Sunday, October 4, 2009

BibliOdyssey: Discover Now!

I know, I know, I mentioned this site before but I am on their email list and I find myself anticipating their sendings with delight. Go there now and sign yourself up for weekly beauty and discovery.


Ready for Death? You Must be Depressed.

Among the many arguments against the legalization of assisted suicide are:

*the sanctity of life is determined by God and must be protected according to His will
*a "slippery slope" erosion of the sanctity of any stage of life will lead to others
*AS will lead to the victimization of the aged, disabled and infirm
*legalizing AS illegitimizes suicide prevention efforts
*the need for AS would be eliminated by better palliative care and pain cessation
*and only the depressed wish for AS or suicide

The connection between depression and suicide is accepted and universally integral to suicide prevention efforts. Thus, many opponents to assisted suicide assume that those facing impending death only wish for assisted suicide when they are depressed. Whether that depression can be attributed to fear of impending death, the pain of the illness, loneliness, a loss of control over one's body, or other factors, adequate treatment for depression is an assumed viable solution for a desire to die, or in the parlance, for not "accepting each day of life as a gift.

The assumption that the desire for death is directly tied to depression over-simplifies the more complicated psychic - and physical - state of those in terminal conditions requesting assisted suicide. A desire to hasten death - death is already pending - extends beyond depression. Death is unavoidable (barring miracle, a subject I will have to write about at another time) and is not caused by the patient, as with suicide, but by the terminal disease of condition. The patient does not wish to die but will die.

Those wishing for assisted suicide can hope to maintain dignity in the face of incurable pain; can have accepted death as inevitable and near; and/or can wish to determine the time and place of their death according to their innate rights. Depression can be a symptom of terminal illness and pending death but it is not the sole cause. Curing depression in the terminally ill won't prevent death.

Yet, in countries where the assisted suicide movement is gaining ground with the courts, public opinion and the medical industry, opponents continue to address treatment of depression as a solution for those seeking assisted suicide. As part of their annual celebration of "A Day for Life" the Irish Catholic Bishops' Conference focuses this year, commendably and following last year's topic of mental health, on suicide. Unfortunately, the conference errantly includes the issue of assisted suicide in their statement. They write:

Life matters. It is commonly accepted that those who die by suicide don’t want to die; they simply wish to end their pain. Suicide prevention is, therefore, a duty of everyone in our society. In this area we need to be particularly concerned for other people and sensitive to their difficulties." You are Precious in my Sight addresses pastoral issues around suicide such as why some people consider suicide and the issue of assisted suicide. Bishop Fleming said "Our Pastoral Letter is for everybody. It contains a special Day for Life prayer and it reminds us that "the message of the Gospel is that, whatever has happened to us, and whatever we have done, we can never be separated from the love of God in Jesus Christ. Pain, even tragedy, are never God’s last word.'

Because assisted suicide, the willful, self-administration of lethal drugs for the sake of hastening death by mentally competent, terminally ill patients, is often confused with suicide, perpetrated by depressed or mentally ill individuals, advocates tend to shy from the term, preferring death with dignity or aid in dying.

By separating depression from the desire for assisted suicide, we can approach the assisted suicide movement from a more practical, rights-oriented, dignity-permitting and scientific standpoint. Curing depression and the causes of suicide is a commendable effort by the Irish Catholic Bishop's Conference. However, curing death is not within their purview.

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Disability Rights and the Assisted Suicide Movement.

Opposition to assisted suicide comes from many corners. For me, one of the most emotionally charged factions of opposition is that of the disabled who fear the "slippery slope" disintegration of our culture into a devaluation of those who are born with or develop physical and mental disabilities.

The disability rights movement, building on a California ruling in 1959 for independent living of those diagnosed with polio, blossomed in the 70s - alongside the "euthanasia" movement and the pro-life movement - rooting itself firmly in the civil rights and consumer movements. (The Rehabilitation Act that requires all organizations receiving federal funds to accommodate the disabled was passed in 1973 the same year Roe v Wade was passed.) Many disability rights groups have allied themselves with pro-life groups to contest the abortion of disabled fetuses even as they have worked for individual rights and choice.

Groups like Not Dead Yet, founded in 1996 in response to the assisted suicides of two disabled people by Dr. Jack Kevorkian and galvanized by the case of Terri Schiavo who was removed from nutrition and hydration by court order in 2005, have joined with other disability organizations to oppose the advance of state assisted suicide bills. When a guardian is given the right to remove a disabled person from life-sustaining medical services, as was the case with Terri Schiavo, the disabled community rightly feels threatened. When doctors can accurately predict down syndrome in fetuses, the disabled community finds discrimination in the choice of a mother to abort.

In a 2006 article regarding the Supreme Court's 6-3 decision on Oregon's Death with Dignity law and explaining why the disabled so fiercely oppose assisted suicide, RaggedEdge writes:

One might think that disability rights activists would be strong supporters of the "right to die" -- after all, the independent-living movement's core beliefs -- that people should be able to make their own choices and control their own lives -- seem to be exactly the beliefs that drive right-to-die advocates.

The problem, say disability rights activists, has to do with the society in which we find ourselves -- and society's attitudes.

Life with a disability is so devalued, society is so bigoted against the idea that life with a severe disability can have quality, that in such a climate the "right to die" becomes a "duty to die." Activists fear that people who become disabled will choose suicide over living with disability. They fear that people whose disabilities make them burdens on family members will be pressured -- subtly or not so subtly -- to end their lives.

The definition of "disabled," which includes such disparate physical and mental states as blindness, schizophrenia, down syndrome, paralization, and persistent vegetative state, only complicates the advocacy for disabled rights and its nexus with assisted suicide. As the above quote belies, the determined fight for independence and self-determination that the disabled have long fought seems to contradict the primary justification for the legalization of assisted suicide.

Yet once was the time when the blind feared that eye-corrective surgery would endanger their disability rights by making blindness an at least partially correctable state. The advancement of medical technology has proved a blessing and a curse for disability rights, altering how society views disabilities in a two-steps-forward-three-steps-back manner.

The assisted suicide movement, advance directives, and living wills have produced, over the past 30 to 40 years but most recently with the legalization of death with dignity in three US states and the push to reform health care, an anxiety among the disabled. They fear, even as their rights have been legally protected, that the public continues to devalue life with disability. When an advance directive can prevent a severely disabled person from being placed on life-sustaining medical support, they detect a devaluation of life with disability. Common is the person who expresses the wish to not live in a persistent vegetative state, as the nation's experience of the death of Terri Schiavo proved, or with other disabilities, seeing disability as a diminishment.

Certainly, there is a tone to discourse among the disabled that resembles what Barbara Ehrenreich characterizes in her definitive 2001 article on breast cancer, "Welcome To Cancerland," as glorification of victimhood, survivor status, and persevering through suffering. One can't fault a paraplegic for finding meaning in their disability, yet the prospect of becoming a paraplegic oneself has caused hundreds of thousands of Americans to sign advance directives. How we protect the rights of the disabled in some ways collides with our ability to experience empathy for their conditions. End of life choice and medical advancements brings that collision to the fore of social discourse.

Because the definition of disability is varies greatly, estimates of those in the world living with disability are difficult to make. The World Health Organization estimates that out of a world population of 6.5 billion, 100 million can be considered moderately or severely disabled. In the US, the disabled make up the third largest minority after Hispanics and African Americans.

How we as a society continue to value life with disability, to protect individual rights, and to address the medical industry's regard and treatment of quality of life and end of life issues will determine the level of protection and rights of those with disabilities. The nexus of the assisted suicide movement and disability rights is encumbered with so many other issues like depression treatment, suicide prevention, the pro-life cause, religious rights, and health care reform that it is hard to predict how either advocacy group will proceed.

New Hampshire continues the push for the legalization of assisted suicide with the committee work they are currently doing on a state bill. The challenge is to provide all citizens with rights to life and dignity in death. How we do so will demonstrate our advancement in human rights as a society.

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