DOCTOR, PLEASE HELP ME DIE

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Contents

Acknowledgments....................................................ixIntroduction.......................................................xiChapter 1 A Short History of the Right to Die.....................1Chapter 2 Framing the Issue.......................................20Chapter 3 From Hippocrates to Lasagna.............................50Chapter 4 Physician, Heal Thy Patient.............................73Chapter 5 Medically Managed Dying.................................90Chapter 6 Professional Imperatives................................111Chapter 7 Legal and Political Issues..............................127Conclusion.........................................................139Recommendations....................................................150Notes..............................................................161Index..............................................................173

Chapter One

IF TO KILL IS a cruelty because it robs one of life, what does it mean to rob a person of death? Society has long grappled with the question of whether it is morally acceptable for physicians to end the suffering of someone who is dying. But I ask a different question here: Is it morally acceptable for physicians to refuse to do so? If a physician can ease a person's suffering and make his or her final moments of life endurable and peaceful by helping the patient die, is it wrong to refuse to do so? Could nonaction be a greater cruelty than action when someone's pain is agonizing and readily ended by medication or other help from his or her physician?

Consider the case of Heracles. Heracles, or Hercules as he is more commonly called, was the half-god son of Zeus and the beautiful, mortal Alcmene. Zeus endowed his son with superhuman strength, an attribute that made him a rather troublesome child but nevertheless enabled him to conquer pretty much any challenge he was presented. When Heracles found himself in a bit of a mess for slaughtering his family (his superhuman strength surpassed only by his superhuman temper, a temper brought on by madness inflicted by his vengeful stepmother, Hera), he was punished by having to endure a series of superhuman feats. He strangled a lion, traveled to hell and back, killed a multiheaded hydra monster, and accomplished several other highly unpleasant, dangerous, and seemingly impossible tasks that, through brute strength and unwavering persistence, he managed to pull off with seeming ease. But for all the painful trials Heracles had overcome, none was as great as enduring the horrific agony of death. Tricked into donning a beautiful cloak that had been soaked in a powerful poison that burned the flesh off anyone who wore it, Heracles screamed in agony the moment the lethal robe touched his skin. He flung off the robe, but alas, all his flesh came with it, skinning alive the man of superhuman strength. Suffering unbearable pain, the immortal god demanded his son help him die.

"You are asking me to be your murderer," the young man answered, refusing to comply with his father's dying command.

"No," Heracles replied, "I am not. I ask you to be my healer, the only physician who can cure my suffering."

But his son refused to help him. Powerless because the only healer who could help him refused to do so, Heracles was forced to die slowly and in great agony. Unable to withstand the pain any longer, he ordered his funeral pyre built. Once it was done, he threw himself into the flames to end the excruciating torture. To burn alive was preferable to the agony of suffering any longer.

Flash forward to the twentieth century, and a woman of ordinary strength confronts the pain of dying. "I am now about to make the great adventure," actress Clara Blandick wrote in 1962, when she was slowly dying with severe arthritis. "I cannot endure this agonizing pain any longer. It is all over my body. Neither can I face the impending blindness. I pray the Lord my soul to take. Amen." Setting her pen down, the eighty-two-year-old woman, immortalized thirty years earlier as "Auntie Em" in The Wizard of Oz, dressed in a beautiful blue gown with her hair perfectly set, lay down on her couch, and took an overdose of pills that her doctor had prescribed to treat her constant pain. She covered herself with a golden blanket and died, surrounded by her favorite photos and press clippings, commemorating a life well lived, with no regrets. Like Heracles, Clara Blandick didn't want to die, but neither did she want to endure a slow agony from severe arthritis that only death could cure.

Sophocles, writing twenty-five hundred years ago, was among the first to address this human tragedy through drama when he narrated the story of Heracles's death in the Athenian tragedy The Women of Trachis. Sophocles understood the desire of dying patients to end their suffering by ending life. "Best by far," he wrote, "when one has seen the light, is to go thither swiftly whence he came."

Sophocles wasn't the only Greek tragedian who recorded the common sentiment. Aeschylus wrote, "Oh that in speed without pain and the slow bed of sickness death could come to us now." Seneca, the Roman stoic, expanded on the theme. He wrote, "The wise man will consider it of no importance whether he causes his end or merely accepts it.... Dying early or late is of no relevance; dying well or ill is. To die well is to escape the danger of living ill."

As these philosophers and dramatists understood, the desire to end suffering by dying quickly is eternal in the history of mankind. Yet the concept of suffering is inextricably woven into a tapestry of beliefs regarding humanity's relationship to the Divine, lacing together the medical and the religious as new technologies raise new questions concerning the changing cultural roles—and powers—of physicians.

A couple years ago I was talking to a legislator who was sponsoring a bill to ban physician aid in dying. I told him how, as a physician, I was distressed to see so much needless suffering at the end of life. He lurched toward me in his seat and asked, "What's wrong with suffering?" As he put it, the concept of needless suffering seemed not just incongruous but unbelievable. I had trouble even replying. Does anyone like to suffer? How could he think there isn't anything wrong with suffering?

To most people, such a question as the legislator posed might appear cruel, even sadistic. But I knew the argument well enough to recognize where he was going with his line of thought. The legislator was of the mindset that people have a duty to share the burden of Christ's suffering and that through suffering comes redemption. As the Catholic writer Joseph Sullivan said, "Suffering is almost the greatest gift of God's love."

The concept of suffering to attain salvation can be traced to the apostle Paul and St. Augustine, who wrote about Christ's love for those who suffered and the need to accept one's suffering as a trial, just as Job suffered his afflictions in silence knowing his Lord would not forsake him. But it has not been until recent years that the concept of suffering has been embraced by the far right as a justification for a variety of deprivations and social sacrifices. It is little wonder, then, that the concept of suffering as divine has been used to justify refusing aid to the dying in the form of physician-assisted death.

What may be surprising, however, is that this...