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PERSPECTIVE ON PROP. 161 : Aid in Dying Is Human, Humane : Assisted suicide for the terminally ill doesn't conflict with medical or religious interests; it does respect individual rights.

October 18, 1992|JAMES W. WALTERS | James W. Walters is a professor of ethics at Loma Linda University

Proposition 161, the physician-assistance-in-dying initiative, divides those who prize the principle of human life from those who value the capacity for human living.

Western religion has long held that human life is sacred because it is created in God's image. God creates life; God takes it away. It is no accident that the Roman Catholic Church is the major financial supporter of the No on 161 campaign, and that the Catholic bishops of California are making an unprecedented appeal to the faithful to defeat the initiative.

Many medical societies in the state also oppose Proposition 161. Again, the principle of life is at issue: Doctors save life, they don't end it.

The venerable fields of religion and medicine have contributed dominant threads to the tapestry of civilized society. Now, advances in each area--medical advances that allow the prolongation of low-quality human life, and heightened views of the value of the individual person--have combined to question the traditional interpretation of human life's sanctity.

Many people--most people, probably--who have seen loved ones slowly dying in modern institutions come away from the experience vowing, "I don't want to die like that." When the capacity for distinctive human living is gone, the flickering flame is not worth the candle. A pulmonary specialist who works with many dying patients in his intensive-care unit recently told me that today's medical technology can often support an individual's mere biologic functioning indefinitely. It is no wonder that 70% of deaths in a modern hospital are the result of a conscious decision to cease treatment.

Society is increasingly pragmatic, viewing life in terms of individual benefit, individually determined. The patient determines what quality of life is important and what life-saving treatment is given or withheld. The recently enacted national Patient Self-Determination Act advances this goal, requiring all hospitals and nursing homes to give incoming patients the opportunity to express their wishes in this regard. Supporters of Proposition 161 see their initiative as merely the logical extension of the patient's current right to self-determination--and so it is. The initiative would allow a patient expected to die within six months to have medical assistance in hastening the inevitable death.

The question is whether America's respect for individual rights should extend to aid-in-dying.

The initiative's opposition shouts an emphatic no. "No on 161" doesn't say that doctor-assisted suicide is wrong; polls show two out of three Americans approving of that. Rather, it says that the initiative is poorly written and full of loopholes that invite abuse. However, this initiative, similar to one that was defeated in Washington state a year ago largely on these grounds, has been tightened up with a number of safeguards, including requirements for mental competency, reporting and documentation. Still, the California initiative could be further strengthened by addition of such restrictions as a "cooling-off" period of several days, to preclude hasty, rash decisions.

However, the pivotal issue is not whether 161 is perfect, but whether physician-aided suicide is appropriate. Because of our society's high valuation of self-determining individuals, it is.

Physician-assisted suicide is not the large and threatening step it first appears. Physicians have long used considerable discretion in doing "good" for their patients, such as giving more morphine than needed to eradicate pain, knowing that the extra dosage would hasten a welcome death. In a recent survey by the American Society of Internal Medicine, 20% of respondents said that they had directly aided patients in dying.

Because assisted dying is motivated by mercy, abuse is not a big threat. And only a small minority of citizens would be likely to seek aid in dying. In the Netherlands, where physician-assisted suicide is accepted though not legally sanctioned, only 2% of deaths are the result of physician assistance.

Assistance in a patient's humane dying in an earlier day often took an informal, physician-directed path; today such a death must be open and patient-directed. Still, there must be limits. Proposition 161 would not have permitted the majority of Dr. Jack Kevorkian's assisted-suicide patients; most were not within six months of death. However, aid-in-dying would relieve the minds of the thousands of citizens who have made "Final Exit" a best seller and reassure countless others that their lives need not end in unrelieved pain or as vegetating husks of a former self.

Organized religion and medicine need not oppose physician-assisted suicide, as it is not contrary to their essential interest--human well-being. Religion and medicine should help to ensure that our best motivations are thoughtfully implemented in a high-tech medical era that demands new ways to respect personal freedom and basic values.

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