Do Americans Balk at Euthanasia?

Last week The New York Times got eight panelists together to answer the question, "Why do Americans Balk at Euthanasia?" It's a loaded question. Do Americans balk at euthanasia? Statistically, the answer is a fairly hearty no. And what do you mean by euthanasia? Death with Dignity, as legalized in Washington since 2008 and Oregon since 1994? Aid in dying, assisted suicide, passive euthanasia, active euthanasia. Of course the definition of the term itself is loaded in the U.S. in a way that it isn't in, say Europe.

At least the panel has some breadth, with Rita L. Marker and Margaret Dore holding down the antis and Jacob Appel and Philip Nitschke holding down the pros. There's enough in between to keep it interesting, and the panel gets more than one non-U.S. voice in there too.

Here's what I have to say about the entries:

Marcia Angell of Harvard Medical School give us the landscape. Where euthanasia is legal, via Death with Dignity laws, it is supported. She gives us two reasons why it's more controversial here in the U.S.: the Catholic Church (which, I might add, operates 1/5 of all hospital beds in the nation, according to their own Vatican-written laws, thanks to conscience clauses that let them skirt state and federal regulation); and our health care system. She posits that the "any practice that might save money raises the specter of rationing." While this is true of media commotion, the fact remains that statistics out of Washington and Oregon show that Death with Dignity laws prevent abuse. And I might add, save lives. When a state's population has had a public conversation about end of life issues, the use of advanced directives, living wills, POLST, and hospice all increase. And educated public, as they say....

Marilyn Golden of Disability Rights Education and Defense Fund writes under the title, "Too Many Flaws in the Law." She sites the case of Barbara Wagner as proof that insurance companies are keen on depriving ill patients of life-saving treatments. You can read my analysis of rationing and the Wagner case here. In short, Wagner didn't get the experimental drug she wanted because it had less than a 5% chance of lengthening her life. Golden is right to point out that diagnoses are not accurate but her pounding of "doctor-prescribed suicide" shows that she's not too willing to discuss how Death with Dignity is working or even to discuss the horrors of being caught between incurable pain and death. As well, it's been fascinating to watch the disability rights groups in the U.S. rally (or be rallied) by anti-euthanasia group. To my mind, patient autonomy (whether that patient is disabled or terminal) should be our social objective. Making the disabled afraid of their doctors isn't really the best advocacy. Yes, the disabled have a history of being treated like half-citizens. But removing patient autonomy from the conversation doesn't change that. Golden also warns that the existing laws are rife with bad reporting and that they subject patients to abuse. It would be much easier to find her argument reasoned if she sited unbiased sources.

Petra de Jong of Right to Die Netherlands notes that "euthanasia and assisted suicide can only be legalized in a country with optimum health care, including palliative care. But most of all, with citizens having access to good health care, regardless of their income." Valid point. If Compassion & Choices (the largest aid in dying advocacy group in the U.S.) wishes to advocate for Death with Dignity laws at the federal level--as a humanitarian right--they'll have to address the fact that those using it currently are predominantly rich, well-educated, and white. Does the U.S. need better health care. Yes, yes, yes. Should that preclude those who are terminal, thoroughly screened by their doctor, and in pain from getting a prescription for a drug that will end their life? I'm not so sure.

Patricia King of Georgetown Law and Johns Hopkins make the very important point that "the poor, the disabled, the elderly and members of racial and ethnic minorities -- worry that if assisted suicide becomes widely available they will be viewed as “throwaway people.” They fear coercion, stigmatization and discrimination, understandably believing that the societal indifference prevalent throughout their lives will also infect their end-of-life care." Important because I'm not sure there are statistics that back this up but also because she reminds us that whether the fear is real or not, it must be treated as legitimate. If you got the short end of the stick repeatedly during life, what's to convince you that you won't also get it in death? That's a powerful life lesson. And politically, it's a charged argument with legs.

Rita L. Marker has a lot of scary but inaccurate stats. She forgets that failed bills intended to protect minorities (in this case, those who just don't want to hurt anymore) are a poor sign of justice in our ancient democracy. Democracy has seldom stood up for minorities. One point that Marker misses again and again is that Death with Dignity laws allow a system of discussing end of life wishes with patients and tracking their deaths. Medicine is not exact. The body is unpredictable. But how many deaths do you think occur outside of Washington and Oregon that would call the double effect into question? Transparency is what Death with Dignity brings. So long as we continue to treat death (and any conversation about it or any preparation for it) like a taboo (a tack that many anti-euthanasia groups pursue) we'll be doing our loved ones a disservice. Put down your "culture of death," Rita, and step away from the computer.

And then there's Margaret Dore. I've spent a good number of hours on the phone with Dore. She's convinced that elders are will be murdered as soon as aid in dying becomes legal, despite the fact that no such thing is happening in Washington and Oregon. Dore is right on two things though: elder abuse is real and alarming. But it's been taking place in every state for far too long and ranges from petty theft to physical and sexual abuse. But that horrible state of our elder care system just isn't due to Death with Dignity. The second point Dore makes, by naming her new non-profit "Choice is an Illusion," is correct. The choice and autonomy language that ushered in the women's rights movement of the 70s and 80s has inadvertently silenced any conversation about community, shared responsibility, and social ethics. It's painted patients' rights conversations into a corner. Otherwise, Dore uses an anecdote about her friend's unexpected recovery to stand in for all other statistics. Yes, miracles happen. Yes, sometimes treatments can turn around a diagnosis. But much more often, terminal diagnoses err on the longer side, drugs are horrendously painful, and patients have more peace if they can talk about what's coming.

Philip Nitschke writes, that the right to aid in dying won't broadly be legalized in the U.S. until Americans reclaim "control over one's body from God."

Jacob Appel warns that the public perception of what euthanasia is and how it works has been poisoned by "pro-life" parties and those who are busy fighting the "culture wars."

What most of these panelists do not stress strongly enough that the dying are desperate. Our system is broken. Pain alleviation is woefully, distressingly behind the times. Our current medical system pushes terminal patients from one aggressive treatment to the next without thought to the torture that they are causing. That's why patients in hospice live longer than those who aren't. The public conversation that comes from a sober discussion of end of life care far outweighs the opportunities for abuse that opponents would like to scare us with. Furthermore, the general medical apparatus that we are all subject to today makes more on a live being than it does a dead one. Euthanasia is a polarizing issue that directly affects a minute number of patients each year--where it's legal. But it's political affects are enormous. And at the moment, those political affects are serving profit-driven parties that oppose real health care reform.

Assisted Suicide Bill Defeated in South Australia

South Australia's Parliament defeated a bill that would have amended an existing law to allow assisted suicide. While it's estimated that 80% of voters favor the amendment, parliament rejected it. From The Sydney Morning Herald:

But Family First MLC Dennis Hood said the bill was "dangerous" and he was relieved it was defeated.

"Parliament has spoken loud and clear. Voluntary euthanasia for SA has been soundly defeated and should be moved off the agenda," he said.

"I am grateful that members listened to my concerns and made the decision on conscience to oppose the bill."

Mr Hood said the bill would have allowed euthanasia for patients that did not have a terminal illness, left psychological referral of patients as an option only and offered a "toothless" Voluntary Euthanasia Board to oversee the practice.

In September this year, Ms Key announced she would introduce the bill into parliament's lower house while Greens upper house MP Mark Parnell will put the identical bill to the Legislative Council.

Mr Parnell had similar legislation defeated in the upper house last year.

At the time, Ms Key said it was time for the SA parliament to catch up with public opinion.

"Over 80 per cent of Australians support the right of the terminally ill and others living in intolerable pain and suffering to seek the assistance of a doctor to end their own lives at a time and in the circumstances of their choosing," she said.

Mr Parnell said the bill required a patient to be examined by two doctors, including at least one specialist and oversight by a Voluntary euthanasia Board.

But influential Port Pirie Catholic bishop Gregory O'Kelly was among vocal opponents of the plan, blaming the recent rise of minor political parties for "pushing death.

"It is a sadness that the first moves around our nation under our new political arrangement seem to be a promotion of death and abuse of marriage," he said in September.

Who Wants To Die? Belgium and Junk Studies.

Fox news and other outlets are reporting that Belgium, long the recipient of scorn for being one of the few nations where assisted suicide is legal, is killing the dying. A survey (of some sort) was conducted of (a very limited number of) nurses on how often they euthanized (however you wish to define that term, type of drug insignificant) a patient (their health status not included in the article) without the patient's consent (written? verbal? what about the family's or the doctors?).

It's the perfect proof of a slippery slope! Give that "culture of death" an inch and it will take your mama!

From the story at Fox:

In interviews with 248 nurses, a fifth admitted they had taken part in a euthanasia procedure based on the “assumption” that the patient wanted to die. Almost half of the nurses confessed to “terminations without request or consent.”

Sure it sounds terrible and scary. Fifty nurses running around offing patients whenever they feel like it, often doing it for the doctor who couldn't be bothered. And what's a vulnerable patient to do when they can't protect themselves and they don't want to die?

I expect it's all rubbish. Britain and Canada, where the primary stories come from, are in the midst of a harsh and unsavory battle over the legalization of assisted suicide. Any story that starts off using the term euthanasia, even one that is about a country in europe, without first clarifying the terms is coming already from a particular position on the issue. Neither article has a link to the original study, nor the name of the study organization - it could have been conducted by the Catholic Church for all we know.

Two of the story versions (here's a British one) quote Peter Saunders of Care Not Killing, an "anti-euthanasia" organization. In both, nothing is said about how the study was conducted, nor is there a description of what is meant by euthanasia. Were the nurses all clear in their answers and using the same definitions? What kinds of hospitals did the nurses work in? From what regions? How old were they? How long had they been nursing? What is consent? Were they trained in palliative care? Do they think that morphine ends lives?

Unfortunately, these types of unsubstantiated stories still move emotions. Just read the comment sections on any of them.

The Case for Suffering.

Here are two interesting clips: one a heartbreaking story from a New Haven, Connecticut newspaper about the experience of a dying friend; the other a article on a talk given by Margaret Somerville on why aid in dying should remain illegal in Canada. What I'm contrasting in these two clips is the way suffering is discussed, the value placed on it, and the religious ideas that inform our justifications of suffering.

The so-called murder-suicide of a North Haven couple suffering from Alzheimer’s and cancer touches me, not only sympathetically, but personally. I have a longtime friend who, as I write, is facing a prolonged dying in "the American way."

She is a virtual prisoner of what, echoing President Dwight D. Eisenhower, one might call "the medical-religious complex."

Certainly, there are reasons to hold life sacred and to beware the institutionalization of death-dealing. Counterweighing these is the respect due to an individual’s autonomy in matters of ultimate value, especially the quality of one’s own life and death.

My friend has led an active, meaningful life, but now finds herself unable even to read, or to take pleasure in personal company, or to get out of her hospice bed, because of both the pain of her illness and the grogginess induced by the drugs used to combat her pain. While everyone caring for her is well-intentioned, the fact is, as she just put it to me, "I want this to be over yesterday."

AND #2:

Arguments against euthanasia are complex and far more difficult to make, she said.

"Today, the argument for euthanasia is the easiest to make," she said, noting the concern for the autonomous individual. "It's my right, my body. The individual has the right to choose death."

The arguments against euthanasia concern its effects on institutions, such as the health care system, hospitals, doctors and society as a whole, she said.

People often argue that we are merciful to dogs by euthanizing them, so why shouldn't we do the same for human beings, she said. "We're not dogs!"

Somerville said one of the biggest challenges is to argue there is something special about human beings without using religious reasons.

Traditional religion used to serve as a way of putting talk of death into a context of eternity, she said. "It is very difficult to justify suffering without some form of religious argument."

Time to Retire the Word Euthanasia

The entire post from LA Times blogs:

People disagree vehemently on issues surrounding death and dying, such as what palliative and medical measures can be appropriately taken at the end of life. But use of the term "euthanasia" doesn't advance the intelligent discussion of end-of-life care, say editors of the Canadian Medical Assn. Journal.

In a commentary published Monday, Dr. Paul C. Hébert and Dr. Ken Flegel argue that the meaning of euthanasia "has become frayed and torn. It mixes ideas and values that confound the debate about dying. It is time to discard it."

Euthanasia originally conveyed the idea of a gentle death. The term eventually evolved and took on another meaning: actions that bring about a gentle death. According to the authors, however, the meaning of the term has broadened further -- and has become clouded -- to encompass actions that involve providing relief to dying people. For example, a survey of doctors in Quebec last year found that 81% said they had practiced euthanasia, and that 48% said palliative sedation -- in which medication is given to provide comfort but which may hasten death -- can be likened to euthanasia.

That's the wrong interpretation, Hebert and Flegel write, saying that "...administering enough narcotics to relieve pain in patients with cancer and adding enough sedation to enable comfort and minimize agitation is appropriate and compassionate care, even when the amounts required increase the probability of death."

Instead of calling such an action euthanasia, health professionals should avoid terms that mean different things to different people, the editorial states. Instead, it advises, doctors should describe their proposed action and its intention and avoid loaded words.

New Angus Reid Poll on "Euthanasia."

From Seattle Post Intelligencer, a post today on a new poll by Angus Reid (a canadian firm I know very little about) on public opinion about "euthanasia." One problem with the poll is that it fails to make a number of distinctions about the definitions it uses, confusing death with dignity with assisted suicide with euthanasia. But for that reason, the poll most likely reflects the public's knowledge of the practice more than it's opinion about it. Here's the article - and don't miss the comments.

Incidentally, I'd love to know who commissioned the poll. Washington has had legal Death with Dignity since 2008. I smell more "pro-life" tampering with a democratically approved bill, even while they support the legitimacy of such a bill in California's prop 8 case....

Poll: Sharp divisions on euthanasia

A new Angus Reid poll find that 42 percent of American adults are in favor of making euthanasia legal in the United States, although 52 percent feel legalizing induced death would leave vulnerable people without sufficient legal protection.

The survey steered clear using such deliberately non-threatening terms as "Death With Dignity" favored by supporters of assisted suicide. In the 2008 election, by a 58 percent to 42 percent vote, Washington became the second U.S. state to legalize physician-assisted suicide.

In its poll of 1,001 American adults, taken Feb. 4 and 5, Reid asked:
"Generally speaking, do you support or oppose legalizing euthanasia in the United States?"

The results: 14 percent answered "Strongly Support," 28 percent "Moderately Support", 14 percent "Moderately Oppose," and 23 percent "Strongly Oppose." A total of 22 percent were not sure.

A near-majority of Democrats (47 percent) support euthanasia, while a bare majority of Republicans (51 percent) oppose it. A total of 47 percent of Independents backed legalized euthanasia.

Still, the public has reservations about induced and assisted death.

The poll asked if people felt that legalizing euthanasia "would leave vulnerable people without sufficient protection." Fifty-two percent agreed, 32 percent disagreed, 15 percent were unsure.

As well, Reid asked if legalizing euthanasia "would send the message that the lives of the sick or disabled are of less valued. The poll's respondents split down the middle, 44 percent in agreement, 44 percent disagreeing, with 12 percent unsure.

A contrasting opinion came when the pollster asked if legalizing euthanasia "would give people who are suffering an opportunity to ease their pain." Seventy percent agreed, only 19 percent disagreed.

The public seemed compassionate toward those making life-or-death choices.

"Do you think people who help a person to commit suicide should be prosecuted?" Reid asked.

Thirty-seven percent said "Yes," 34 percent answered "No," with 28 percent "Not Sure." Independent voters were strongest in saying those who assist suicide should not be prosecuted.

The poll put a related question more bluntly:

"If a parent is found guilty of assisting a terminally ill son or daughter to die, what do you think should be the appropriate punishment."

Just 6 percent opted for life imprisonment, and only 21 percent for any prison sentence, with 12 percent favoring a fine. Thirty-five percent opted for "No Penalty at All", while 26 percent were unsure.

Advocates of Washington's assisted suicide measure, led by former Gov. Booth Gardner, spent $4.8 million on their successful 2008 campaign.

The Washington vote gave momentum to a movement stalled for more than a decade after Oregon became the first state to legalize physician-assisted suicide.

The Atlantic Profiles Ludwig Minelli, Dignitas President.

An excerpt from Bruce Falconer's profile of Switzerland's controversial Ludwig Minelli, president of Dignitas, a "suicide clinic," in the March 2010 The Atlantic:

Assisted suicide did not always carry the stigma it does today. It was an accepted practice in the ancient world. Athenian magistrates stockpiled poisons for their citizens, with the admonition “If your life is hateful to you, die; if you are overwhelmed by fate, drink the hemlock.” The Hippocratic Oath, written sometime between the fifth and third centuries B.C., pledged doctors to refrain from hastening the deaths of their patients and specifically prohibited the prescription of fatal drugs. The oath was a seminal development in the ethics of medicine, but was ignored by most ancient physicians. Only hundreds of years later, with the rise of Christianity and its belief in the sanctity of human life, did attitudes toward euthanasia swing decisively in the other direction. By the 12th century, mercy killing was opposed throughout the Western world. Thomas More’s Utopia, published in 1516, reinvigorated debate with its vision of a society in which “the magistrates and priests do not hesitate to prescribe euthanasia,” and where the sick “end their lives willingly, either by starvation or drugs.” Later, during the Enlightenment, thinkers like Francis Bacon, David Hume, and Montesquieu, among others, also defended the practice, though their writings did little to alter the prevailing wisdom.

The modern argument over euthanasia began only in the 19th century with the advent of medical anesthetics like ether and morphine. In 1870, a schoolteacher named Samuel D. Williams delivered a speech to the Birmingham Speculative Club in England. He argued that, for patients suffering from terminal illness, physicians should use chloroform not only to relieve pain, but to “destroy consciousness at once, and put the sufferer to a quick and painless death.” His comments were later collected into a book that received favorable attention from prestigious political and scientific journals and inaugurated a period of spirited discussion, in both Europe and the United States, over euthanasia’s potential to cure certain social ills. Scientific rationality was the byword of the age. Darwin’s theory of evolution had itself evolved into the sociological notion of “survival of the fittest.” Euthanasia promised the possibility of a healthier and more productive society, free from the burden of caring for its weakest members—the sick, the old, and the mentally ill. In 1906, two bills introduced in the Ohio legislature called for the legalization of euthanasia for terminally ill adults and for “hideously deformed and idiotic children.” They were voted down.

Terri Schiavo And A New Study That Looks at the Vegetative State.

One study, three sources. I'll spend more time analyzing the study tomorrow but in the meanwhile, let's use the case of Terri Schiavo and see how each publication addresses the study. I'll also track down commentary at pro-life blogs tomorrow to see how the study is discussed.

Washington Post:

The research inevitably raised questions about patients such as Terri Schiavo, the Florida woman in a persistent vegetative state whose family dispute over whether to discontinue her care ignited a national debate over the right-to-die issue that eventually led to congressional intervention. Schiavo's brother, Bobby Schindler, said the new study highlights the limits of medicine to provide an accurate diagnosis.

"They are completely unreliable," Schindler said in a telephone interview. "I wish this could have been used on my sister to see what could have been done to help her."

But Owen, Schiff and other experts stressed the research does not indicate that may patients in vegetative states are necessarily aware or have any hope of recovery. Many, including Schiavo, have suffered much more massive brain danger for far longer than the patients in this study.

"In some cases, the damage to the brain is so severe that it is simply inconceivable they could produce any responses," Owen said.

As many as 20,000 Americans are in a vegetative state -- meaning they are alive and awake, but without any sense of awareness, while 100,000 to 300,000 are in a related condition known as a minimally conscious state, in which they exhibit impaired or intermittent awareness.

Seattle Post Intelligencer:

They also noted that the positive signals appeared only in people with traumatic brain injury - not in patients whose brains had been deprived of oxygen, as can happen when the heart stops. Terri Schiavo, the vegetative woman at the center of a national controversy before her feeding tube was removed and she was allowed to die in 2005, suffered oxygen deprivation.

The new work, published online Wednesday by the New England Journal of Medicine, came from researchers in Britain and Belgium. One author is Dr. Steven Laureys at the University of Liege in Belgium. He made headlines in November by showing awareness in Rom Houben, a 46-year-old man who had been diagnosed as being vegetative for 23 years. (Houben was excluded from the new study because he could not keep his head still enough in the brain scanner to produce a usable scan; his awareness was revealed by bedside behavioral tests).

The New York Times:

Nor does the finding apply to victims of severe oxygen depletion, like Terri Schiavo, the Florida woman who became unresponsive after her heart stopped and was taken off life support in 2005 during an explosive controversy over patients’ rights.

Moreover, experts said the new test was not ready for wide use as a diagnostic tool; serious technical challenges remain to be worked out.

Still, the experts agreed that the new study exposed the limits of the current bedside test for diagnosing mental state: checking whether patients’ eyes can track objects, and carefully looking for any signs — eye blinks, finger twitches — in response to questions or commands.

“I’m convinced as an observer that in these few cases, the M.R.I. technique, in these researchers’ hands, gives us a window into human consciousness that we have not had and that potentially adds to the clinical exam we currently use,” said Dr. James L. Bernat, a neurologist at Dartmouth-Hitchcock Medical Center in New Hampshire.

Baby Isaiah: Is Futile Care for the Living or the Dying?

Medical advancements have pushed us into a climate where anything that can be done for a dying patient often is done, and just as often without the patient's consent. What specific care a patient may wish is often not documented properly - all care scenarios are difficult to anticipate - or family members or hospitals may disagree with that wish. Grief is a powerful force; our desire to hold onto the beloved sometimes supplants what is best for the beloved.

The result is what is called "futile care": medical treatments that do nothing to improve a patient's condition and often inflict undue stress and suffering on the patient but that offer hope to the family and those involved in the process.

Alex Schadenberg at Canada's Euthanasia Prevention Coalition summarizes a recent case in that country that addresses futile care and - I think - asks us to consider whom that futile care benefits:

Baby Isaiah was born with the umbilical cord around his neck after a 40 labour in Alberta. He was not breathing when he was born but was revived and sent to the Stollery Children's hospital in Edmonton Alberta.

After approximately 90 days of receiving care, the parents of Baby Isaiah - Rebecca and Isaac May, were told that the hospital would withdraw the ventilator from Baby Isaiah.

The parents went to court to request another 90 days of care to give Baby Isaiah a chance to further improve. When speaking with Rebecca May, she made it very clear that they hoped to be able to bring Isaiah home and care for him. She understood that Isaiah may not survive very long and if he survived, that he may be profoundly disabled, but she was willing to care for him and love him, no matter what happened.

The Euthanasia Prevention Coalition has supported the wish of the May family to give Baby Isaiah a chance to improve to the point where they could bring him home.

While Schadenberg has properly and adequately explained that removing Isaiah from artificial life support would not be "euthanasia," he and his organization have strongly backed the May family in their fight against the hospital, citing the "precedent" that the case sets.

Like many other organizations around the world, Schadenberg and others have highly publicized Baby Isaiah's "struggle" as a "pro-life" cause. Schadenberg explains why:

Modern bioethics has bought into futile care theory. Futile care theory originally focussed on withdrawing treatment when it became futile, burdensome and ineffective. Over the past decade, and more, futile care theory now focusses on withdrawing effective treatment from patients that are deemed to be futile.

The ventilator is effectively providing oxygen for Baby Isaiah, who is growing and physiologically thriving with the care. The hospital and the physician view Baby Isaiah as being futile and believe that they are wasting the resource of the ventilator on a futile patient.

If the May family loses this court case consider where the issue may go next. People with alzheimers or dementia, people with profound disabilities, and more.

Next consider how such a legal precedent could be used if euthanasia ever became legal in Canada.

Schadenberg and others have tacked the term "theory" onto the end of futile care, a rhetorical calculation that has effectively been used to conflat the definition of scientific theory (set of principles that explain natural phenomena) with a theory in everyday life (a guess) - made popular in regards to evolution.

As Susan Jacoby writes, "The popular 'just a theory' argument rests not only on religious faith but on our national indifference to the specific meanings of words in specific contexts."

With this distortion, "pro-life" groups can debunk medical (and any other) science when they like in lieu of hope for a miracle from God. And indeed, medical science is not foolproof any more than the human body is uncomplicated. (Schadenberg's explanation is fraught with other exaggerations and assumptions as well: futile care is really necessary care, viable patients are removed from necessary care, Baby Isaiah is "thriving," removing one patient from artificial life support threatens other patients....)

But the real point of this post is this: Whom does futile care serve?

A clue may reside in a recent quote by Bobby Schindler, brother of Terri Schiavo and founder, with his parents, of the Terri Schindler Schiavo Foundation, dedicated to a Catholic, "pro-life" agenda of "protecting" those who have suffered severe disabilities from removal of artificial life support. Schindler stated regarding caring for those like his sister:

"They allow us to show our compassion, our love. I believe that they are blessings.

“And if you talk to families that are caring for people like my sister, they look at their loved one as a blessing – to be in this position of having to care for them – because they are completely vulnerable to us."

There's something inherently subversive about loving someone because they are completely vulnerable to you, about prolonging the life of a body for one's own redemptive sacrifice and subsequent "blessing." Schindler slips in "having to care" as an indication that the choice is not ours but presumably God's.

The foundation of this desire to love the vulnerable is, of course, compassion. But also, as medical ethics works to guide us through questions of artificial life support, I believe, it is also one of theological purpose. The "pro-life" stance that all life is sacred is on the face very noble and just. Not until applied to real life examples does the protection of that "sanctity" at all costs exemplify discrimination: opposition to contraception, women's and patient's rights, and to the wishes of the dying. It is in that opposition that the suffering of the other is imposed for the sake of one's own redemption. When "having to care" for a vulnerable person, God teaches us the benefits of unrequited love, of suffering, of patience.

I'm not able to speak specifically to the May's decision. I don't know their purpose. But when the private struggle of an infant is prolonged and made an example of vulnerability, an example of God's plan, a cause for hope of miracles and a case against some hypothetical "slippery slope" preying on the terminal, the disabled, the elderly, the compassion for a brain-dead child and their family is lost and subverted. They've become a cause, an argument against science and a justification for futile care.

That our lives are redeemed by suffering, that we are made better, indeed won to the bossom of Christ, by our pain, grief, and abject self-sacrifice is strongly entrenched in fundamental religious ideas - those currently and strongly espoused by the Catholic and Fundamentalist organizations that comprise the current "pro-life" movement.

Caring for the "least of these" should not demand prolonging their lives at all cost so that we can love unconditionally, so that we can suffer in that caring process in order to be closer to God. Somewhere in the argument the ability to accept death and the innate course of human life must figure. Our redemption must not feed on the suffering of others.

Scotland and the Work of "Life" Crusaders.

To the string of Westernized countries that have contemplated aid in dying over the past year, add Scotland. This week, Margo Macdonald introduced a bill that has been called more permitting than the Netherlands' - and according to opponents of aid in dying the latter country is not one to emulate. In every court case in the US, the Netherlands has been held up as the primary "culture of death" capital, only exceeding Switzerland in it's wickedness because the latter has made efforts to reign in "suicide culture" by considering changing it's "permissive" laws.

Of course Scotland's bill, the End of Life Assistance Bill, has caused an international "pro-life" ruckus. Here are some links from the usual noisy criers:

From Peter Saunders, Director of Britain's Care Not Killing

From Wesley J. Smith, of the junk science haven Discovery Institute, who paused to demonize Scotland before ranting his (premature?) joy at the defeat of the US health care bill.

From Alex Schadenberg at Euthanasia Prevention Coalition

Rather than dig into the bill to tell you the pros and cons of it's construction, or tell you the forces that are working on the ground to address it's passage, or the story of the MP who introduced it, I'd rather ask a question:

Why is there a rash of constituents in Westernized countries who are compelled to press their legislators and government leaders for aid in dying?

To those who work from the premise that society is bifurcated into good and evil, that "the culture of death" has risen from the "threat" of modernization and the decline of church power over personal lives - the Peter Saunders, Wesley J. Smiths and the Alex Schadenbergs - a great decline in human morality is what most threatens the "sanctity of life" around the globe.

This fear of change and the future is a powerful force or these men wouldn't make their living hating personal autonomy and patients' who fight for their right to control their medical destiny. These men think they are grappling against the new decline in personal and societal morals. However successful their strategies are at the moment, they are on the grand scale actually actors who, like the American teabaggers who are funded by corporations to promote government deregulation, aiding and abetting power structures by spreading fear of sound government representation of individual citizens.

To the rest of us who view the Westernized medical landscape without the fear or ideology, without the self-righteous desire to keep society governed by unchanging and draconian faithful strictures, the cause of aid in dying bills is more difficult to explain.

The patriarchal character of medicine has combined with new technology to remove patients' from their own medical decision-making. The church and the state have colluded to, with all their might, leave such rights in the hands of doctors dedicated to curing disease; doctors who now operate within a closed, corporatized and cost-driven delivery system that compels patients into futile care, over-treatment, and ignorance of how death occurs. Patients are rendered helpless in this new landscape and so they fight, country by country, to wrest their control over death back from these institutional forces.

The new dying culture has pitted helpless, resourceless patients against the church, the state and the medical profession, much more powerful and organized institutions.

The three men I cite consider themselves crusaders for society's morality. In truth, they are crusaders, throwbacks to the time when ideological views of the world were unchallenged by science and medicine. Their ways are dated because they appeal to a moral compass that no longer exists, and indeed was a state and church sanctioned imposition on personal beliefs and autonomy. These men are the enemies of patients' rights, of social services that work to end suffering, and of human advancement.

And their maniacal, antiquated work has allowed the state and the medical profession, forces that they otherwise despise when they counter the church, to dictate what rights individuals have in the world of new technology.

They are throw-backs to be sure. With self-righteousness and paternalism they claim to stand for the disabled, the poor, the ill, the "least of these." But their stand is on their own ideological premise, not on the rights of individuals in a pluralistic society. They demean the autonomy of every patient and yet claim compassion. They paint selected facts and statistics as proof of moral debasement. They monger fear among the elderly and disabled.

And most importantly, they fail to address the cause of these bills in a mature, real-world manner, preferring to work in their good vs. evil constructs, rather than seek non-judgmental approaches to the crisis in modern medicine of a good death.

Scotland is not the last country where citizens rise up and say they want to make their own health care decisions. Crusaders who work to keep individuals under the power of corporations, the state and the church will always exist. They will continue to frame the issue of patients rights as one of "moral decline". And they will continue to do the work of imposing power structures while patronizingly claiming that they indeed know what is best for a patient.

The task we have as a society is to recognize who they work for.