Wednesday, 17 February 2016

Giving Death a Helping Hand

In 1930 Carl Panzram was hanged. The account of his life makes dismal reading. When he went to the noose he confessed to 21 murders and 1,000 rapes. He lived by theft and his hatred of humankind was shown in random acts of cruelty and vandalism. Given the danger he posed to society, the non existent hopes of rehabilitating him, and his ingenuity at escaping from prison, it is hard to argue against the eventual imposition of the death penalty on him.

For those who argue in favour of the death penalty cases like Carl Panzram are trotted out as evidence: there are some people, it is argued, who are so irredeemably evil that the world is better off without them. There are some acts of wickedness so monstrous that death seems a just punishment for them. Last year, standing in Auschwitz I could sympathise with that view. But of course, when the death penalty is legalised  it is never quite so cut and dried. No matter how thorough the legal system there are always people who are wrongly accused and wrongly convicted. And amongst those who are guilty of murder the ultimate punishment seems to be applied in a very skewed fashion. Those who can afford the best defences; those whose connections and assets allow them to play the system know how to beat it. So death row fills with the young, the  poor and black and the mentally ill. It fills with those whose life circumstances or addictions or passions have led them to make fatally stupid decisions. And repentant and reformed souls are led to the gas chambers alongside the irredeemably wicked. I would hazard a guess that unambiguously evil wretches like Carl Panzram are a minority of those who are executed.

So when we discuss the subject of medically assisted suicide I find it uncomfortable when the cases urged as exemplars for its acceptance are so clear cut and seemingly unambiguous, and where the implication is that all presenting cases will be like this. My experience with the elderly and dying is that judgements of coercion and rationality when people are making such a decision will be very difficult to assess.
  • People are ambiguous creatures. We are perfectly capable of holding two or more conflicting ideas in our heads at the same time and switch between them on a minute by minute basis depending on what mood we are in and who we have been talking to last and what we have read or seen on TV. 
  • When debilitated by serious illness it is very possible for people to be consumed with guilt over the burden they cause their relatives; to overestimate the trouble they are to others and underestimate their own worth and needs.
  • When faced with the prospect of an inheritance disappearing in rest home bills; when faced with their own unease around illness and death; when consumed by longstanding animosities or jealousies it is easy for close relatives to covertly or overtly place enormous pressure on a dying person. It can be hard to detect this.
  • When faced with the loss of much that they hold dear it is natural for people to grieve and feel depressed, and to make decisions which are influenced by short term states of mind.  
 If we were to allow medically assisted suicide we would, of course, need to have a system and that system would need to be devised and governed and policed by somebody. Which would mean that it would be, inevitably, flawed and open to manipulation by those with the will and the means to do so.  Give it enough time to operate and the system would become as skewed as the one for sorting candidates for death row. The most vulnerable and weak amongst us; those who have no champion or those with venal and selfish champions; those whose grief processes are currently delivering them anger or depression; those with low self esteem; those frightened of the future; these are the ones who would make up most of the numbers.

Of course there are people whose future is bleak and who face a very unpleasant time between now and death. But we have means of palliative care which can make almost every passage to death bearable, and the risks of systematically allowing us to shorten lives which have become troublesome to ourselves or others are  too great to allow.


Alden Smith said...

I understand and empathize with the wisdom and cautions that are explicit in all you say, up until the very last paragraph of your post where I have some concerns about the statement .... "which can make almost every passage to death bearable - "every" is a relative term. Let me explain.

A few years ago I read an article in the NZ Listener magazine about palliative care and the efficacy of pain killing drugs. Apparently there are, because of their genetic makeup a small number of people (less than one percent) who do not respond to any type or dosage of pain relief. The article was about new research into more efficient drugs.

The writer of the Listener article wrote about a personal experience involving his sister. He came back to NZ to visit her in hospital. She had cancer of the spine. He arrived only knowing which ward, not the room number she was in. He only needed the ward number because when he got out to the lift he just followed the blood curdling primal screams to someone whose spine was being systematically broken as the cancer advanced. No drugs were effective. She took two weeks to die. I found this a harrowing and haunting story. I use this story to balance your words ... "and who face a very unpleasant time between now and death." 'Unpleasant' in this case is rather an understatement.

Less than one percent who die like this is still about one in every two hundred - but when we are talking about the whole population of the planet, that is a considerable number of people.

It is of great importance that voices such as yours should be heard regarding the institutionalising into the system practises of 'slippery slopes' that can be subverted by uncaring relatives or some future (or current) call by the state for efficiencies and cost cutting in hospitals, but these argument are predicated (wisely so) on the more negative aspects of human behaviour. But I think we also need to look at the positive side of the coin - our capacity for compassion and the needs and requests of the dying each of whom is always an individual before they are a percentage. We especially need to heed those requests from patients such as in my example who die without hope of relief from their suffering.

I don't have an complete answer to this difficult debate except to say that absolute relief from overwhelming pain for all those in hospice care is the solution. Let's hope medical science develops such relief. Perhaps in the meantime we should be reluctant to advocate a 'one size fits all' solutions to fraught and complex situations. Perhaps patients whose DNA has made them resistant to all attempts at pain relief should be treated as special cases. Perhaps in the maelstrom of their pain and fear someone should ask them what THEY want to happen?

Kelvin Wright said...

I guess this is a case in point. Here is an unambiguous case, where, on the surface of it, the case for assisted death seems unarguable. But the problem is that this sort of case is not typical. Most are far more ambiguous than this, and no matter what system is set up, no matter how rigorously it is vetted and monitored, it will be open to abuse and exploitation. Yes it is a slippery slope. No matter where the boundary is set on this one there will always be the case just over the boundary, and the case just a little further over than that. And whoever is deciding on these will face, and be influenced by, interested parties who have varying abilities to buy advice and apply pressure.

I used the parallel of arguments about capital punishment, above, but of course there is a huge difference. Probably no one reading my blog is ever going to wind up on death row. Certainly everyone reading my blog is going to die, and for most of us it's probably going to be a fairly long and drawn out process. Your example above is a bit personal for me too. Unlike many people I can make a reasonable guess at how I am going to die: by metastatic prostate cancer. That is most likely to manifest itself in metastetes growing in my bones, and the most common place for this to happen is the spine. Who knows? My words here may yet come back to haunt me.