Sunday, March 7, 2010

Debunking Mr. Smith on the Washington Numbers.

A recent column from Wesley J. Smith comments on the new report out of Washington on how Death with Dignity is working there. I comment on his posts so often because he's so good at perpetuating lies about Death with Dignity and assisted suicide - on all end of life care. Here are some things he again gets wrong:

The first dehumanizing assisted suicide “statistics” from Washington are in, with 36 people reportedly overdosing themselves via lethally prescribed drugs in the first year. Washington voters were “sold” on assisted suicide, as is always the case, with the fear of being in pain that cannot be alleviated. But, as in Oregon, assisted suicide in practice is mostly about existential fears. These are serious issues to be sure, but they are not demises of writhing agony used by assisted suicide advocates to sell hemlock as if it were honey.

I'm afraid that Smith is out of line with the majority of voters in Oregon who have long had public-square, in-depth discussions about end of life care. I don't think democracy or laws always work to protect individual rights but I have to say that Washington has proven that all the doomsday scenarios painted by opponents of the laws have not come to bear.

What's at contest is how Smith defines death and human life. From his continued involvement with the Schindler family, the Catholic church, and from his writings, it's obvious that he's determined that death - defined until the 60s and 70s as the rather simultaneous end of breathing, heart beat, and brain function - now must be redefined because of technology that can perpetuate the first two artificially.

The latter, brain function, according to Smith and his fellow "pro-life" advocates, is unimportant. (Except when a big news story like the recent finding of brain activity in some PVS patients (though not any patients who suffered anoxia as Terri Schiavo had) comes along as a possible hook that they can hang their insensitive claims of murder on.) But brain function is not unimportant to elders. For many, it defines who they are. In many ways so does physical competence, mobility, living. These values in no way slight the lives of those with less mobility but simply reflect human ideas of what it means to be alive.

Yet, Smith's attempts at redefining death are incongruent with the majority of society and the laws that are constantly evolving to address new technology. Autonomy was cited in the report as the top reason for patients to request aid in dying. That's a statistic, not an opinion. And it signifies that loss of autonomy means something to a lot of people, whether Smith wishes to call it "existential" or not. What's at issue is that his definition of dying - all aggressive care all the time, regardless of the wishes of the patient or their family - is not the definition that society wishes to work from.

I'll let his juvenile attempts to discredit the report - a long-time tactic of end of life care opponents, science-deniers, ideologues, and conservative religious groups bent on dictating how we should live - and his portrait of proponents of aid in dying as killers slide. No one is out to cut down terminal patients but to treat them as they wish to be treated at the end of life, not as someone else thinks they should be treated. Hemlock as honey? "Sold" on assisted suicide? Fear of end of life "quality of life" is real and great. We are inhumane fools to ignore them. But Smith has an agenda. And the fact that the report doesn't show his predictions of old ladies being coerced into ingesting lethal drugs for their money, minorities and the disabled being preyed on, the "culture of death" devouring the most vulnerable in society, makes him more surly than usual. He's got a "slippery slope" argument to prove and unfortunately, the statistics don't work in his favor. So what does he do? He goes after hospice.

From the story:

Doctors said loss of autonomy was an end-of-life concern for all 47 patients. Ninety-one percent were also concerned about losing the ability to participate in activities that made life enjoyable, and 82 percent were worried about “loss of dignity,” their doctors said. The report also said that more than 40 percent were worried about losing control of bodily functions, 23 percent about being a burden on family, friends or caregivers, and 25 percent were concerned about inadequate pain control. Only one person was concerned about the financial implications of treatment, according to the doctors’ reports.

The report also states that 72% of people who committed assisted suicide were in hospice. This marks the continues assault by assisted suicide consciousness on hospice medicine. Suicide prevention is one of the important services hospice is supposed to provide, along with other interventions, to help a suicidal terminally ill patient get past the darkness to live the rest of his or her life.

Uh, what's 72% of 36? That hospice is being taken over by AS advocates is silly. The common practice in hospice is to treat a terminal patient's paint - indeed that's why it was founded. The issue here is that treating pain often means sedation, often until death. That's not an option that some like. Conflating suicide with with assisted suicide is a disingenuous trope. As Death with Dignity works in Oregon and Washington, the patient is dying from a terminal disease. That disease is the killer, not terminal illness.

It works, too. Several years ago, St. Christopher’s Hospice, founded by the great medical humanitarian Dame Cecily Saunders, released a report showing that of 1700 AIDS patients, only two had requested assisted suicide and none had killed themselves, a remarkable figure since this was when the epidemic was at its worst. The point of the report was to show that quality of their care could overcome the worst situations. But with legalized assisted suicide, this essential service is often (or always, who knows?) denied to patients, particularly since the ideologues of Compassion and Choices are usually involved in facilitating these deaths.

Saunders founded her hospice at a time when technology was just starting to change the definition of death. And she's been quoted as saying, as a staunch Catholic and following of C.S. Lewis, that she founded hospice in part to combat euthanasia. Modern assisted suicide is divorced from early definitions of euthanasia, both Socrates-type and the Nazi-type. Hospice is a brilliant and humane approach to end of life care; by proclaiming it as a service that reduces patients' options, as subject to "the culture of death" is absurd. But it's a common method of scaring the dying into spending their last days, weeks, months in hospitals, exactly where 80% of them say they don't want to be. We know that Oregon, since the legalization of Death with Dignity, has the highest percentage of in-home deaths of any state in the country. For all his claims at knowledge of this subject, he is woefully uninformed or dishonest about hospice use in states where DwD is legal. I won't even touch Saunder's AIDS report. The AIDS movement is responsible for reviving the assisted suicide movement. Yes, ending suffering at the end of life is sufficient to give some terminal patients the peace they want. Others see no difference between sedation to unconsciousness and ending their suffering.

So, Washington looks like Oregon, redux. And that’s too bad. Terminally ill patients deserve better than to have their worst fears verified by doctors issuing lethal prescriptions instead of vowing to stay with the patient to the end caring for their pain, validating their dignity, and supporting the importance of their lives.

Dignity, pain, suffering, autonomy, "quality of life" are not the same for all terminal patients. That the Washington report confirms Oregon's results is fantastic news! These bills have encouraged the elderly and ill to discuss how they die; have perpetuated humane treatment of the dying; have moved more patients into hospice; have allowed patients to die where they want, at home with their family; have established successful "do not resuscitate" laws and practices; have encouraged families to work together to ensure that patients have the treatments they want at the end of life. Think what you want about assisted suicide. These bills have proven that accepting death and working to give patient's their choices in treatment are imperative, life-affirming, humane, and encouraging signs.

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