An article in the September 3 2011 issue of the NY Times (http://www.nytimes.com/2011/09/03/opinion/when-doctors-become-patients.html?_r=1&hp=&pagewanted=print), while not directly about assisted suicide, is relevant to it in showing how the responses of caregivers influence the decisions and lives of those coping with catastrophic illness.
The patient-author, physician Erik Manheimer, describes himself as having been at peace with his decision to refuse care that had a 75% chance of curing his cancer. He writes that he was dwelling on the 25% chance that it would not and on his illness-deepened realization that the overall chance of death for everyone is 100%. With those odds, he writes, he decided that the suffering caused by the treatment was not worth it. By refusing care, he made himself a terminal patient. Nothing in the proposed Vermont law to make assisted suicide legal prohibits a doctor’s assisting in the suicide of a person who has deliberately chosen to make a non-terminal disease terminal by refusing treatment.
Manheimer’s wife reacted to the revocable decision to refuse care simply by saying, “You’re going to finish the treatment.” Confronted with this caring response, the patient agreed. He now writes that the initial decision to refuse care was irrational. In other words, he is glad to be alive and attributes his survival to his wife’s response.
In June, the BBC televised an assisted suicide at the Dignitas suicide house in Switzerland. The patient, Peter Smedley, suffered from Motor Neurone disease (ALS, or Lou Gehrig’s Disease). In the film, which we won’t link but which is readily available on the internet, the patient is shown asking his wife, “Should I take the (poison) now? Confronted with her husband’s doubts and knowing that his decision is not revocable, she answers, “Don’t ask me, darling. It’s your decision.” He says, “No, No, I’ll take it. It’s just the timing. I’m quite prepared to do it now.” The wife then actually sighs with seeming exasperation and says impatiently, “When you’re ready.”
What is “terminal”? Remember that Manheimer’s illness would have likely killed him without the treatment his wife insisted he take. The cancer may yet recur and kill him. ALS is commonly considered terminal. 50% of ALS patients die within a year of diagnosis. 1 in 5 lives five years, 1 in 10 ten years, and physicist Stephen Hawking has lived with the disease for 50 years (http://en.wikipedia.org/wiki/Motor_neurone_disease). Who knows how long Peter Smedley would have lived? Who knows how long anyone will live, with or without treatment? All prognoses are educated guesses.
Smedley, who the death-day video shows was able to walk with help, to talk clearly and to hold and drink his own cup of tea, is seen turning to his wife and asking her if he should take the drugs. Had she reacted as Manheimer’s wife did to his refusal of treatment, she would have replied, “I don’t want you to take the medicine. I want you with me as long as possible. I will care for you.” Instead, there was nothing but, “It’s your decision…..When you’re ready.” In the video, she seems numb, as much a victim of societal acceptance of suicide for the ill as Smedley himself.
We know a person who, when her terminally ill mother said she might commmit suicide using the pain medication she was going to receive from hospice, simply said, in the presence of the hospice workers, “I won’t let her do that. “ The mother made no objection. She appeared relieved, not angry. She lived three more months, her pain well controlled. Despite periods of anxiety and anger, she never mentioned suicide again. We believe the reassurance that the people around her did not want her to die allowed her to choose what she clearly really wanted: to live and eventually die comfortably and naturally.
At http://ajp.psychiatryonline.org/cgi/reprint/162/6/1060, readers can find an article from the peer-reviewed American Journal of Psychiatry, “Competing Paradigms of Response to Assisted Suicide Requests in Oregon.” It compares the “It’s your decision” reaction with which a request for assisted suicide is met when it is legal with what it calls the traditional response to suicide, embodied in the simple statement, “I don’t want you to commit suicide.” Not surprisingly it finds that it is the second, caring response that gives the patient true choice, true control, and a death with true dignity.