One of the most important stories of recent months was Dr. Diane Meier's change of heart about physician-assisted suicide (PAS). Meier, a New York physician and professor of geriatrics, is a specialist in "palliative care"—pain relief—for dying patients. For some years, she was an influential advocate of the legalization of PAS. But this past spring, Meier publicly reversed course. In a column in the April 24 New York Times, Meier made public the reasons for her change of mind. Her insights suggest broader connections for those committed to the sanctity of human life.
First, according to Meier, PAS advocates assume patients are mentally alert and competent to make a rational choice to end their lives. Meier now argues that these patients rarely are able to exercise such judgment. Normally they are confused, anxious, depressed, or simply incapable of thinking clearly—hardly a propitious context for making an important, life-or-death decision.
Second, those in favor of PAS normally would restrict its use to situations in which patients are within six months of death. Meier argues that it is nearly impossible to predict when patients are going to die until the last few days of their lives.
Third, PAS advocates claim that patients can be protected from coerced decisions to end their lives through the use of a doctor's signed certification. Meier now claims that noncoercion is impossible for a doctor to certify. Especially given the enormous financial pressures that medical bills impose, the availability of PAS is itself coercive. Dying patients know that merely by signing a document they would reduce the financial pressure on their families. No one needs to say a word about it.
Why this sounds all too familiar Advocates of PAS have succeeded in only one state: Oregon. The regulations Meier discussed in her article are drawn from the Oregon law. Already at least two assisted suicides have been performed there, though public officials are keeping such a tight lid on information that no one can know for sure how many assisted suicides have occurred or will occur. But the explicit goal of PAS advocates is to go national, making the Oregon experiment the American way of life.
According to David P. Gushee, director of the Center for Christian Leadership at Union University, it is deeply disturbing to compare early returns from the Oregon PAS experiment with an experiment in medicalized killing with which we are all familiar: abortion. Gushee, who is also vice president of Evangelicals for Social Action, notes that initial advocates of full legalization of abortion operated from a model strikingly similar to the medical and regulatory milieu envisioned by supporters of PAS and currently operating in Oregon. Women facing unwanted pregnancies would undertake a rational conversation with their physicians, who would guide them through their medical options to the best choice for them.
In fact, what emerged was a pattern in which emotional, confused, and frightened women turned to impersonal specialized abortion clinics staffed by marginally competent doctors whose full-time medical chore day by day is the termination of pregnancy. This fundamental corruption of the doctor-patient relationship, observes Gushee, is repeating itself with the Oregon PAS experiment. Both of the two known PAS victims in Oregon were refused PAS by their own physicians, only to receive referrals to death doctors from the Oregon branches of Compassion in Dying and the Hemlock Society. One can imagine a new industry of such physicians if PAS goes national, says Gushee, just like with abortion providers.
Likewise, advocates of full legalization of abortion assumed that this option would be selected by a small number of women under specialized circumstances. Abortion would be "safe, legal, and rare." This assumption parallels that of PAS advocates who intend to restrict that procedure to "the last six months of life" for certifiably terminally ill patients.
However, it is fully to be expected that just as abortion came to be the option of first rather than last resort for so many, so will PAS grow into a widely used procedure that far exceeds its originally envisioned boundaries, especially given the nebulous definitions of those boundaries.
PAS advocates are concerned to protect patient autonomy and noncoercion. Interestingly enough, Gushee notes, so were advocates of abortion; indeed, autonomy, noncoercion, and self-determination are the watchwords of the pro-choice movement. But such autonomy for women facing crisis pregnancies has turned out to be quite elusive. Many women end up at abortion clinics due to pressure from their fathers, husbands, boyfriends, and sexual partners. Just so, we can fully expect that patient autonomy in the area of assisted-suicide will erode under psychological, financial, and social pressures.
Fortunately, PAS has not won universal support. Dr. Meier's reversal is a hopeful sign. Perhaps we have learned a few things in the 25 years between Roe v. Wade and the Oregon PAS experiment.
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