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Published: Monday, 8/10/2009

Assisted suicide takes center stage again

LAST month, the well-known British composer Sir Edward Downes, 85, and his wife of 54 years, Lady Joan, 75, committed suicide together in a clinic in Switzerland. She had terminal cancer, and he had gone blind and lost much of his hearing. They made the decision with the consent of their children.

The assisted suicide of the two prominent people has returned the issue of euthanasia to center stage and has reignited the debate about limits of personal choice versus societal responsibility.

Assisted suicide is legal in the Netherlands, Belgium, Luxemburg, and Switzerland and in this country in the states of Washington and Oregon.

The debate often centers around the morality of the act. Those who are against assisted suicide contend, often erroneously and somewhat arrogantly, that there is no pain that cannot be relieved and that there is always help and remedy available to those who are in the depth of despair as a result of their illness. I do not believe any of these wise-heads have ever been in situations that compel people to take that step.

I use the words erroneous and arrogant because I had been, for more than 45 years, part of the medical profession that looks at life through the narrow prism of the Hippocratic Oath. In this distorted view, do no harm turns into keep alive at all cost.

The broader issues of life and death and the humane approach to those issues defy the cookie-cutter, one-size-fits-all prescription. These philosophical and moral imperatives are neither taught to physicians during training nor are they widely practiced in the profession. In this self-righteous stance, assisted suicide always appears inhumane, unnecessary, and immoral. I disagree.

There are situations where people cannot live or cope with their ailments. They struggle but find themselves trapped in a vicious cycle. Somehow, confusing metaphors such as life is precious, God determines the end, and there is always hope are clichs and euphemisms meant to pacify caregivers rather than patients.

Why can't a person of sound mind make the decision to exit the world with grace and dignity when there are no other viable options? And when do the caregivers, if ever, realize that sometimes living with the burden of disease is worse than the death itself?

There are of course some deadly traps on this slippery slope. Was the patient coerced into the decision? Was the option of any viable palliative care discussed with the patient? If left alone, what course would the disease have taken and how long would it have taken to reach the end? Was there any family dynamic that might have influenced the decision? Was grandmother put on an ice floe because she had become a burden?

These are legitimate and important concerns. But based on the principles of evidence-based medicine that are increasingly being used in medical practice and in policy decisions, we should be able to devise pathways to chart a realistic route. Today, all major decisions at hospitals and doctors' offices and on policy issues at state and federal levels are guided by numbers and facts. We have done that with most diseases where we can plot their courses in light of available variables such as age, socioeconomic status, family history, and other risk factors. And still we are unable or unwilling to plot the course of a terminally ill patient or one in the throes of physical or mental illness.

The phrase "sanctity of life" has become the ultimate shield in any conversation about euthanasia. The words camouflage real-life situations when the sufferer's life ceases to be worth living. The phrase has a rather firm and unyielding religious underpinning and thus any intervention that hastens a person's exit is considered as playing God.

We do that already. The burgeoning fields of genetics and genetic engineering, the embryonic stem-cell research, artificial insemination and the test-tube babies, the creation of artificial sperm, the creation of farm animals, and much more. The list is long and tedious.

Jack Kevorkian, unfairly dubbed Dr. Death by the media, brought the issue of assisted suicide center stage in this country when in 1998 he showed a videotaped suicide involving a patient with Lou Gehrig's disease on 60 Minutes. Convicted of second-degree murder, he served eight years behind bars.

Kevorkian helped bring a taboo subject to the public arena that some find disconcerting. While every civilized society pays attention to the greater good of its people, individual rights and control of one's life are also cherished principles of such societies. With the assisted suicide of two prominent people, those limits are again being debated and tested.

Dr. S. Amjad Hussain is a retired Toledo surgeon whose column appears every other week in The Blade.

Contact him at: aghaji@bex.net



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