In a comment Michael Fugate referred us to a new article by Steve Lopez, the Los Angeles Times correspondent who has taken on assisted dying as an issue of pressing importance (thanks Michael). You can read the article, and watch an accompanying video, here. It is highly recommended. The title of the article is “Chorus of voices grows stronger for ‘death with dignity.’ The article brings out some important aspects of the discussion about assisted dying, and I will enumerate what I think are the important ones here.

First, there is a clear sign that even born again Christians, and ceteris paribus, other religious believers, may be able to see asking for and receiving assistance to die not as an act of unfaithfulness, but as a decision as reasonably and faithfully made as other life decisions. Generally speaking, religions have seen assisted dying as consisting in acts of suicide. This is a mistake. Suicide is an act of desperation taken in the midst of an otherwise normal life. It may or may not be justified by circumstances, but it is an act completely different from that of the person who seeks, because of suffering, to end life (themselves), or to have life brought to an end (by another), because there is no other way to meliorate the suffering involved either in a terminal illness, or in some other condition that leads to the degradation of a person’s quality of life to the point where, for that person, suffering has become intolerable.

(This is one reason, by the way, that I oppose laws which specify terminality as a necessary condition for assisted dying. For others may suffer as much or more than a terminally ill person, and may suffer for a much longer period of time. Another consideration is that, by specifying terminality, assisted dying laws implicitly state that terminality is a condition of life which may, almost by definition, include intolerable suffering. Since assistance in dying should be a choice, the issue of choice should be in the foreground of such laws, not specific conditions. It is for the individual alone to decide when life has become, for them, intolerable.)

What these people want, says Steve Lopez, is control:

In response to columns about those events, stories have streamed in from people who are running out of time themselves, or enduring the pain of watching loved ones fade. The deaths they face are as different as the lives they’ve lived, but a steady refrain runs through their emails and letters.

People want more control in the end. They want to be in charge of one last thing.

Dying is a part of life, and as a part of life there is no reason why one’s own decisions should not govern what happens when a person has come near to death, or is suffering in such a way that they consider their lives to be reasonably thought to be at an end, when all that is left is suffering and decline.

Second, notice carefully what this does not say. It does not say that people who want this sort of control cannot be convinced that their lives are still worth living. As Lopez points out, people in Oregon and Washington states may apply for and receive medication which will ease them out of life when they are ready. However, not everyone who does so makes use of the medication. As Lopez points out:

In Oregon and Washington, many people who [meet] the requirements for aid in dying don’t end up using the medication. But they say they’re comforted knowing they have the option.

In other words, and third, the whole point is being in control, having the right to decide how they will die, and not having to feel that they are simply the unwilling puppets of their diseases or conditions. The alternative is being forced to die in ways prescribed by their diseases, and what reason could anyone give for compelling people to die this way? This question has special force when you consider that diseases have known trajectories which are very different from each other. Any doctor will tell you, for instance, that dying of pancreatic cancer is a particularly harsh way to die. I have been present at the bedside of a woman who had cancer of the spine which metastasised to her brain, and her last hour was one long, uninterrupted scream. Others, however, will die with little or no or controllable pain, and may be able to function normally until shortly before death. Since disease trajectories are so different, on what basis is it held that every person must follow their disease trajectory to its “natural” end? Why, in situations of this sort, may people not make up their own minds, as they have done throughout their lives?

These questions become more insistent when you consider the kinds of things that people say about dying, and who has the right to decide when they should die. And this brings me to the fourth point. Religious believers have generally said that when you die is not up to you to decide. That matter lies in the hands of God alone. However, as people have noticed, this does not stop people from prolonging their lives. If the decision as to when a person may die is in God’s hands, how come the disproportion between what can and what cannot be chosen? Prolonging life is okay, shortening life is not. As Lopez says of one person, Heather O’Hara, whose ex-husband shot himself because of the miseries and indignities of end-stage lung cancer:

O’Hara points out that those who say death should be left in God’s hands often take drastic steps to prolong their lives using ventilators or feeding tubes. “They condemn you for taking your life, but they don’t condemn you for being artificially kept alive.”

Which reminds me of John Donne’s remark that you cannot know, when you seek a cure for your disease, whether or not you are curing yourself of a disease by which God had intended for you to die. In other words, the argument about God’s role in life and death decisions cuts both ways, and it is simply dishonest of the religious to fail to notice this.

Lopez ends his article with an account of Dr. E.T. Rulinson, who worked as an anaesthesiologist during World War II, and went on to a long career in general surgery. Upon retirement, he travelled the world with his wife, scuba diving and doing underwater photography. Now 97, he wrote a letter to Californians about assisted dying. Here is part of the letter that Lopez includes in his article:

Dear Californians planning to live out your life in this state:

I am a physician. Since the 1940s I have been deeply dedicated to quality of life for my patients and loved ones. I am now 97, and can feel life ebbing away steadily… The majority of people I have cared for at the end of their lives desperately have wanted the dignity of ending their lives as they lived their lives, with some influence over their conditions…

I have … friends who saw no better choice for themselves in their … suffering but to end their lives ungraciously, by suicide. The loved ones left behind were devastated by the consequences… I am encouraging you to begin conversations about the end of life choices such as are available for the dignity of citizens in other states.

Which brings me to the fifth important point that I note in Lopez’s article. One of the common criticisms of assisted dying is that those who are left behind must bear the consequences, but when they say this they have in mind those who have died, as Dr. Rulinson says, ungraciously, because there was no other alternative. And that can indeed be difficult to live with. That someone saw no other way out than to shoot or hang themselves, for example, and doing so in a state of desperation, alone, would certainly be hard for those left behind to live with, quite aside from the trauma of coming upon their loved one’s dead body in a state that reflects that person’s desperation and torment at the end. My wife Elizabeth planned and carried out an act which she thought would end her life. That it failed did not entirely take away the distress of knowing that she spent what she thought was her last hour alone, without my support to comfort her, and to tell her that if that is what she wanted to do, I supported her and loved her just the same. The thought of it still brings tears to my eyes. I cannot imagine what it would have been like if it had succeeded, and I never got to tell her how much I loved her, and how much our love meant to me. But this not an argument against assisted dying. It is an argument that it should be legalised, and regularised as a one of the end of life choices that people may make for themselves, so they are not reduced to making acts in desperation, and, as sometimes happens, not only not succeeding in their intent, but making their suffering much worse as a consequence.