tv Ethical Perspectives on the News ABC November 22, 2015 11:00am-11:30am CST
on the news. name is scoo samuelson and i'm a professor of philosophy at kirkwood community college on the iowa city campus. do we have a right to end our lives? should physicians help us to do so? dr. peter rasmussen thought so. he argued for legal protection for physician assisted suicide and just this month, using oregon's so caled death with dignity law, he took his own life after being diagnosed with malignant brain cancer. just last month governor jerry brown signed california's aid in dying bill into law. california is the fifth state to authorize physician assisted suicide. many other stttes have considered or are considering similar legislation but the opposition to such laws is intense. many religious folk believe that such laws violate the sacredness of life, yet others see ttem as undermining g the hippocratic oath that says doctors should first and foremost do no harm, and yet
others fear a slippery slope that would eventually lead us to value some lives more than others. should iowa pass an aid ii dying law? do we have an absolute right over our own lives? should physicians help us to die on our own terms? or do we have a moral obligation to accept our lives a.d our deathson terms other than our own will? ? have a greattanel on today to discuss these issues. to my left is becky benson, the director of the university of iowa pediatric palliative care program. thanks so much for being on, becky. becky benson: thank you. scott samuelson: francis degnin, a professor of ilosophy at university of northern iowa. thanks for being on francis. francis degnin: thank you. scott samuelson: at the end, linda livingston, a pastor at ascension lutheran church, linda, thank you for being on. linda livingsto: it's good to be here. scott samuelson: okay, well becky, let's just sttt off with the big
have a law that allows mentally competent, terminally ill adults to voluntarily request and receive drugs to end their own lives? becky benson: well, i think that's a very difficult question. i think my first answer to that would be that i don't think that that's the best solution to how do we take better care of people at the end of their lives. i think that putting more money and emphasis into palliative care e rograms and really i think we've bebeome disconnecttd from the natural process of dying in america and we like the idea of control. that's a very unifying principle for most americans is we like to control when things happen but i tink that death is a mystery ih some ways, and it happens on its own timeline. i eel that we should have more people who can guide us through that process well, rather than try to wrench control over it. i think that without really discussing advance directives wiih people early on in their disease courses and making sure that we have very effective ways of helping them control symptoms towards end of life, that the easiest
write these prescriptions and let people decide when they've had enough but i'm not sure that's 2eally the best answer to the question. scott samuelson: can you just say a quick word, we might have to come back to it, about what you see as the promise of palliative care as a kind of first step, at least, before we even get to these other issues? becky 4& benson: sure, i see palliative care as one of the fields that has expertise in how to manage symptoms and suffering that often come along with end of life or with a serious illness. i think that that's ofte what people e struggling with when they're deciding that they need thth control or this way out of the dying experience. i think that even physicians are disconnected from the process of natural death. we're usededto death in he icu thatt involvlvd unplugging people from machines or sudden death but very few of us really experience natural death anymore, the way it can
happen, and so we can't even describe what that should look like to families and help them see that it can be a safe experience, even though it's a new journey for each of us when we go on it. scott samuelson: right, okay well yu've put a lot of issues on the table we'll have to come back to but let's get francis in on the dissussion with some terminology. maybe firsttnd foremost you hear this issue discussed in lots of different ways, death with dignity, euthanasia, physician assisted suicide, aid in dyin what's tt proper way of even talking about what it is we're getting at here, that these laws are doing, and what's at ske in these teminological issues? francis degnin: well, the first thing i aaways worry about, i'm cautious about the word euthanasia because it means so many different things to different people. literally in the greek it means, good death, right, which would be a really cool thing. we have to die anyway, better to have a good death than a bad death. euthanasia, for some people, is very, very broad, it means a whole bunch of things and some people it means just narrow
mercy killing. what i like to do is just when i'm talking to my students, i try to keep it as simp as possle. we have veral different l lvels. at one level u keep theebody alive at all coo. most people would agree that that actually is a violent thing to do. you're causing people to suffer terribly. that's where palliative care, and again just $& to simplify the definition, i just think of palliative care is ow do we providd comfort and pain relief from suffering, right? the second level would be something like allowing natural death and that's where palliative care also comes in very, that where basically we're keeping people comfortable but we're no longer aggressively trying to keep their bodies alive. it's because we know that patient doest want it or because we've run out of our options, ooy? the next vel down i think of is physician suicide differs from mercy killing because it's the patient's decision and mercy killing it's not my decision; it'
right. francis degnin: assisted suicide and this is also part of the reason why there's a lot of different questions around it where does it attack, for example, the integrity of the medical profession. mercy killing, i think, would challenge that but not assisted suicide because again, it's respecting the atient's ights. on the other hand, w w have to avoid what i'm going to call also subtle coercion. if we don't have good palliative care, if we don't have good resources take care of people, it becomes too easy to right that prescription. scott samuelson: right, it becomes a temptation for the patient to think that maybe i do need to let go here or have my life ken degnin: correct. scott samuelson: become a burden on people or whatever. they're suffering and they're not getting the help they need. scott samuelson: right. francis degnin: i might you're inking here anan it's this, i think that in almost all cases, when someone asks for assisted suicide, there's a need that's not being
addressed. oregon has one of te highet rates of satisfaction around dying of any state in part because when it's the question gets askeddbout assisted suicide the conversation takes place and in that conversation we often find that other need and can address it. scott samuelson: our options become ... francis degnin: options become possible. scott samuelson: possible. francis degnin: i'm not willing to say thaha that's true for everybody. i think there are still going to be, well, i don't know, but i respect the fact that there may be some people out there for whom this i really what they want. i also want to respect that as well but i want to make sure that evvry resource is exhausted first to protect them and provide a palliative death, a different kind, a good death that doesn't require this. scott samuelson: yeah, okay, well let's get linda in on his as well. i think@we've heard a fairly convincing case that we should at least take steps to ease people's pain, to give them a sense of options, but does there come a time when a person has a right to take their own life, to have a physscian help them, to die painlessly, or is that somehow violating some sense of
a sacredness of life? linda livingsto: i personally would welcome a law similar to oregon's that think s safeguards to protect against all of those things that people were so worried about, the slippery slope. we have, for most of a century, made medical advances that have allooed people tt intervene and take cocotrol to extend their lives. there are now a generation of people who have lived beyond what they know they would have because they had that bypass surgery, because they've been mobile twenty years longer than they expected because they haze a new hip and two new knees. these same people now, i lieve, when ddagnosed with a terminal illness, are ready to say, "i have lived a good life and i do want a good death." when that is done prayerfully, from my point
of view, when that is done in conversation with family, and in consultation with physicians i think there is an opportunity to provide death with ddgnity that does not violate the sacredness of life in any way, that becomes a celebration. my understandin g of the statistics in oregon, are that the people who have taken advantage of that la have predominantly died at home. the ability to be at home, surrouounded by family, in what is a much more natural situation than the majorrty of the people who die in the united states, becomes part of the goal for these people. i am open to those possibilities. scott samuelson:n: to go back to the first thing you were saying, it sounds like you're saying we've already sort of being playing around with the limits
we've already been able to extend life one way so this is a kind of natural response to that, that we are now thinking about, okay, if we can push the back date of death, perhaps we also can bring it forward a little bit when we no longer see the life as being one that is going to provide us any kind of meaning. does that, i mean, becky, you were talking about the kind of respecting the mystery of life. does that worry you at all, that if we start to take control of when we die thaha it mehow overrides some of that sense of, the sense of mystery and how ultimately the line between life and death is not in our power? becky enson: it worries me a little bit, to be honest, because i'm a physician. i sometimes am in the role of telling somebody how long i think they have. i'm the type of person who then looks to see whether i was right orrot and physicians are actually pretty bad at predicting. there are certain diseases that have a fairly
scott samuellon: yeah. beccy benson: there are maay others with lots of fluctuations and particularly when you go as far as six months out. that's fairly difficult for us to tell with any certainty. i know plenty of people who were given six months to live who lived two years, five years, and even longer. i know others who our best guess was six months and they lived for two weeks. really we struggle. the closer it gets to the actual time of death, i think, the better we are but i would hate to o ve somebodyyhave more confidence than they should in what our guestimate of what time they have left is, and then make decisions that are really irreversible based on that. scott samuelson: right, ut what about the case that linda, i take it, was referring to that says, "okay, you know i've already had some major surgeries. i've lived longer than i tught i cou\d have. i've had my fair innings," as we sometimes say, and so yeah,
to be six months or two years but it's going to be sometime soon. why shouldn't i be allowed to say, "i'd rather be on my own terms? i'd rather know that it could be at home. i'd rather it be pinless rather than dagging out." becky benson: yeah, i think another interesting thing about the oregon data that actually speaks to this point is that not everyone who requests to fill a prescription actually uses it. lilia livingsto: yeah. becky benson: iifact, i thinknkit's around a third who actually go ahead and use it. the rest, i think, want that as a back up in case the dying process becomes- scott amuelson: becomes too much. becky benson: too much. too much suffering. i think really our job aa healthcare professionals and as physicians in particular is to help people to know that we can guide them through that experience. it saddens me when i hear people say things likk, "i don't wwnt to starve to deaeah," which really is part of the body's
natural way of dying the last weeks of life sometimes. we've become so distanced from that, that it seems horrifying to us. i think we need to be better at helping people t understand what a natural process looks like and that we can support them. i can totally understand that people who have been told they might experience seizures or their lungs filling up with fluid. these are scary things but we do have ways of treating those symptoms and helping even those deaths be good deaths. i'm not also one to say that would never, , ever consider this but i think it really should be for those few people who sort of want autonomy and dignity above all else. often timess agree that there's some other need, whether it's that they are depressed or they're worried about their family, that we can help be addressed in that space
stresssnd anxiety and help them achieve the sense of well being even when they're dying. scott samuelson: i want to hear what you have to say about this too, francis. we often talk aaut things lii euthanasia or phphsician assisted suicide as somehow violating the sacredness of life. it's playing god. we take some of what becky's saying. we could even just talk about it in terms of we humans, we don't really ow what's going on here. we can't predict and so should we not, at some level, at the most basic level of life and death, respect that line and say we can't ultimately draw it? it is not in my hands to say when i die. that perhaps that's not as bad as taking someonne else's life but it is still a kind of act of murder in some ways to determine when the line between life and death shall be drawn. francis degnin: i think that's a good oint. part offhe question is who gets to make that decision, right,
wouldn't want to make that decision for somebody else. even, we run inino this questii of playing god all the time in the hospital. when i see patients and the patients say, "well, if you turn off the ventilator aren't we playing god?" well, we were playing god by putting them on n he ventilator in the first place, right? scott samuelson: right. francis degnin: turning off the ventilator, i think is a ght kinds of conditiis. scott samuelson: yeah. francis degnin: because then we're kind of admitting our humility before god. scott samuelson: right. francis degnin: now, this we're taking a samuelson: right,,o that's this idea of letting die- francis degnin: right. scott samuelson: is somehow perhaps- francis degnin: letting die- scott samuelson: different from- francis degnin: as opposee to taking ittnd there's
there. becky benson: yeah. scott samuelson: taking a life. francis degnin: it gets a lot harder. this is why i think weeneed to do everything possible to address the other concerns and also to make sure that there's not things that they haven't thought about, right that it's not just temporary depression. that it's not something like that. ultimately i'm not going to take away, if somebody is thoughtful, and if they're spiritual, if they're prayerful about it, if their relationship with god tells them that this is okay, i d dn't want to take away that choicc from them but i do want to make sure that every other alternative has been exhausted first. scott samuelson: right, right. well, you mentioned, linda, some safeguards about this and you seem be on the same page in terms of@saying, this should a very, very serious decision. linda livingsto: yes. scott samuelson: when it happens it should be done, as you put it, p payerfully or at least in light of the big issues that are going on, that it should be a kind of last resort. it should not be done lightly. can we have a law prayerfully make the cision? linda livingsto: no, francis degnin: well, thoughtfully though. scott
nda livingstst: tughtfullyyott samuelso kthe cision? linda livingsto: the safeguards of oregon, i think, require that it is a thoughtful cision. ott suelson: what es that mean? what's- linda livingsto: nltation, not only with one ctor but with cd physician who together are making a ruling onmpetecy, omental health. ancis degnin: and terminal. nda livingsso: yes, e rminality ofofe diagnosis. becky benson: to the best at we can- linda vingstoyeah. becky benson: come up with. nda lingsto: yeah, i think therare people who are- francis dein: ll, ere's also a waiting period. nda livingsto: right. francis gnin:t has be multiple requests whtness.inda livingsto: ltle verbaleests and aquest inghting. scott sauelson: right. linda livingsto: separated byby i think, fiieen ys. ancis degnin: fifteen days. linda livingsto: it really- scott samuelson: right, so it can't be a light decision. linda livingsto: requires a oughtfulne ss- scott samuelson: right. linda vings: on the part of peopleo are going through that process. scott suelson: hen, okay, so thateems very reasonable buthen what out meone who sas, "well, i have isschronic illnnss that isdebilitatg. it's not terminal but i don't want to live with this rever. wham i different om the person who a doctor hasgiven a year and the doctor could be wrong anyway? why n't i also have thright to ke my life?" here's where i thnk people start to worry about- linda livingsto: that slippery slopop. slope. linda livingsto: yeah. scott samuelson: why is it so important that the illness is diagnosed as terminal and and i don't really want to continue with that? linda livingsto: i
think the concern on the parts of a lot of people is that lawswslike this, and thus far i don't think the concern has been born out, but the concern is that a right to die with dignity might become a burden of a duty to die. i don't want my family to be burdened- scott samuelson: right. lind livingsto: with this prolonged, potentially- ott samuelson: right. linda livingsto: expensive end of life. scott samuelson: right. linda livingsto: : afeguards thaa say at wewewill protect against that, it won't become an issue of easily pushing people toward that decision. pastoray i have been with people who, because of the treatment they're receiving, c cn make a choii. a person on kidney dialysis can decide to discontinue that dialysis and within a couple of weeks they will die. people who are taking medication that is life supporting can make a determination to discontinue their
medication. the danger with thaa of course, ii that it might lead to a stroke, a heart attack. it might lead to debilitation but not death and so there's a fearfulness, i think, on the part of a lot of people who would say, "if i coulddbe weeks i would die if i discontinue my medication," we might see more peole making that kind of choice. a contact i poignant to me. the father, grandfather was dying, had been diagnosed terminally ill with cancer, best guess of the doctors was he would die within seventy two hours. now we're a week and a half in. the family has been keeping vigil, breath is hard and difficult. i was
and one son was just clearly so agitated anan i invited hhm out d went into a consultation room to talk. i said, "what can i do to help you?" he said, "you can get my family out of that room and i ill take care of this." i saidd "well, i can't do that," and he said, "i know but if that were my dog i could take him behind the barn. that's my father." he was so passionate and what i was able to do was give him permission to leave the hospital, to notthave be there through every prolonged breath that he had been watching for a week and a half. francis degnin: rght. becky benson: i think those are often more distressing for the family. i thinkk lot of times w w can get a sense that the patient, by the way their face is, is actually at peace but it's very difficult for the
family because we're not used to watching and death takesits time. that process takes its time and hat's not something we're accustomed to. when it happens on tv it's not drawn out like that so it's just very different from what we're used to. i think one of the questions that you've been asking is what's the difference diagnosis or if that's causing a lot of suffering? i can't fully answer that but i do think that i've heard people who have terminal diagnosis say, "i'm not suicidal. i'm not requesting death. i don't want to die but my disease is killing me and i want to have some control over that process. scott samuelson: right. becky benson: versus and years if they continue on with their current treatments or even if they don't have treatments but they're sufffing in one way- scott samuelson:
right. becky benson: existentially often. scott samuelson: yeah, and i'm, i have to say i'm sympathetic to the distinction that you're drawing and it does seem to me legitimate one, but at the same tim it does seem a troubling one to draw at some level because we're all going to die and there's gogong, in some caaes, to be some pain before it happens. the person who's saying, "okay, i'm forty five years old and i have a chronic illness and that might mean i'm going to die in thirty years and it's going to be thirty yyrs of suffering,,versus the pereron who's eighty and they're told they're going to die in six months. i don't know. it's, to me, it's a little bit of a difficult distinction. i know, francis, you're- francis deenin: it also gets more complicated because, and this is the reason we talk about physician assisted, is because many people when they try to commit suicide on their own are unsuccessful. scott samuelson: right. francis degnin: they merely injure themselves or cause greatete harm to themselles and greater suffering down the road. scott samuelson: right. francis degnin: it's a hard one. i know nuland is going to, you know nuland who wrote the prize winning book, how we die, he's going say yes to both of your cases.
scott samuelson: right. francis degnin: i think it's really difficult, more difficult with the chronic because you also say, "well, what if we find a cure?" scott samuelson: right. francis degnin: what if we find a real treatment for them? scott samuelson: right. francis degnin: sometimes we do but also sometimes we don't. scott samlson: right. francis degnin: again, it comes- it's difficult but nuland rites basicacaly either in a devastating, extreme old age, or i believe a devastating illness, that may or may not be terminal. scott samuelson: right. well, but so then what about then the doctor issue? it seems like a very fundamental oath of a doctor not to kill sommone, not to harm someone. francis degnin: that's also a misunderstan ding of the hippocratic oath. scott samuelson: okay. francis degnin: the ppocratic oath was actually ot common among greek physicians. it was among the pythagorean tradition and so rth. they acacually, when they made the oath not to help in suicide, actually that was to set themselves apart from- scott samuelson: from- francis degnin: what was actually common in greek thought. scott samuelson: common practice, right. ffncis degnin: : ven bibilically, the ible doesn't say suicide is wrong. in fact, there's a few places where it's perfectly okay. it's rather, the notion that it's wrong in the bible comes from st.
augustine who says that, "well, god's greatest gift to us is life itself and therefore to commit suicide is to reject it," but it's not even biblical. scott samuelson: okay, well fair enough but could not one say that while of course there have always been traditions tha have allowed suicide that there is a poerful tradition that says it's wrwrng? francis gnin: that's true. scott samuelson: you can go back to augustine, there's a religious tradition that at some level it shows a kind of wrong relationship to life itself. okay, and so mae some people are going to do that but then the questioio is should aadoctor then also bbpart of that? linda livingsto: i think the definitions again, the semantics get tricky- scott samuelson: right. linda livinto: because there dre those who are opposed to palliative care because they believe it is passisie euthanasia, thaa it is the first step on the slippery slope. francis degnin: that's a misunderstan ding of the slippery slope, by the way, too because the problem with the slippery slope argument is it's used to say because that end is so badde need to ggas far as we
scott samuelson: right. francis degnin: the place of least violence is always somewhere on the slope. the place of- but there's always a bit of a gray area. scott samuelson: right. francis degnin we're not gging to be perfectct about that. scott samuelson: right. francis degnin: the argument's often misused but it's not what it- the slippery slope argument works really well as a caution to be careful where we are on the slope. righto me but again i'm coming back to this issuuof does a i take it, it would be a kind of moral dilemma, at least for many doctors to say, "i'm going to use drugs to ta this person's life."becky benson: it certainly is, yes,s,and the american medical associationn and most medical associations are not supporting death with dignity or aid in dying at this point because of that realization that it can be a harm that's irreversible. many palliative care physicians, in fact, would say, "we need to do everything we can to support a person's quality of life and to help them with well being but to actually aid in their dying in an active way, such as prescribing something or
giving them information that they can use to take their own life is not really within the healing realm that a doctor would espouse of themselves." degnin: that's also a reason why no doctor should be required to do this, i know, because then it's not necessary but let me push the palliative care issue one step urther. there's also, i think, a really important thing that many people misunderstand, even some doctors misunderstan d, often times when we're actually palliative care is this, we're doing enough to relieve the suffering, if it incidentay happens to hasten death, that's acceptable and that's also by ttis us supreme court washington versus glucksberg decision. it's legal in all fifty states but some doctors are afraid to give enough pain medication because then they're afraid it's assisted suicide, which is not considered asssted suicide. assisted suicide would be when the intent, and it's a large amount given, and also taken by the patient, in order for that purpose. yeah, in palliative care there
do hasten death a little bit. scott samuelson: right. becky benson: although recent studies have shown that good palliative care alongside curative treatment is actually more likely to be life extending- francis degnin: true. becky benson: and to improe quality of life so i think, you know i don't want people to shy away from palliative care and i think if we gave people the option of having hospice as easily as in some states they can get a prescription for a life ending medication, if they had the same availability of hospice, i think that would really be a much better way to address this issue of how to ease suffering g t the e ed of life. francis degnin: right, hospice should not be the last x months. there are place where palliative care is even where a person might need six months ofofit to help them to get back to a normal life. it's a much richer field. becky benson: yeah, well, i have about ten more questions that i want to get to but i'm afraid that we've run out of time. i would really ike to thank becky, francis, and linda for a really stimulating conversation. i feel like these are important issues for us to think about. we sometimes want to put death out of
our minds but perhaps, since w w all h hve to face it in many different forms perhaps, it's important to bring it kind of to the forefront of consciousnes s. i really appreciate the conversation. i hope it's one that you continue in your homes and communities. thank you very much and we'll see you next time on e ehical perspectives on the news.