Autonomy, Choosing One’s Death Day


Mother’s Day came and went. I was left thinking, of course, about my mom. She passed away from natural causes four years ago, at the age of ninety-two, a ripe old age by anyone’s standards. There were times, when I was teenager, I believed she would not live. Crippling depression in middle-age almost ended her life. She came close to suicide and had to be hospitalized on several occasions. What stopped her were – my father’s tender loving care and concern, her children, medical staff who encouraged her to go on living, and her strong faith.

I was left wondering – what if? What if she didn’t have support and medication? What if she didn’t have faith to fall back on? What if she was told autonomy was the most important thing? You must take control. Don’t let anyone tell you what you can do with your own life. Why go on living if the struggle is too difficult, if you are in pain, if you are tired of life? If euthanasia was legal forty years ago she could have found a doctor to administer the lethal dose and some would have applauded her decision.

I imagine the damage it could have done to our family if she had taken her own life, or had it taken from her through physician assisted suicide. Our lives would have been altered in ways we can’t even imagine. She would have missed much – watching her children grow up, welcoming grandchildren and great-grandchildren. Her life wasn’t easy, but she learned how to deal with the depression. My life isn’t easy. No one’s is. Life is struggle, pain, discouragement and disappointment. It is also pleasurable, encouraging and joyful.

Safeguards and guidelines are bound to fail. Government safeguards will not stop people suffering from depression from seeking PAS. Are they not suffering intolerable pain? Doctors will be placed in the terrible position of making judgement calls. Who can die and who will live? How close should a terminal cancer patient be to death before the lethal dose is administered? A week, a month or a year?

If all depends on autonomy – to decide for one’s self the time to die, what is the point of safeguards? People will find a way around them.

What if people asking for PAS are asking out of a sense of duty, because they feel they are a burden? What if they are depressed? What if they are being pressured into the decision? What if they are demented or unconscious or mentally handicapped? Safeguards and guidelines will not protect them.

We ought to err on the side of caution. Let’s concentrate on eliminating the suffering, not eliminating the sufferer. This is true compassion.

If you don’t believe me, consider what  palliative care physician Dr. Margaret Cottle  has to say:

     In places where euthanasia and physician-assisted suicide are legal, there has been a rapid expansion and total absence of enforcement of the so-called ‘safeguards.’ Patients with mental illnesses, early stage eye disease and even ringing in the ears have been euthanized. Children and patients with dementia, neither of whom can provide meaningful ‘consent,’ have also been targets. In one study published in the Canadian Medical Association Journal in 2010, the physicians who reported that they caused the death of patients admitted anonymously that one in every three of those patients never gave explicit consent.

      A study published in the New England Journal of Medicine in March 2015 reviewed the most recent data in Belgium around hastened death. It showed that 4.6 percent of all deaths in Belgium were euthanasia deaths, while 1.7 percent of all deaths were euthanasia deaths without the explicit consent of the patient.

While these percentages seem rather small, serious concerns emerge when compared to the mortality statistics in the U.S. There were 2,596,993 deaths in the U.S. in 2013, and 4.6 percent of that is almost 120,000 deaths. This would qualify physician-assisted suicide and euthanasia as the sixth leading cause of death in the U.S., almost as many as the fifth leading cause of death, strokes, with about 129,000 deaths…

      Patients do not need hastened death; they need excellent care and a deep understanding of their difficult situations. They need all of us to be present with them in profound solidarity. They need the palliative care resources that the majority of patients and families do not have. It is a major human rights violation to be suggesting death as an “answer” to our society’s lack of commitment to care for our vulnerable citizens!

     Every physician knows it is frighteningly easy for patients to die – keeping them alive is the hard work, and caring for them respectfully and compassionately in the process is even tougher. It takes courage and hope to treat patients, especially when the outcome is far from certain.

Agreeing with patients that their lives are not worth living and helping them die destroys the trust between patients and physicians, while also revealing a distinct lack of ingenuity in our treatments.

Real compassion is shown by finding ways to be innovative in our approach instead of just following a set of guidelines, thereby reaching people in despair, both at the end of life and in other circumstances, and making it clear they matter to us, their lives are important and we will be with them in their troubles. 


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