The Erasure of Autonomy

The Erasure of Autonomy June 22, 2016

StoneDoorway

Earlier this month, California’s assisted-dying law went into effect. As I wrote previously, the bill was passed in a special session of the legislature last year, over the fierce opposition of religious groups.

At first, there was uncertainty about what Gov. Jerry Brown would do. Brown studied at a Jesuit seminary in his youth, and some people worried that his former beliefs lingered and would persuade him to veto the bill. But in the end, he signed it into law with a simple, powerful argument:

“In the end, I was left to reflect on what I would want in the face of my own death,” Brown added. “I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn’t deny that right to others.” (source)

The dangerous trend of human beings making autonomous decisions about their own lives is spreading. Canada’s Parliament also just passed an assisted-dying law in accordance with a mandate from the country’s Supreme Court.

Both laws place strict conditions on when people may seek aid in dying: for example, they require patients to be suffering from a terminal illness, as opposed to an unbearable but not fatal ailment. California’s law also says that no doctor or hospital is required to prescribe lethal drugs or to tell people where they can go to obtain them, and Catholic hospitals have already, predictably, announced that they won’t participate. Even so, this is a step forward and a victory for the humanist moral principle that we’re the rightful owners of our lives, and we can choose to lay them down if suffering becomes unbearable.

It’s also in accord with the highest principles of medical ethics. This is best argued by a Californian doctor who makes the common-sense point that in every other area of medicine, respecting the patient’s wishes is a paramount duty. Why should assisted dying be any different?

“We always listen to the patient. We never tell a patient: ‘This is what you have to do. You have no choice.’ Yet at the moment when their life is ending — when they say, ‘I don’t want to live in this bed for the next three weeks waiting to die’ — it’s an odd change in the consent procedure. Suddenly they become wrong and we become right. That does not make sense to me. Dying should not be completely separate from everything else we do in medicine.”

Since polls show nearly seven in ten Americans support a right to aid in dying, this argument clearly carries weight with the public. Oregon’s experience shows that actual usage of the law is minimal, but as Gov. Brown said, many people find comfort in knowing the exit option is available if they want it. That’s as it should be.

But despite this growing majority support, some people are furious about California’s law, and you can probably guess who:

The West Coast state became the fourth in the U.S. to legalize deadly doctor-prescribed suicides in October, following Oregon, Washington and Vermont.

(Obligatory editorial note: Are there non-deadly suicides?)

The evangelicals at LifeNews do an admirable job of pretending their opposition doesn’t come from religious doctrine. Instead, they fret that elderly or disabled people might be coerced into ending their lives, even though they can’t offer a single example of that actually happening. At most, they have examples of very ill people being informed by their insurance companies that assisted dying was an option, as if merely making them aware of this was an infringement on their rights. (California’s law prohibits insurers from even mentioning aid in dying; the patient has to initiate the conversation.)

As with abortion, the religious right’s argument against euthanasia completely erases human autonomy. They assume that no one could possibly choose to die of their own free will, that it must be the result of pressure from sinister outsiders. Their case relies on the arrogant and oblivious assumption that their beliefs are the norm for all humanity and whatever they themselves want must be what everyone wants (again, flat-out false according to poll data).

This position requires them to keep their eyes firmly shut to obvious counterexamples. In an earlier post, when they write about Brittany Maynard, they bemoan that she was “used by assisted suicide advocates to promote their agenda” – despite the fact that Maynard herself was a vocal advocate for the right to die. Again, they persist in claiming, in the face of the evidence, that the desires and volition of a terminally ill person don’t exist or don’t matter.

What happens if a dying person is suffering beyond their ability to endure and can’t be treated while remaining lucid? What if they don’t want to be forced to undergo the disintegration of self or the final loss of dignity from terminal illness? What options would the religious right give these people, what comfort would they have to offer? They don’t answer that, because they can’t answer that.

But when the churches don’t have to justify themselves to the public, when they can make up their own rules and impose them on the unwilling, horror results. Katherine Stewart reminds us of that by citing a chilling clause from the Catholic “Ethical and Religious Directives” for church-run hospitals:

Directive number 61 adds: “Patients experiencing suffering that cannot be alleviated should be helped to appreciate the Christian understanding of redemptive suffering.”

Would you want to be under the care of a doctor who believed that? That’s not the manifesto of a physician, but of a medieval inquisitor who justifies torture by claiming it’s good for his victims’ souls.

Fortunately, the tide is turning against these ghoulish religious beliefs that torture people trapped in their own failing bodies. Enough people are intimately familiar with the pains and indignities of dying to see the wrongness of forcing anyone to endure them. There’s no beauty or dignity in terminal suffering. If anything, severe pain strips away what’s best about us, and at its worst, it can reduce people to a near-animalistic state.

Take it from Kevin Drum, a progressive writer who revealed in January that he has multiple myeloma, a cancer of the bone marrow:

The odds are slim that I’ll ever collect a Social Security check.

…Sometime in the next few years the cancer will start to progress rapidly and there will be no more treatments to try. My bones will become more brittle and may break or accumulate microfractures. My immune system will deteriorate, making me vulnerable to opportunistic outside infections. I may suffer from hemorrhages or renal failure…

I don’t want to die in pain — or drugged into a stupor by pain meds — all while connected to tubes and respirators in a hospital room. When the end is near, I want to take my own life.

This is the scenario that Catholics and evangelicals would like to paper over, but they can’t erase the experience of those who’ve seen it happen to loved ones. It’s no wonder they’re losing the battle of public opinion, so long as they have nothing to offer but gauzy rhetoric about the beauty of pain. To those of us who are familiar with the reality, their arguments are hollow and obscene.

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