Suicide

Permission to Die

California could become the fifth state to misidentify suicide as a medical treatment.

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In a CNN essay published last October, Brittany Maynard, a 29-year-old with terminal brain cancer, explained why she and her husband had moved from California to Oregon: so she could legally obtain the barbiturates she would use to kill herself on November 1. "I would not tell anyone else that he or she should choose death with dignity," she wrote. "My question is: Who has the right to tell me that I don't deserve this choice?"

There was no good answer to that question, and Maynard's moving story helps explain why California legislators last week approved a bill legalizing physician-assisted suicide, which if signed by Gov. Jerry Brown will increase to five the number of states where the practice is allowed. But while Maynard was driven by a determination to maintain her autonomy, her posthumous victory is couched in language that concedes the government's authority to intrude into the most intimate aspects of our lives.

To take advantage of the Oregon Death With Dignity Act, Maynard had to establish residency in that state, which required finding a new home in Portland, obtaining a new driver's license, changing her voter registration, finding people to look after her pets, and arranging a leave of absence for her husband. As Maynard noted, "The vast majority of families do not have the flexibility, resources and time to make all these changes."

None of that would have been necessary if Maynard had simply been allowed to walk into a store and walk out with the barbiturates she needed. But because the government has decreed that people must have a permission slip from a state-appointed gatekeeper to obtain these drugs (and many others), she and her husband were forced to uproot themselves during an already trying and tumultuous time.

Rather than recognize the impropriety of dictating to adults what substances they may introduce into their own bodies, California's legislators decided to allow a new, purportedly medical use of barbiturates, subject to stringent requirements aimed at ensuring that people kill themselves only for the right reasons. But suicide is not a medical treatment, and the government has no business forcing people to remain alive when it disagrees with their reasons for wanting to die.

Maynard said she wanted to "use the medical practice of aid in dying," which would allow her to "request and receive a prescription from a physician for medication that I could self-ingest to end my dying process if it becomes unbearable." But if barbiturates are a "medication" in this context, so is cyanide, carbon monoxide, a noose, or a bullet.

The medicalization of suicide is driven largely by the drug laws, which give physicians special access to the substances that are most suitable for the purpose. But as Thomas Szasz observes in his book Fatal Freedom, calling suicide a "medical practice" also helps disguise the nature of this choice, implying that science can replace morality.

Survey data suggest that framing the issue this way has helped assuage public concerns about letting people leave this world on their own terms. According to a recent Gallup poll, 68 percent of Americans agree that "when a person has a disease that cannot be cured and is living in severe pain," doctors "should be allowed by law to assist the patient to commit suicide if the patient requests it."

Opponents of physician-assisted suicide worry that such requests will be made under duress, that people will kill themselves to spare their families the expense of potentially life-saving treatment. But family pressure is at least as likely to push patients in the opposite direction, encouraging them to endure iffy and arduous treatments when they prefer a quick end.

It is folly to think regulations can ensure the right outcome (however that's defined) in every case. The most the government should do is make sure each individual's wishes are respected, even when other people—including people with medical degrees—don't approve of them. 

© Copyright 2015 by Creators Syndicate Inc.

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  1. I think people have the right to commit suicide. But, “should be allowed by law to assist the patient to commit suicide” is going to come to mean, “required by law to assist”.

    1. Or worse, allowed by law to drive the decision. Followed by multiple law suits, followed by legislation creating a bureau of ‘crats.

      1. Yep, I can see it now,,,, a Dcotor you getting tossed in jail because they will not kill someone…

    2. Maybe, but we are very far aware from that. suicide is illegal in 46 states. Merely discussing suicide provides grounds for imprisonment in a psychiatric facility based on the “could harm herself or others” standard – imprisonment that is authorized ex parte and can be extended indefinitely. There is a massive institutional interest in suicide prevention among doctors, psychiatrists/psychologists and law enforcement. Decriminalizing suicide would risk the beaurocracy built around that interest.

      1. very far *away, not *aware (thanks cellphone autocorrect)

      2. “..suicide is illegal in 46 state.”

        Ok, I commit suicide, at that point what is the state going to do to me – not allow me to be buried?

        1. If you succeed at suicide, you win! The suicide laws allow the government to forcibly try to stop you against your will. And institutionalize you to prevent you from trying.

      3. Wikipedia does not agree with you. Suicide is not a crime anywhere in the US. Nor should it be.

        Suicide is a choice. And like all choices, some can be driven by mental illness, but those choices cannot be proof of mental illness any more than drinking is proof of alcoholism.

  2. “…suicide is not a medical treatment, and the government has no business forcing people to remain alive when it disagrees with their reasons for wanting to die.”

    If only that were this were the end of it.

    “… the government has no business forcing people to remain alive when it disagrees with their reasons for wanting to die.”

    But no, now we have the government forcing the enlistment of others, who may have no desire to participate in the death of another, and declaring that a solution to the problem.

    There is nothing libertarian about permission be it for marijuana, or a lethal dose, nor is their anything libertarian about compulsory participation in the wants or actions of others.

    1. Second quote should have been ” calling suicide a “medical practice” also helps disguise the nature of this choice, implying that science can replace morality.”

    2. honestly where is the concern about compulsion coming from in this case? not attacking your POV and willing to entertain your position but I am having difficulty with the connection. has a doctor been forced to assist a suicide they didnt want to? how could a doctor be forced to do anything other than write a prescription?

      1. on the other side of things I can imagine regulations that would compel doctors to provide certain types of care in certain kinds of situations … specifically emergency care. its a much different situation than baking a cake. imagine an ER doctor Christian Scientist … such an individual could be very problematic in certain circumstances (like if he got a job at a normal hospital somehow).

        1. In the immediate future the compulsory aspects will mainly affect other healthcare professions – nurses in the office, the pharmacist who will be handed the prescription, etc.

          But as physicians become less and less independent practitioners and more employees it will also become their problem too.

      2. This is just the idiotic argument that social conservatives have seized onto to hide the fact that they think suicide is immoral and should be prevented by the State.

        1. This is the sort of idiocy one gets from people who do not understand the distinction between suicide and homicide – legally, or morally sanctioned or not.

          1. No, it isn’t that they can’t see the difference between suicide and homicide. It goes back to the Bible and that if commit suicide you will go to Hell – no matter about being saved, etc. So our predecessors saw it as immoral and made it illegal for all.

            That is the only real reason, I think, we have the law.

            But, if you commit suicide you can’t pay taxes anymore. Now what is the State going to do, they just lost income.

            1. I’m pretty sure suicide is not illegal. In Canada, they removed it as a crime in 1972. In the US, I think almost all states made it legal in the 90s.

      3. If I sell a giun to a thug who has said he is going to use it to rob people… Am I not somehow libel?

        I mean look at proctuct law sutes and how people get sued because people use a product for a use other than intended… or just something stupid?

  3. See? This is why we need common sense gun control, like requirements to obtain a prescription from a doctor to purchase firearms.

    Do you know how many people commit medical malpractice with guns each year?

    1. few terms are as prone to bullshit as “common sense”

  4. The idea that the State is or can be qualified to control what drugs people use is ridiculous, and drives further absurdities. The crawling fear that some authoritarian have that somebody, somewhere, may be getting stones keeps people with chronic pain suffering for no good reason. The idea that doctors must give permission for a mortally ill person to take an overdose grants doctors the status of Priest, to which the chancre mechanics are not entitled, and by placing matters in the hands of someone licensed by the State involves the State in something that is none of its goddamned business.

    Further, as the chattering champions of Socialized Medicine advance their cause, they will inevitably push the State into the position of making “Quality of Life” decisions which the State will naturally come to make according to the convenience of the State.

    If there were a way to make Suicide and assisting suicide legal by taking power away from the State, I would be in favor of it. All the attempts I have seen to date end up, to one degree or another, inviting the State in to a decision that should be outside its purview.

    1. Foreseen consequences are not unintended consequences.

  5. Couldn’t she just overdose on sleeping pills or any of a dozen over the counter drugs? Killing oneself is easy, especially when prearranged with family members so the ambulance isn’t called. There are dozens of way to do so in the modern home. If you’re concerned about a painless or pretty corpse its a little harder, but not by much.

    1. The problem is trying to male sure some arrogant prosecutor doesn’t decide to charge an innocent person with murder. A pharmacist who”should have know” (when did a Pharmacy degree come with telepathy?), or a doctor. Or, worst of all, a family member.

    2. Government makes this more difficult than you imagine. Family members that help to prearrange a suicide can be, and have been, prosecuted.

      1. Yeah. That’s a bigger problem with the law than the unavailability of drugs to do it with, I think.

  6. We charge even a libertarian/minarchic government with the protection of life and property, and it’s the life portion that is the crux. The government, ultimately, uses crude, boilerplate methods. If we’ve charged it with protecting life, it will set about doing it as simply as possible – if no one dies then life has been preserved and their duty has been discharged. If suicide begins to be “allowed”, then there’s a huge amount of subtlety necessary that’s not the government’s strong suit, and bureaucracies are born, bloat, and calcify around these subtleties. If suicide is “legalized”, and there’s no regulation, then each instance is going to have to be investigated to make sure it’s not a frame – that he person is killed and the suicide is backfilled. So, to make it simpler, they set up regulated methods to ensure the suicidal can execute their wishes and it is “registered” with the authorities so they know they don’t have to investigate the subtleties. But that creates another bureaucracy.

    So, if we want collective protection from harm/death unwanted at the hands of others, and we charge the unwieldy government to do it, we simply need to accept that suicide will likely have to be a gun, some woods, a garbage bag, and a short and sweet note in one’s own handwriting. Suicide with drugs, at home, in your comfy bed, with friends and family gathered around is probably out.

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  9. I thought only the FDA could approve “on-label” use of drugs. Now state legislatures can do it?

    1. This would be off label to say the least.

      Let’s not forget these are the same drugs that manufacturers are denying use of in the performance of lethal injection executions.

      Further, in the case of “medically assisted suicide” the prescriptions would be in direct violation of Federal law, specifically the Controlled Substance Act.

      Not that I have a problem with states nullifying overreaching federal law, just that we cannot be selective about the practice.

      1. And in which case states that seek to limit or restrict abortions through the enforcement of legislated medical standards are equally valid.

  10. Opponents of physician-assisted suicide worry that such requests will be made under duress, that people will kill themselves to spare their families the expense of potentially life-saving treatment.

    And what, pray tell, would be so terrible about that – other than the fact that it might cost some hospital or doctors some business?

    1. If the person themselves does not want to die but is coerced into doing it by a family more concerned with the bottom line that doesn’t sound horrible to you?

      1. Depends on what you mean by “coerced.” Also depends on the age and/or relationship of the person in question. Obviously a family has a moral and legal obligation to provide for the care of a child, but not necessarily for some other family member.

      2. And by the way, most suicides don’t actually want to die – they just don’t care to endure the circumstances that would be necessary to continue living. I speak with some first hand knowledge in the matter: I had a younger brother who blew his head off about ten years ago for no particular reason that anyone could discern other than the fact that he couldn’t seem to attain the lifestyle he desired. Another younger brother died fifteen years ago of a massive brain hemorrhage caused by years of abusing alcohol and drugs, which he would not give up even though the doctor told him it was killing him ( stupid doctors, what do they know – right?)

        Fortunately – or unfortunately, depending on one’s perspective – neither left a wife or any children behind. Both these guys were in their late forties. Very hard on my poor mother.

  11. I struggle with this because the idea that anyone is entitled to decide when they should die gets murky when we take in the context of any potential mental illnesses. If someone is battling cancer and it’s depression that causes them to want to take their life how far do we indulge? Do we not have a responsibility to look out for people like that? I don’t have answers, merely concerns. I don’t want government ruling our lives and I hate regulations, but this one causes me pause.

    1. Do we not have a responsibility to look out for people like that?

      No, *we* don’t. That’s why humans usually engage in social behavior to build support networks, comprised of family, friends, and/or hired professionals. It’s *their* responsibility, not mine or any other stranger. I want zero say in what people do to their bodies, whether under the influence of a substance or a disease/disorder, but then again I seem to be an abnormal human who doesn’t feel the need to control others or protect them from themselves. Does this sound too harsh? I’m open to changing my mind on this but it will be due to reason, not appeals to emotion. In my opinion, your question that I quoted is the first step on the proverbial road to hell, paved with good intentions.

      context of any potential mental illnesses

      I would be more hesitant to place such trust in a field rife with misdiagnoses, studies that cannot be replicated, and questionable medication protocols.

  12. My wife chose to die by refusing the operation that would have cured her. I argued with her, I still get mad at her, but I have to admit that it was her decision. No one else can make that decision, especially not a bureaucrat with a checklist.

  13. It is ridiculous that while suicide is legal in most places, counselling someone to commit suicide is illegal. I can think of no other instance where doing something is legal, but telling someone to do the same thing is illegal.

  14. This is more craziness, now from the Libertairians…

    Why must every State have all it’s laws be the same. Let the people who live there decide how they want to live.

    …and in this case it is even stranger, this woman can kill her self any time and there is not much anyone can do about it. (I mean she will be dead.)

    Let the people decide if they want Gay Marrage, Abortion, the Right to die and then leave them alone.

    If you don’t like the local laws MOVE! Go live soemwhere where the laws suit your fancy.

    I would never live in California, Maryland, Illinois, or New York because they have laws and taxes I disagree with, why is it not the same for this kind of thing?

    I mean really, a bus ride to another place to get married or have your abortion is not such a big deal.

  15. No need to involve doctors at all. Simply remove the obstructions to the distribution and sale of cheap Do-It-Yourself! kits. No need for special drugs, either; more commonplace substances are cheaper and totally reliable (which is as reliable or more reliable than drug). The only reason it ain’t happening already is government interference in the market.

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  17. Keeping people alive provides income for doctors, nurses, hospitals, and big pharma.

  18. “None of that would have been necessary if Maynard had simply been allowed to walk into a store and walk out with the barbiturates she needed. But because the government has decreed that people must have a permission slip from a state-appointed gatekeeper to obtain these drugs (and many others), she and her husband were forced to uproot themselves during an already trying and tumultuous time.”

    Absolute nonsense. There are a myriad of ways to kill oneself if you really want to. There was no force used to uproot them, rather, they chose to be forced by the state, and one specific choice that she made on the “how-to.”

    For me, the issue is why did this individual think she had to have a legal “permission slip” to do so?

  19. Your source has done you a disservice. Assisted suicide is a homicide in Montana. Our MT Supreme Court ruled that if a doctor is charged with a homicide they might have a potential defense based on consent. The Court did not address civil liabilities. No one in Montana has immunity from civil or criminal charges. Does that sound legal to you? Oregon model bills have been rejected by our legislature in 2011, 2013 and 2015 because of gapping loopholes that expand the scope of abuse of elders and folks with disabilities of all ages. Passage would have established dangerous public policy.
    In Oregon and Washington heirs are allowed to participate from the start to the end, eviscerating intended safe guards. Everyone involved in the lethal process gets immediate immunity and family members are not required to be contacted. A witness is not required to confirm the dose was self-administered so if they struggled and changed their mind who would ever know? In addition these laws prohibit investigations or public inquiries leaving no recourse for surviving family members who were not contacted. Does that sound like good public policy to you? This is very dangerous public policy that does not serve the common good. It serves the health insurance corporations very well. All of these loopholes are embodied in California’s ABX2-15. A veto is in good order. A correction would be in good order.
    Oregon and Washington should amend their initiative-sound-bite driven dangerous laws.

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