Should Physician-Assisted Suicide be legal throughout the US?

[Broomstick]

@Voyager

But what if the Nazis force abortions on lesser types? By your argument, we must ban abortions now just in case.

The difference is that I have confidence that in our system no one is going to be forced to have an abortion, at least not in the sense of being physically restrained. I do think it’s possible for a woman to be pressured into getting an abortion, but even if she does she’ll still be alive afterward to seek legal redress.

Kill someone against their will, without their consent, and they’re dead. It’s over.

@Voyager

So, if a rapist would feel bad about the woman he raped aborting his child, she shouldn’t be allowed to?

Aside from the man not having a say in whether or not a woman has an abortion, as a criminal he would doubly have no say in it. Feel bad about a baby being aborted that you conceived via rape? Don’t rape people, just for a start. If a man feels having a child he sired aborted will make him feel bad then be damn sure he doesn’t sire an unwanted child. If he’s not a rapist then maybe he could offer to take full, no-strings-attached custody of the child but it’s still not his decision. If he is a rapist - well, don’t think that sort of person should have custody. He should be in jail, in which case taking care of the infant would be impossible.

@Voyager

Our friend just killed herself through PAS. (She was in California.) She had a degenerative disease that meant she was losing control of her body, but her thought processes were unaffected. She made the decision herself. Her children and even her friends were aware of her decision. You would have condemned her to a life trapped inside a useless body, which is the worst torture I can imagine.

You are incorrect. True, I don’t like PAS and don’t think it is a good thing, BUT, just as the phrase “don’t like abortions? Don’t have one!” can be applied, I may not like or approve of PAS, but if it DOES exist in society I want to be sure no one is subjected to it without consent.. Your friend consented. I wouldn’t interfere, even if I don’t like what she did. She consented. I won’t stop her.

Just don’t ever expect me to think it was a good thing. At best, it was the lesser evil.

If you’re so gung-ho on doctors killing people I want the assure that this will NEVER happen to me, personally, just as I can be reasonably sure no one is ever going to strap me down to a table and force an abortion on me. I do not consent. I do not approve. I do not want this evil for myself even if other people do want it, even if it’s legal.

@Novelty_Bobble

Pretty much every poll I’ve ever seem on this suggests that the vast, vast majority of people see the logic in this, that they want that option for themselves and their loved ones.

Again, I do not want this. I do not consent.

I would also find it a moral abomination if people who can NOT consent are summarily put to death out of some misguided, twisted “mercy”.

[Broomstick]

@wolfpup

These (and the examples in your previous post) are ridiculous straw man examples that have absolutely nothing to do with the topic of medically assisted suicide. No one has suggested that it should be OK to kill a child because he or she has autism.

If a child (or adult) with autism is non-verbal then there is the possibility of their legal guardian deciding on their behalf. The lives and the quality of the lives of the disabled have, historically, been seen as lesser, as not worthy.

These people who are willing to murder their own, autistic children - what would be stopping them for requesting PAS on behalf of their “suffering” child?

@wolfpup

If it had been in force at the time that Robert Latimer chose to kill his severely disabled daughter – one of your scare-story examples – it would have made no difference whatsoever as she did not meet many of the eligibility criteria, including being over 18 and having the ability to give informed consent and the clear absence of any coercion.

THANK YOU. That is exactly the sort of thing I have been asking about. What are the safeguards around this process? THANK YOU for actually answering the question instead of simply attacking me.

And bravo to the Canadian courts for protecting those who can’t speak for themselves.

@Machine_Elf

Options that are not cost-effective are already denied to patients, even in places where PAS is not legal; that’s nothing new. Why is it more irksome if the patient is offered choice between a quick painless death instead of a lingering, painful one?

Because that “lingering, painful” death might not need to be such. As you note, options are routinely denied to patients. In a system like Canada’s where medical care is given based not according to how it affects the bottom line of a private company but rather on effectiveness and need I hope this is less like to happen.

Much of the end-of-life suffering COULD be better treated, leading to people want to live out their lives instead of kill themselves, or so I would hope. I don’t want PAS becoming the ONLY choice when there are alternatives. We already live in a nation where in some state doctors are forbidden to give alternatives to a full pregnancy to a patient, where private companies can deny medical care to someone based on cost rather than effectiveness, why should PAS be any different?

@Machine_Elf

It also covered the case of a man ( Randy Stroup ) who was denied state-sponsored treatment for his prostate cancer because his odds of survival were considered too low - in other words, the treatment was deemed to not be cost-effective (i.e. there needs to be a >5% chance of survival beyond 5 years). They did, however, offer to cover the cost of palliative and hospice care, up to and including PAS. After Stroup made a very public fuss about it, the state relented and covered the cost of his chemo.

THANK YOU. That is the sort of thing I was asking about. Also, an illustration of “we’ll just let you die because it’s cheaper” came into play. I do think there is a point where chemo or radiation is pointless BUT a fully informed patient should be allowed to make choices. I think Stroup made a lousy choice (given those odds I’d opt for palliative care myself, although not the PAS) but it was his choice to make, not mine.

@Machine_Elf

Given that resources are finite, and there absolutely will be cases where treatments are reasonably denied by insurers because they are not cost-effective, how does the availability of PAS make things worse? Would Stroup’s situation have been somehow improved if PAS were not presented as a covered option?

What’s bad is “this isn’t cost effective but we’ll pay to let you kill yourself”. Or worse yet “we’ll pay to have a doctor kill you”. I’m not at all keen on letting Mr. Stroup swallow a handful of pills but at least in that case no one is killing him, and clearly he’s consenting if he’s doing it. I really, really have an issue with a doctor taking an action that deliberately kills a patient. It seems the opposite of what a doctor should be doing.

[Broomstick]

@eschrodinger

In my state, the physician assistance is writing a prescription for pills. The patient has to meet certain criteria (terminal within 6 months, not depressed, not coerced, etc.) has to ask more than once, and has to have approval from more than one doctor. And then, when they have the pills, they get to decide if and when to take them. No one is killing someone against their will. It’s still suicide.

OK, don’t ask me to approve, but if the patient is taking the pills themselves then I’m not going to interfere in those circumstances. Under those rules I am not going to have someone murder me when I’m helpless.

I very much DO have a problem with doctors actively killing a patient who is unable to consent at that point.

Now, if that patient in advance had indicated their wishes (preferably in writing, but these days video or other things might also work as well) in such circumstances that would also be consent. Although I still have a lot of problems with any doctor taking an action who’s entire purpose is to kill a patient.

I’ve put my wishes in writing. I wish everyone would.

[Novelty_Bobble]

@Broomstick

Again, I do not want this. I do not consent.

Well that’s the central founding principle of every PAS system that I’ve ever heard proposed. It is built around consent so if you don’t want it and you don’t consent then it won’t be done to you.
What the vast majority are asking for is that same degree of autonomy to be extended to us.

@Broomstick

I would also find it a moral abomination if people who can NOT consent are summarily put to death out of some misguided, twisted “mercy”.

That is not what is being proposed.

[Voyager]

@Broomstick

The difference is that I have confidence that in our system no one is going to be forced to have an abortion, at least not in the sense of being physically restrained. I do think it’s possible for a woman to be pressured into getting an abortion, but even if she does she’ll still be alive afterward to seek legal redress.

Kill someone against their will, without their consent, and they’re dead. It’s over.

It’s over for the fetus, and I doubt that a woman forced to have an abortion is going to find legal redress any more satisfying than the relatives of someone wrongfully killed. And I can see a society that kills inconvenient old people also terminating inconvenient pregnancies.
You said a reason against allowing PAS is that it could make others sad. So can abortions. Terrible reason to ban them in either case.

@Broomstick

You are incorrect. True, I don’t like PAS and don’t think it is a good thing, BUT, just as the phrase “don’t like abortions? Don’t have one!” can be applied, I may not like or approve of PAS, but if it DOES exist in society I want to be sure no one is subjected to it without consent… Your friend consented. I wouldn’t interfere, even if I don’t like what she did. She consented. I won’t stop her.

I don’t think anyone here is for PAS without consent. As I said, legalization means you can enforce restrictions. I don’t know about you, but I have an end of life preference form files with my lawyer and my doctor. In fact it is one of the things they visibly track. One option is using any means possible to prolong your life. I had that checked for my first one (I changed my mind later) and no one tried to argue me out of it.

[Machine_Elf]

@Broomstick

What’s bad is “this isn’t cost effective but we’ll pay to let you kill yourself”.

You haven’t answered the question I asked. Given two scenarios:

“Treatment isn’t cost-effective but we’ll pay for palliative/hospice care or PAS.”

OR

“Treatment isn’t cost-effective, but we’ll pay for palliative/hospice care.”

Why do you consider the former to be worse than the latter?

@Broomstick

I do think there is a point where chemo or radiation is pointless BUT a fully informed patient should be allowed to make choices.

If a patient wants to foot the entire bill for treatments with extremely low odds of success, then yes, they can do whatever they want. If someone else is footing the bill - whether it’s a state, province, country, rich uncle, or private health insurance provider - then the payer gets to set bounds on what they are willing to pay for. Stroup’s odds of five-year survival were deemed to be less than 5%, which the state of Oregon said were too low to justify expensive treatment on their dime. Similar to transplant organs, funds are limited and we want to allocate them for optimal use among a large pool of users. Had Oregon not poured money into Stroup’s fruitless treatment, they might have had funds available to spend on someone else with much better five-year odds, buying more years of life per dollar.

I’d be interested to hear from someone in Canada or the UK as to whether a patient in either of those systems has total authority to demand expensive-but-fruitless treatments; I suspect not.

Regarding Canada and medical assistance in dying:

@Broomstick

THANK YOU. That is exactly the sort of thing I have been asking about. What are the safeguards around this process? THANK YOU for actually answering the question instead of simply attacking me.

Here you go:

Medical assistance in dying: Overview - Canada.ca

It’s a lot to read, but from a quick browsing, it appears that eligibility requires informed consent to come directly from a mentally competent patient. Generally speaking, medical treatment choices can be made by someone else if a patient is not competent to participate in their own care decisions, but this is one of those safeguard things: in Canada, if you are not mentally competent, nobody else can sign you up for a medically-assisted death. Colorado, where my mom died, has a similar safeguard and I would expect most/all other places where PAS is legal have basically the same requirements/safeguards.

[wolfpup]

@Broomstick

If you’re so gung-ho on doctors killing people I want the assure that this will NEVER happen to me, personally, just as I can be reasonably sure no one is ever going to strap me down to a table and force an abortion on me. I do not consent. I do not approve. I do not want this evil for myself even if other people do want it, even if it’s legal.

@Broomstick

I’ve put my wishes in writing. I wish everyone would.

It’s not my business to pry into what your wishes are, but I will say this. It sounds from that first quote that you favour the principle of “preserve life at any cost”. Medical ethics defaults to that, to “do everything possible to save a life”, regardless of the consequences. This being the default, most enlightened standing medical orders with regard to extreme treatments are DNR orders – Do Not Resuscitate – which explicitly say that this is NOT what is wanted. DNR expresses a wish to die in peace and dignity rather than being revived with a permanent breathing tube and/or feeding tube and perhaps painful broken ribs (in the case of extreme CPR) and having a quality of life no better than a vegetable.

I hope this is not what you regard as a good option. If not, you must be able to see the argument for PAS. As for the safeguards that you keep asking about, please read the previously cited link about how it’s managed in Canada, where PAS is actual law. This is not something that happens often, because most people die naturally without undue distress, but when PAS is needed, it’s really, really needed. As I said earlier, this is not a philosophy that devalues life, which would be a very simplistic interpretation of PAS. It is, rather, one that affirms life by recognizing the critical importance of the autonomy of the individual, their right to informed consent, and their right to a life that has meaningful quality.

Access to PAS in Canada is nevertheless mediated by very strict medical and ethical protocols to guard against any possible abuse.

[eschrodinger]

In my state, I remember also reading that some people who request PAS wind up not using it. People have explained that it actually helps them to tolerate their pain and suffering by knowing they can end it if they need to. And some find that they don’t need to, but have benefitted from the availability of the option.

[wolfpup]

@eschrodinger

In my state, I remember also reading that some people who request PAS wind up not using it. People have explained that it actually helps them to tolerate their pain and suffering by knowing they can end it if they need to. And some find that they don’t need to, but have benefitted from the availability of the option. &nbsp

Indeed. Here is a landmark case, from a few years before Medical Assistance in Dying became law in Canada:

B.C. woman joins right-to-die lawsuit | CBC News

This woman was terrified that she would lose all ability to act for herself or to express her wishes and be eventually trapped in a living but basically inert body, unable to do anything about what would be basically a living hell. The BC Supreme Court sided with her, and the ruling brought her great comfort until her eventual death, which occurred without intervention. Medical Assistance in Dying became law in Canada about five years later.

[ASL_v2.0]

@Broomstick

Now, if that patient in advance had indicated their wishes (preferably in writing, but these days video or other things might also work as well) in such circumstances that would also be consent. Although I still have a lot of problems with any doctor taking an action who’s entire purpose is to kill a patient.

I’ve put my wishes in writing. I wish everyone would.

Why should we respect your wishes, in writing or otherwise, but not the wishes of someone seeking to end their own life as a means to escape pain?

…or, since you seem to offer grudging support for a scheme whereby a physician might prescribe pills to a patient but then require the patient to take the pills themselves, do you think someone whose condition makes them unable to take or keep pills down should be deprived of agency over end of life decisions?

ETA: And by the way, I’m still curious if you (or anyone else) can point to any historical examples where a PAS scheme was enacted as a sincere effort to give greater agency to patients coping with pain and terminal ailments, but then morphed into a eugenics program or some other form of state-sponsored murder where the will of the patient became irrelevant. Because absent that or some other kind of evidence that A will (or even is just likely to) lead to B, your argument that PAS will lead to coercion and murder is just a straight slippery slope fallacy.

[eschrodinger]

@eschrodinger

In my state, I remember also reading that some people who request PAS wind up not using it. People have explained that it actually helps them to tolerate their pain and suffering by knowing they can end it if they need to. And some find that they don’t need to, but have benefitted from the availability of the option.

Having looked it up, I should point out that, although uncontrolled pain is a concern, more patients cited loss of autonomy and bodily functions as their reasons for seeking the prescription. In other words, it’s more about the concept of quality of life, and the dignity part of death with dignity that leads many people to want to choose the time and manner of their deaths when they have less than 6 months to live. My point above still applies, as the point of it is that having the choice preserves autonomy and dignity.

Also, in looking it up, I saw that there has been an amendment. Each of the timing rules may be waived if it is longer than the person’s expected lifespan. So, for the requirement that two requests be separated by 15 days, it can be less than 15 days if that exceeds how long the person has to live.

[chela]

It’s an uncomfortable thought whenever I visit the nursing home and see those patients who are completely out of it, physically and mentally. But living on in a greatly diminished capacity. Its a strange scenario. Even if they’re shells of their former selves they matter still, they existed and once lived full lives.

Woman in end stages of ALS

A Fight to Die — Bloomberg Businessweek