A sermon has religious stuff in it (Sermon prep III).

[rivka]

More of my argument about assisted suicide follows. This part is really long, so I'm putting it behind a cut tag. This is also the part that needs the most work, [N.B.: Michael says no, it's the last section (not posted yet) that needs the most work. So watch for something worse than this.] because I'm not used to making religious arguments - there are so few contexts in which they are appropriate. (Of course, a sermon would be one of them.)

Opinions and argument continue to be welcome.

Why is physical decline considered so different from other negative events that we consider setting it apart as the only acceptable justification for suicide? I have some ideas.

We live in a society that values independence so much that parents of month-old babies are cautioned not to let them get too dependent on their mothers. A society that finds dependence so humiliating a condition that "Depends" is the name of an adult diaper. We live in – we are raised in – we continually breathe the air of a society in which our worth is fundamentally seen as coming from what we do. "What do you do? When are you going to do something with your life? What contributions can you make to society?" Our abilities and our actions are the most important things about us... right?

So that when we cannot do, when our capabilities become disabilities, when we can no longer preserve the rugged independence that is the American ideal… we may not know anymore what we have left.

Or perhaps we don’t put much stock in the abilities of our bodies, but we feel that our primary value lies in our minds, our intellects. I might be able to accept the idea of using a wheelchair, but feel that if I could no longer put together an incisive argument, or read The New York Times, or balance my checkbook, my worth as a person would be degraded.

We may fall into this way of thinking - which some call ablism or disablism – about ourselves. And more gravely: when other people can no longer do, when they are not capable, when they face increasing dependency as they age or become disabled... it may seem to us, through the lens of our independence-and-action-prizing culture, as if it would be perfectly rational for them to conclude that their life is not worth living. A conclusion we would never accept from a physically healthy person.

Where do our UU values lead us, on these issues? That’s a complicated question to answer, and it is clear that where assisted suicide is concerned different members of our congregation have looked within themselves and found very different answers. We may also perceive conflict between different UU values. Our Unitarian forebears were Puritans; from them we may have inherited a sense that our works are what give us value. Unitarians have long prized intellect and rationality; excellent values, but ones which may leave us vulnerable to losing our sense of worth if our intellect fades.

More generally, our Unitarian emphasis on rationality may mean that when someone presents an apparently rational argument that their life is not worth living, it is difficult for us to look deeper beneath the surface of that rational argument, to test the assumptions on which it rests.

And as religious liberals, we may shy away from a position on assisted suicide which would appear to put us on the same side as the right-to-life movement and the Catholic Church. If they’re opposed to assisted suicide on religious grounds, doesn’t that automatically mean that we ought to favor it?

No. I want to call for us to re-examine this issue, approaching it with Universalist hearts as well as Unitarian minds. The First Principle reminds us that we have inherent worth. "We affirm the inherent worth and dignity of all people." Not because of their actions or capabilities, but as an integral part of their very being. Our UU values tell us that we do not have to do to have worth. We simply have to be. Our UU values direct us to honor the lives of people who are disabled, frail, depressed, mentally incapacitated, to the same extent that we value the lives of people who are healthy, vital, confident, intelligent.

To me, the First Principle unequivocally says that when someone tells me that their life is worthless, I cannot agree with them. I must find a way to support and affirm their worth.

The Second Principle guides us toward justice, equity, and compassion in human relations. I want to spend time talking about this, because assisted suicide is often framed as the "compassionate" answer to suffering at the end of life. So let’s consider those problems in greater depth, and the solutions to which the Second Principle may lead us.

So far I’ve focused on the emotional and existential challenges of people facing death or severe disability: a sense of meaninglessness, hopelessness, loss of personal value. We know those are far from the only challenges. People struggle with pain, which is often inadequately controlled. They fear that they will be a care burden for relatives and friends, or that they will have to give up their freedom for the restrictions of a nursing home. They fear that they will be poorly treated when they are helpless. They fear leaving their spouse with tremendous medical debt, or wiping out the estate they hoped to leave to their children. These are not irrational fears. They are often very real. They may seem overwhelming when we, or our loved ones, are facing them.

What, then, is the just, equitable, and compassionate response to someone who says that "the circumstances of my life are intolerable"?

When I look back at UU history, I see that we have faced that question again and again. Our UU forebears have answered that question with their social action work for abolition, for civil rights, for women’s rights, for immigrants, for lesbian, gay, and transgendered people, for oppressed people all over the world. We have fought to relieve suffering and increase freedom and improve living conditions in the most desperate and hopeless of circumstances.

Only with this issue, as far as I can tell, have UUs been encouraged to come to the conclusion that when the conditions of someone’s life are intolerable, the just and compassionate response is to kill them.

That doesn’t make sense to me. To me that is a profound rejection of our responsibilities under the First and Second Principles, and a profound rejection of our denominational history as agents of transformative social change. I don’t know how we got here, except that – as Aaron Beck warned us – on this issue we’ve gotten sucked into agreeing with helpless, demoralized, and oppressed people that their situation is truly hopeless.

I say to you that it is not. When faced with the suffering of people who are disabled or dying, we have options beyond reframing "compassion" and "dignity" to mean fatal overdoses for those who lose hope.

(Then I have stuff about what we need to do to support people who are dying and transform end-of-life care, which I'll break off into a fourth sermon prep post.)

Comments

[kalmn.livejournal.com]

Only with this issue, as far as I can tell, have UUs been encouraged to come to the conclusion that when the conditions of someone’s life are intolerable, the just and compassionate response is to kill them.

ha!

if people do not fall of their chairs when you say that, it is because they are secretly robots. go, you. this is great.

[hobbitbabe.livejournal.com]

Yes! It's a key point - and it's an appropriately-shocking way to present it, after all the buildup.

[ororo.livejournal.com]

This is a fascinating journey you've been on. thank you for sharing it.

[naomikritzer]

I think this is a really good section, actually.

The big open question for me here is, "How can societal change help people who want to die because they are terminally ill?" Which I assume you will address in the next section.

I think the assumption a lot of your audience is making is that the suffering created by terminal illness is solely a medical issue; social change does not fix medical issues, thus letting us off the hook. You're challenging that really vigorously here, but I think you will need to underscore that again in the next section.

[txobserver.livejournal.com]

I have been reading all your posts about this and I see your point of view. But I would like to share a personal story. It relates to the subject of your sermon as follows: I am going to describe the two year horror that my mom experienced and tell you that I believe one of my sisters (at least) will be extremely interested in assisted suicide if she sees herself going down the same path. I myself have decided to try and keep the means for suicide at hand for the same reason. My mom had a right brain stroke taking away her ability to see things on her left side. She had subsequent brain events that might have been some kind of seizure or additional strokes. The most awful part of the stroke was that it left her with psychotic episodes (not all the time, but pretty much every evening and night) in which she was convinced she was away from her (girlhood) home, and her mom was worried sick about her. She would repeatedly try to call her mother (who died 20 years before). She would try to get up and go to the parking lot to transport herself home, sometimes believing she would catch the bus, sometimes thinking she could drive, etc. She also thought people had stolen her furniture and that she was being held captive. Her psychiatrist prescribed anti-psychotics. These would help for a while (days to a couple of weeks) then would build up in her system causing her to be immobile and requiring complete assistance to get to the toilet, get in a wheel chair, everything. Then they would lower the dose or stop the medication. Her mobility would return, but so would her delusions. She was in psychic agony, and despite taking her to multiple doctors, she was never free of this horrific cycle of symptoms. She finally had a heart attack and died.

There was not a time when assisted suicide would have come up in the care of my mom. But for her children who saw this happening and got the nightly calls to come to the nursing home (or 3000 miles away, the daily calls where she told of her plight), unable to help her no matter what we tried, we all were left wanting to be certain this never happens to us. Consequently, I don't think your arguments against assisted suicide apply to, for example, my sister were she to have such a stroke and ask for help committing suicide in a lucid period. Because it was quite evident to us that the medical community has no answer for my mother's type of misery. She had excellent insurance (retired military wife) and an estate that paid for good care. Two of her daughters lived very near and went to see her multiple times a week. I spent a week with her once a quarter during this time, as I live across the country, and so did my brother. I would be interested in your reaction to this situation.

[tsjafo.livejournal.com]

I'm also interested in this situation. What of those who make their decision while they are still rational enough to carry it out? Or those who have expressed their wishes but are no longer able to carry them out?

[rivka.livejournal.com]

It sounds like an absolutely horrific situation. I am so sorry that you and your family had to go through that, and I'm not at all surprised that you and your sister feel so intensely about never wanting to experience anything remotely similar.

I feel like there's not much that I can say about a particular situation, given that I wasn't there and don't know what treatments your mother had, the specifics of her care arrangements, what else might have been done, etc. I do understand your conviction that there were no other medical options, and wouldn't be now either (since you describe the absence of an answer in the present tense). I am curious as to how long ago this was; there have been massive improvements in the ability to treat psychosis and bizarre neuropsychological conditions in the last ten years.

I also wonder about your statement "there was not a time when assisted suicide would have come up in the care of my mom." Did she disapprove of suicide? Or was it more that none of you wanted to bring up something blatantly illegal? Or were the rest of you not ready to let her go, or hopeful that some solution would be found up until the end, or concerned that she was not competent to consent, or something else?

You say that you keep the means of suicide on hand. As a covert action of a private individual, there isn't really anything that can be done to stop that. I'm talking about efforts to set up some sort of system of social arbiters, such that people are asked to determine that certain people's desire to commit suicide is irrational and should be met with psychiatric treatment, and that other people's desire to commit suicide reflects the true worthlessness of their lives. Essentially, asking other people to sanction and be complicit in your death. I think that type of system has inevitable negative effects on society as well as on the individual, and I will continue to argue against it.

You don't have to agree with me, though.

[txobserver.livejournal.com]

My mother died two years ago. She was a devout Catholic and I believe would not have requested assisted suicide if it had been available in her state. I do not at all believe in substituting my own judgment for the individual who is in the situation.

As the citation shows (noted in my later comment), it seems that the effects of the Oregon law had a beneficial effect on the awareness and use by physicians of palliative care and referral to hospice. I wonder what evidence there is for the inevitable negative effects you fear, and whether, instead, it matters how the legalization of assisted suicide is institutionalized?

[rivka.livejournal.com]

I wonder what evidence there is for the inevitable negative effects you fear, and whether, instead, it matters how the legalization of assisted suicide is institutionalized?

I don't think there is a way of knowing, for example, how many people have died in Oregon who could instead have benefited from therapy for demoralization syndrome. Or if you go back to my story about Ray - if he had committed suicide before he began therapy, who would have registered that as a negative outcome? He would have been another terminally ill person, out of treatment options, who saw no hope in his future wanted to die. There would have been no way to measure the loss of an extra year of life, during which he utterly transformed his understanding of himself.

As far as other effects: the statistics on assisted suicide in the Netherlands are pretty appalling. It's been legal for more than twenty years there. The laws require a great many checks and balances, but the evidence shows that they simply aren't followed. Patients are supposed to be the ones to bring it up, but more than half of doctors have suggested it to a patient. And one in four doctors admits, in surveys, to having killed a patient who did not request it. One in four.

Right now there is considerable support in the Netherlands for revising the law to allow any person over the age of 70, no matter how healthy, to request assisted suicide. Examples of reasons given by supporters of the law include feeling lonely and isolated, being widowed, and becoming less physically capable. I find that a pretty appalling example of how perceptions of the value of an older/weaker/vulnerable life have been degraded. Of course, given the lack of a control group, there's no way to test whether the apparent acceptability of this new proposal is an effect of legalized assisted suicide.

[firecat]

there have been massive improvements in the ability to treat psychosis and bizarre neuropsychological conditions in the last ten years.

My experience in the past year is similar to txobserver's. My mother has Alzheimers that includes pretty severe delusions at times; paranoid delusions are a very common aspect of middle-stage Alzheimers. New anti-psychotic meds help some, but they have pretty major side effects (similar to those txobserver described) and she still spends a great deal of time feeling terribly frightened.

Your sermon mentions mental decline, and if no longer being able to do the things you used to were the only issue, I would agree with you. But you don't mention incurable fear.

I would really like to be able to write an advance health care directive that says "If I get incurable dementia, I am frightened most of the time, and no available treatments alleviate this, I want to be helped to die." I would really like to live in a society where my loved ones could get help carrying out my wish and would not have to face murder charges.

[txobserver.livejournal.com]

Exactly this.

[tsjafo.livejournal.com]

Instead of active assistance, what of simply not standing in the way of suicide? A kind of "do not resuscitate" document? If someone has to take active measures to remain alive and makes a conscious decide to stop, asking folks to not interfere would not be assisted suicide?

[matthewwdaly.livejournal.com]

Very thoughtful. And well-argued. If this is the second-worst part of your sermon, then it should be a relief to you.

I do disagree with it as a liberal person of faith. Or I might; perhaps it is something that you might clarify. I believe that your principles might well convince you that you should persuade me that my life has value. However, if those principles lead you to reject my right to self-determination, then it is a rejection of my identity and is unjust.

I think that the ablism charge is one that we should analyze as a culture. I don't think that it alone stands up as a major factor, but it's fair to suggest that it is in the mix. Conversely, I think that the belief that the greatest priority of one's life should be to preserve one's life is no less an error. This is not a fresh idea; there are causes for which Gandhi was willing to die, and Jesus believed that the greatest love is laying down ones life for one's friends (John 15).

It's a difficult decision that we will more and more be asked to face ourselves as clinical immortality becomes increasingly less fantastic. But to say that the answer is always "no" is to doom us all to the curse of Tithonus. For myself, I'd rather spend my estate endowing a college scholarship than paying hundreds of thousands of dollars to extend my life beyond my body's natural ability to live. My death is mandatory, but being forgotten after my death is something that is worth struggling against. In any event, with all due respect, you are not welcome to make the decision on my behalf.

[rivka.livejournal.com]

I believe that your principles might well convince you that you should persuade me that my life has value. However, if those principles lead you to reject my right to self-determination, then it is a rejection of my identity and is unjust.

To whom do you extend the right to self-determination when in comes to suicide? It is current practice to allow (and in some cases, require) involuntary hospitalization of suicidal people for psychiatric treatment. Do you oppose those laws, in favor of a universal "right to die?" Or do you support the right to suicide only in cases of terminal illness and/or severe disability?

Also: if you go down into the basement and shoot yourself in the head without involving or warning anyone, I suppose you might argue that this is no one's business but your own. (Your family and friends would probably disagree.)

Proponents of assisted suicide aren't arguing for their right to do that. They're arguing for the right to have socially sanctioned, medically supported suicide. They're arguing that although some suicides may be irrational, others are not. That puts society into the position of judging which is which. The only real way to do so is for some outside person or group to decide whether there is indeed no possible value to the suicidal person's future life.

As a member of the society involved, I absolutely have a say in whether we should be sanctioning some suicides. By asking for social approval, assisted suicide proponents have officially made it my business.

Conversely, I think that the belief that the greatest priority of one's life should be to preserve one's life is no less an error. [..] For myself, I'd rather spend my estate endowing a college scholarship than paying hundreds of thousands of dollars to extend my life beyond my body's natural ability to live.

This is a false dichotomy. The choice isn't between, on the one hand, being compelled to pursue every possible medical intervention no matter how painful and futile, or on the other hand, demanding a suicide pill from your doctor. Every person has the right to refuse medical treatment. Every person has the right to decide at which point to allow nature to take its course. There is no positive duty to accept potentially curative medical treatment.

If you are terminally ill and you decide at some point that you aren't going to go into the hospital anymore, and you choose to receive symptom-relieving treatments and pain control at home until such time that you die at home, I fully support that.

If you are terminally ill and you decide that you want some hospital committee to make an official determination that the rest of your natural life wouldn't be worth anything anyway, such that a doctor should be given the all-clear to violate the Hippocratic Oath and kill you while everyone else is forced to stand by and do nothing, then you and I are going to have a fight.

[txobserver.livejournal.com]

You are lumping all terminal situations together. There may be no medical treatment that alleviates the situation. If I were in my mother's situation (but with my own values regarding the moral meaning of suicide) I believe it would be rational to conclude that there was not a way that I would get better. Now you may assume that were you treating this hypothetical patient you could find a way to give meaning to her life. I urge you to be more realistic about the amount of skilled state of the art care given to patients in general, much less elderly residents of nursing homes. Doctors do not spend hours at the bedside of each patient, assisting them to tease meaning out of their miserable situation and trying various state-of-the-art alternative treatments to see how well they will work, or giving personalized therapy. Your HIV patient was not the norm.

A decision to allow assisted suicide is not a determination that the rest of the patient's life is worthless, it is a determination that the patient is capable of deciding this for themselves. In Oregon it seems that many such patients obtain comfort from the knowledge that they have the control to end life should they wish to, yet never exercise that option.

I'm afraid that your statement that I don't have to agree with you is not quite true. If your position prevails I DO have to agree with you because I will have no choice.

[firecat]

I urge you to be more realistic about the amount of skilled state of the art care given to patients in general, much less elderly residents of nursing homes.

Furthermore, from reading the alz.org caregivers forum, it appears that a number of people with dementia live in their homes and receive 24/7 care from their own families along with specialized care from doctors and therapists. And they still spend a great deal of time feeling frightened, lost, and lonely.

[txobserver.livejournal.com]

Ironically, my father had Alzheimer's and had been nursed by my mom prior to her stroke. We placed him in the same nursing home as she, and he died six months after my mother. He seemed much more content, though he did wander, and was known to curse at the nurses from time to time.

My mom was never content. Withdrawal of her treatment would have meant more psychotic episodes, not death. That is why her children dread the possibility of this outcome for ourselves. What are the real choices someone in that position has?

[matthewwdaly.livejournal.com]

Just to lay it all out, I believe that medically assisted suicide should be legal and available to anyone (in contrast, say, to the way that abortion is legal but unavailable to poor women in the Midwest), and that the medical profession should implement guidelines as a check against coercion or depression.

But I do not believe that being in the final stage of a terminal illness should be the requirement. I think that someone in a lucid phase of a degenerative dementia-causing condition should be allowed as well, and heck I think that an Olympic skier who loses her legs in a car accident should be allowed to ask (although I would be sad if the counseling didn't change her mind). To fully lay out the depth of my feelings, I think that a guy going through a midlife crisis should be allowed to ask, on the grounds that the methods that laymen choose to take their lives is often more socially disadvantageous than a medical procedure would be. That's dangerous in the sense that people in my society might make choices that I or someone else might disagree with. But, you know, that puts it in line with the right to an abortion or gender transitioning or plenty of other things where I think that conservatives need to STFU about how someone else making personal choices is somehow harshing their squee. It isn't -- the world sees a free society and the people whose opinions matter thank you for preserving it.

Also, I'm sure I don't need to mention that the Hippocratic Oath forbids doctors from performing abortions (to say nothing of surgery), except that it doesn't any more. It's an evolving document, and I think that we should discuss whether it needs to evolve again on this issue. I don't want to force my doctor to give me a suicide pill upon the diagnosis of early-onset Alzheimers (which is a condition that is totally abhorrent to me), but if Doctor K down the street is comfortable with making that diagnosis, I don't think that the medical complex should prevent a doctor and a patient from reaching a mutually acceptable benevolent medical outcome just because it hastens death. It overcomes an unpleasant disease with no cure, and that should be enough.

To answer your question (which probably goes far beyond the scope of your sermon), I believe fundamentally that it is foolish to deny that anyone has the capacity to follow through on the choice to end their life. Suicide itself has been decriminalized throughout the United States, and I welcome those decisions. Of course, attempted suicide remains a crime, and I generally approve of that as well. If someone chooses to end their life in a way that makes a public nuisance of themselves (by standing on a bridge snarling rush hour traffic or tying up a 911 line in an effort to be talked down), I think that the state has a right to end that nuisance, and further that they have the obligations to prevent the death of anyone in their custody and also to perform psychiatric evaluations of anyone accused of a crime. I once had a roommate who went through this process, and I am glad that it exists because it was the first step in that person coming to wellness.

However, I think it would be better yet if suicide were not a dirty little secret that only comes up in crisis situations. If my roommate had the option of candidly pursuing a medically assisted suicide only on the basis that life was mentally unbearable, then my roommate's wellness would have come sooner and without the involuntary institutionalization that was a burden on my roommate, the state, and everyone else. Again, I would suggest a comparison to the liberalization of abortion access and how that ended the horrors of self-induced abortion and medically unlicensed procedures in exchange for safe medical procedures even if they were abhorrent to a portion of society. I would suggest that we would see similar increases in the social outcomes of suicide if we had a more pragmatic and healthy outlook on its access.

[rivka.livejournal.com]

Well, that's... consistent, anyway. It doesn't bother you that the desire for suicide is usually transient and responds to treatment?

Also: the medical profession should implement guidelines as a check against coercion or depression.

Please explain how one would go about certifying that a person who says "my life is awful and there is no hope of improvement, so much so that I want to kill myself" is not depressed.

If my roommate had the option of candidly pursuing a medically assisted suicide only on the basis that life was mentally unbearable, then my roommate's wellness would have come sooner

"Wellness" does not mean what you seem to think it means.

[matthewwdaly.livejournal.com]

Well, that's... consistent, anyway. It doesn't bother you that the desire for suicide is usually transient and responds to treatment?

It bothers me greatly. That's why I want people who want to commit suicide to feel welcome in the system instead of made to feel like their only solutions must come from themselves.

Anyway, I'll stop trying to express my viewpoint, as you are more versed on the subject and your sermon says what you intend it to.

[acceberskoorb.livejournal.com]

So very good!

[txobserver.livejournal.com]

Oregon publishes a mandated report annually about that year's outcomes under the Death With Dignity Act. Here is the latest one:
http://www.oregon.gov/DHS/ph/pas/docs/year12.pdf

The first page shows a graph of patients who received lethal prescriptions and those that actually took them. What this tells me is that many people wanted to retain the option of suicide, not that all wanted to die. I completely agree that the society should provide better palliative care and this article suggests that the DWD Act has increased doctors' awareness and use of that in Oregon. http://jama.ama-assn.org/cgi/content/full/285/18/2363

But fundamentally, and after full efforts have been made to invest a dying person's life with comfort and meaning, it is up to the person. For the reasons I described above, I would want access to the option of ending my life. Then I might or might not exercise it.

[acceberskoorb.livejournal.com]

The first page shows a graph of patients who received lethal prescriptions and those that actually took them. What this tells me is that many people wanted to retain the option of suicide, not that all wanted to die.

Your conclusion might be right. But another possibility (from this data) is that at some point after receiving the lethal prescription, the patients changed their minds. I think one of the difficult things about debating this issue is that, in trying to come to a thoughtful and rational decision, we have to make assumptions. We tend to imagine a person would feel X, without appreciating that thoughts and feelings change.

It's troubling to me that none of the 59 patients who died in 2009 by taking their lethal doses were referred to psychological treatment. I find it hard to say society did right by these folks by making it acceptable for them to kill themselves, but unnecessary to help them through the mentally and emotionally difficult decision to end their lives.

[rivka.livejournal.com]

It's troubling to me that none of the 59 patients who died in 2009 by taking their lethal doses were referred to psychological treatment.

!!! That will teach me not to follow links, won't it? Thank you for looking through the report and pulling this out. That really is horrifying, especially since under Oregon law people who want to commit suicide are supposed to be certified as "nondepressed." (Don't ask me how one would make that determination about a suicidal person, because I don't know. But apparently oncologists and other nonpsych medical doctors don't have a problem doing it.)

I also notice that although the objections to my position here have focused on untreatable neuropsychiatric symptoms which make it impossible for someone to benefit from efforts to improve their quality of life, an overwhelming majority of assisted suicides in Oregon appear to be attributable to demoralization. The reasons given are the ones that Dr. Kissane found could be alleviated by psychotherapy, and the ones I argue are associated with ablism and poor standards of care.

I suspect that a person with overwhelming untreatable neuropsychiatric symptoms is not actually eligible to commit suicide in Oregon due to their impaired ability to consent.

[txobserver.livejournal.com]

Kissane was discussing euthanasia not assisted suicide. He deplored the lack of palliative care in the Australian situation. He described the patients as not necessarily being terminal. In contrast, 91.5% of patients who died in 2009 in Oregon were in hospice care. This means that they were screened and judged to be within 6 months of dying when they were admitted to hospice care, and had gone through some amount of interviewing and thoughtful decision-making to be admitted. Hospice facilitates and encourages palliative care of all sorts. When my father was admitted to hospice care, part of the team was a psychiatric social worker, so there is a mental health professional involved. (Of course in his case, this didn't result in any mental health care for him...he couldn't communicate by then.) So it seems like the persons involved may have felt that psychotherapy was not relevant to their situation given the other supports that were in place.

[rivka.livejournal.com]

Kissane was discussing euthanasia not assisted suicide. He deplored the lack of palliative care in the Australian situation. He described the patients as not necessarily being terminal.

What?

Are you referencing something you found by Googling Kissane? Because I'm talking about things that he said when I heard him speak at a conference in 2003.

[johnpalmer.livejournal.com]

Why is physical decline considered so different from other negative events that we consider setting it apart as the only acceptable justification for suicide? I have some ideas.

Speaking for me only - I've never considered it an acceptable *justification* for suicide.

However, I do grant that in most cases, suicide is not rational. People are extremely resilient, and even in awful circumstances, tend not to want to die. Argumentum ad populum is tricky in some cases, but, if enough people desire something, it's safe to say that there's something desirable about it.

However, at end of life, some of that breaks down. "Don't kill yourself because of X; you might have a long and happy life after X gets better, or even in spite of X staying as bad, or getting worse," doesn't apply.

Of course, you might have a *happy* life, even if not a long one, with a fatal disease. And only those who refuse to accept an earlier death as an answer will look for the ways to make those last days happy, no matter how great the challenge.

In that sense, assisted suicide might be compassion, but it's the cheap compassion. It's the "Are there no prisons, no workhouses?" answer. There's *an* answer - so, don't bother me trying to find a better, more compassionate one!

[juthwara.livejournal.com]

I see several people bringing up the issue of Alzheimer's disease/dementia, and before my father died of Alzheimer's, it was definitely on my list of reasons for assisted suicide. But the more I think about it, the more problems I have with it.

My biggest is that we can't truly know what's going on in the head of someone who isn't mentally competent to tell us. And so I have grave reservations about allowing society to walk down the road of allowing people to actively kill someone who isn't mentally competent to make that decision, even with an advance directive. It might start with the elderly who are going to die soon, but how soon would it extend to the mentally ill who don't respond to treatment, or people who are medically stable, but too brain damaged to have real awareness? What sort of test can we possibly come up with to determine the life quality of someone who can't communicate? When would caregivers exhausted by the demands of taking care of an Alzheimer's patient start choosing to end their loved one's life because they can't afford a good nursing home?

When my father was first diagnosed, I kept fantasizing about his having a sudden fatal heart attack, because all I could see is that he was going to die. And I think that's what happens when we talk about assisted suicide - all we can focus on is the death that is coming. But, and I say this while emphasizing this is just my experience and opinion, while he clearly wasn't very happy in his last six months and it was clear he wasn't going to live out the year, it would have felt like murder to take him to the doctor to end his life prematurely, because of how helpless and dependent he was.

[papersky.livejournal.com]

I've had experience with a few people with Alzheimers and/or dementia, and it's always been that most of the time they are confused and bewildered but if you catch them at the right angle they're still in there and you can talk to them.

I have a close friend who is mentally deteriorating -- she forgets things. You tell her something, she forgets all about it and asks you again. It used to be that she'd remember for a while, now she'll forget something from this morning. But if you can deal with repeating things and not act upset, she's still her, she's still worth talking to. My aunt had a friend in the same situation only much worse (incontinent, incredibly confused), and even when he was awfully confused she kept on talking as if he was making sense and sometimes he would -- she put hours of time every day into this, and every few days they'd have an actual conversation. He was still in there. The problem for most people like this is that nobody is putting the time in. My cousin's mother-in-law didn't seem to have anything left -- but she was in a home, being visited once every few months.

One of my relatives has been experiencing confusion and general decline for the last couple of years. But even now, she gets much more focused when she is with people she knows, who are happy to hear her talk about the past.

The paranoia stuff mentioned above is much more frightening to me than the kind of deterioration I have seen close up.