taken in accordance with this chapter shall not constitute suicide, assisted suicide, mercy killing or homicide under any criminal law of the commonwealth.” The sanctioned terminology is “ending life in a humane and dignified manner” —this turn of phrase appears no fewer than 14 times in the proposed 'Chapter 201G Massachusetts Death With Dignity Act.'

Question 2 not only assumes the citizen's right to directly author state law, it presumes to amend the dictionary as well.

Death with Dignity —if there's a way to prescribe this with a pill I think we should all be for it, but what bothers me is when I read this law as drafted, when I look past the embrace of the term, what I see is an outline focused upon administrative concerns, the appropriate witness, waiting periods and forms to fill out and keep on file. None of this seems to secure anything like dignity for the dying. Laws are for the living, and this law like most is about liability and litigation. We cover ourselves with a suffering person's signature on a form titled "REQUEST FOR MEDICATION TO END MY LIFE IN A DIGNIFIED MANNER" —duly signed by the appropriately disinterested objective witnesses. This, my friends, is paper work. I can picture the scene all too well. I can just see the clipboard.

I shouldn't be so sharp I suppose. I don't doubt that the people who have worked to put this legislation together and have it put before us as a ballot question have done so with the best of intentions. They seek to ease the suffering of the terminally ill and their families. Sorry, but it's the manipulative language that irks me. Over the past few years I've seen both my parents die and I've seen more and more of their generation passing, their families and loved ones dealing with the pain. None of those dying left this world in ways ideally scripted. Yet, I never saw anything in the death of any one of them that detracted from their actual dignity. There is suffering and pain and hardship. Strong men and women become vulnerable and weak and needy. The sentiment for easing that burden —avoiding that scene— is a strong one— one I can respect and understand. But I worry at the same time that the support for this legislation, at least some of it, is so driven by the intense emotion surrounding so many of these hard choices that come with the end of life. I've seen it argued that Question 2 advances a law about Dignity and Personal Choice and yet to read it in detail what one comes away with is the the procedural aspect of it all. What’s being described isn't so much an enabled free choice as an exhaustive  protocol, not about the dying and their dignity so much as about the dispensaries and their exposures and liabilities.

There are a great number of problems with the way we regard death (and life) in this society. We've seen some progress in recent years in certain areas —with respect for Living Wills, hospice care —there are improvements we could still stand to make in pain management and palliative care for the suffering, in the support we lend to families of the terminally ill. We might improve the situation with political focus, and it is right that we try. I just question whether 'The Massachusetts Death With Dignity Act' serves to sustain that focus or neatly dispenses with it instead, like a pill. The law would establish means and methods for prescribing suicide as "medicine" and would serve to create a setting for posing the question to the suffering and vulnerable —and with a dramatically changed climate of expectation for the answer.

There are valid ethical reasons that the Mass Medical Society, a professional association of over 24,000 physicians and medical students, has publicly stated opposition to this law.

Might we simply be trying to streamline or contain death for convenience's sake, to tune it to the tempo of our neatly compartmented modern lives? I guess I am suggesting we stop and give that question some thought before we answer 'Question 2' — that we question the culture change this legislation would advance —or perhaps the climate change we might be signaling a surrender. The argument I saw cited recently, that I found especially sobering, was that the majority of those seeking this “medication” —in places where it is already legal like Oregon, were motivated not by pain or a diminished self, but by a fear of losing control, becoming a burden upon their loved ones. Maybe there is some dignity in that pride, something poignant, human and even beautiful. But, as we allow it, I wonder if we aren’t also mistaken, not to take our burdens and the last lessons life and love give us. I wonder if we shouldn't challenge the notion that Dignity is something anyone could ever prescribe with a pill.

Wednesday, September 19, 2012

And here we are having to judge

There's something strange I've noticed over the past few months, as our presidential politics have been playing out and I've found myself from time to time in exchanges with my more conservative friends, inclined to support Mitt Romney for president. Of course there's always chance to examine President Obama's many faults and failures. We can go over those at length and in depth, but when we try to see Mitt Romney examined or challenged on a point, the response almost always comes that whatever fault's found with Romney, Obama's done the same or worse. It just strikes me odd that, when it comes down to brass tacks, so often the assessment Romney's champions offer in defense of their man is that he's no different from Obama. I won't get into a long list of examples so as not to distract from my point about the latest. Suffice to say we've seen some strange and disparate things judged equivalent.

The latest example comes of Candidate Romney's musings on the composition of the American electorate so recently come to light, his letting out that there's a goodly percentage of the populace —47% I think he figured it— whom he estimates as beneath or at least outside his concern. “My job is not to worry about those people,” quoth he. "I’ll never convince them that they should take personal responsibility and care for their lives."

 The immediate response I saw from quite a few conservative friends was to reach for Obama's famous "cling to guns and God" comment from back in 2008 as a comparison. We all remember that one. (There's several of my acquaintances who like to remind me of it every now and then.)

"[I]t's not surprising then that they get bitter, and they cling to guns or religion," then candidate Obama said. The soundbyte was a big seller.

Wasn't this just the same kind of unguarded comment that Romney is now suffering over?

But I've got to counter that, while these may be similarly unguarded moments, the substance of what these men said is worth considering. And there is some awfully important contrast there.

Back in '08 Obama was speaking to campaign volunteers and allowing for some exasperation at demagogue appeals to "guns and God" (and the intimation that he posed a threat to them both) —how these served to distract from the substantive policy issues that actually do effect people's lives. (Look to Romney's pledge not to take God off of our coinage as a fine more recent example). While Obama was expressing frustration at the cultivated and ingrained skepticism he and his campaign faced, he still sought to reach the voters he was describing. His comments came as he urged his campaign to persist in trying to persuade."You know, we’ll have a series of talking points. But the truth is that our challenge is to get people persuaded that we can make progress when there's no evidence of that in their daily lives." What the candidate was telling his campaign was that every voter deserved attention, whether they appeared to be a part of some rival demographic base or not.

 I don't think you can characterize Romney's remarks that way.

"There are 47 percent of the people who will vote for the president no matter what. All right? There are 47 percent who are with him, who are dependent upon government, who believe that they are victims, who believe that government has a responsibility to care for them, who believe that they are entitled to health care, to food, to housing, to you-name-it... These are people who pay no taxes...
[M]y job is not to worry about those people. I’ll never convince them that they should take personal responsibility and care for their lives."

There were whole segments of the population Romney was writing off as essentially not his concern with those words. Winning office would be about persuading some other "5 to 10 percent in the middle" (between the Lowly and the Ascendent) to side with him. That's what this campaign would be about.

Apologists now explain Romney was only talking candidly about political realities of the election contest. The candidate's wife tells us really he "does not disdain the poor" —for all his resignation about their sense of personal responsibility. Sorry, but Mitt Romney's apologists saying that he was only talking about the election strategy and not the governing —and that this somehow makes what he said more acceptable— misses the point, not just the point of my argument, but the point of the design to our political system.

There’s an important distinction between democratic debate and mere election strategy. In the former you make your case for the truth and the proper course for the country as you see it and you offer it even to people who might disagree with you or challenge you. Every now and then you might even improve your position by considering the criticism you receive. In the latter you’re no longer interested in engaged argument. The contest is all and the contest is about stirring your base and suppressing your opponent’s. You might win that contest, but you gain nothing in the process. You only expend resources. While you might secure the levers of power (until the next contest) you do not lead by the merit of consistent ideas.

I’m inclined to forgive Barack Obama for sticking his foot in it about "guns and God" back in the day, because the context he did it in was an argument about reaching past skepticism and appealing on the level of reason, even to those you might see as your opponent's base, those who might disagree with you. I’m less inclined to forgive Romney’s gaffe, as his argument was just the opposite. He described a mass of the electorate to circumscribe and dismiss, to work past rather than treat as fellow citizens to engage and respect.

The image that comes to mind is of Solomon from the old Bible story, with the two women and one baby before him: two women with apparently equivalent claims that he had to judge. One was willing to see the child cut approximately in half, the other not.

And here we are having to judge.

Tuesday, September 4, 2012

Sniffing at the sweet smell of success

Well, I went and did it. I sat down and gave a listen to Mitt Romney's speech to the GOP convention from last week. I hadn't found the time to give it a fair airing to my mind until this past weekend. (It was a busy week, last week.) So forgive me if I'm posting on the topic of old news.

I guess I have to say Romney's acceptance of the nomination wasn't a bad speech, all in all. I think it sounded the right sonics for the candidate as he moves into final campaign mode. There was a decent mixture of platitude and stirring stuff. I'll grant that and, smartly, at least at first, he toned down some of the Obama bashing and affected a more measured respectful —and potentially presidential— tone. With any election that involves challenging an incumbent, one of the things you have to allow for —and even actively pursue — is winning the support of voters who supported your opponent the last time out. Blaming them for voting in a guy who hates God and freedom and doesn't even understand what being an American is —well, let's say that's something of a hard place to do that from. Romney's speech at its core was about making that path from a vote for Obama in 2008 to a different place this year.

[As aside, I've always thought one of the things that cost John Kerry in '04 was the implicit message of his campaign that only a completely ignorant bigot and utter fool could ever have supported his opponent.]

So it was that instead of the usual harangue, Romney posed the picture of an America that had come to together despite party differences and with good wishes for the new president as he set out upon his term of office these three and a half years ago. We all wished the president well, Candidate Romney recalled, that's just the way we are —we wanted him to succeed as we wanted America to succeed —it's only fair if we're disappointed with him now...

Luckily, I was seated far enough away from my computer as I heard this that I managed not to spray the machine's delicate circuitry with the coffee that came spewing from my mouth and nose. I gasped at the notion: Wished him well? Wanted him to succeed? This from the same man who in January of 2009 —about, oh, a little over one week into the Obama administration— was complaining that he shouldn't be expected to support "failed policies" —the same political party whose Senate Leader announced at the very dawn of the administration that his 'number one priority' was going to be seeing to it that Barack Obama serves but a single term.

Succeed... ha.

But I suppose I shouldn't complain. Even the suggested conceit that this cooperative atmosphere once existed might be somehow useful. It could be the seedling sense that it could happen one day... "again." Could this be Romney's... hope? (Not that he'd ever use the term) at least if he's elected anyway?

Actually this word "success" has been turning in my own little stone tumbler of a skull ever since I watched Romney's speech (and wiped off my desk). There came another telling moment for me in the candidate's speech, it was when he let into President Obama for somehow being against success. Romney had given a brief listing (somewhat selective some might argue) of the "success stories" he could tell about his years at Bain Capital."These are American success stories," Romney said. "And yet the centerpiece of the President's entire re-election campaign is attacking success. Is it any wonder that someone who attacks success has led the worst economic recovery since the Great Depression? In America, we celebrate success, we don't apologize for it."

I'm going to go out on a limb here and posit that President Obama doesn't dislike, attack or apologize for success in itself. We could maybe argue over whether he too much dislikes, attacks and would feel awfully sorry to see Mitt Romney succeed at getting elected president, but that's another discussion I think. I'm wondering if maybe what is really at issue between our two candidates and their political parties, is how we define that term —success. The President doesn't attack or apologize for success, but he does challenge the selective narrative of Mitt Romney's "success stories." Should the same definition of success that a CEO uses in the corporate boardroom serve for the President of The United States? Do the Community Organizer and The CEO have different and equaly valid definitions for us to work with? Should we figure out how to best combine them?

That might be a discussion worth having.

Just maybe the problem of defining success cuts right to the heart of the matter. The bottom line is something we all have to be aware of, but a true accounting of whether that bottom line describes a success or failure —a moving forward or a sliding back— involves seeing it from the perspective of the whole, not the individual player —or even your team in the contest. The short term profit taking that dismantles and outsources industrial capacity might score as a success and a profit on the level of an investor transaction, while bearing only cost to the men and women who worked in that industry, to the communities formed by those men and women, to the society that had made a place for that work. Romney rightly remarked that pursuing success in business involves investing effort and taking risks and even accepting the occasional failure. But what I question is whether he sees beyond the loss that you enter in a ledger, that you shrug off in the working balance —or view philosophically as 'creative destruction'— to the loss that cuts deeper than that. I wonder if he has an answer for the whole, both those who profit and those who lose. To ask such a question isn't to attack success in general or even Mitt Romney in particular. It's to pose a challenge I want to see him meet, successfully.

Early on in the convention we heard Mitt Romney praised for the hard truths he would tell us —once we elect him president. It seems to me a little something more to this definition of success would be a good place to start. There's got to be more to his success stories than the aura of his estimable wealth —there's just a little complexity to that sweet smell of success. We would be remiss if we didn't sniff at it just a little.