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.

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