Waiting for Baby vs. Waiting for Death: Reflecting on End-of-Life Ethics

Should dying Americans have the legal right to end their lives with help from their doctors? In Oregon, they have already had the right for the last ten years, since the state passed its “Death with Dignity Act,” after great controversy, in 1997.

Last week the Pew Forum on Religion & Public Life hosted a polite but pointed debate between two formidable players with very different points of view. ReligionWriter, attending the event, watched the two expertly zing the argument back and forth across the court, as Pew senior fellow David Masci umpired the match. And the winner? You’ll have to decide for yourself.

Autonomy vs. the Slippery Slope

The debate was not about religion per se. Leon Kass, former chair of the President’s Council on Bioethics, who opposes legalized aid in dying, asserted that his objection was not theological:

For me, it’s not a religious argument that your life is not yours, and therefore you submit to whatever comes your way, though I suspect if one thought that there might be less mischief done.

Rather, said Kass, his objection was not only that the Hippocratic Oath specifically forbids doctors from giving “deadly drugs” to those who ask for them, and that, in his view, the State of Oregon does not adequately ensure the law is not abused, but also that legalization of aid in dying leads to a slippery slope, at the bottom of which is a society where old or disabled people are encouraged to see themselves as “better off dead.”

Barbara Coombs Lee, president of the pro-aid-in-dying organization, Compassion & Choices, argued that the slope is not slippery at all, that ten years of Oregon’s Death with Dignity Act have not led to involuntary euthanasia or other horrors, and that many people simply take comfort in knowing they have an option and the right to exercise it. Said Coombs Lee, Oregon’s current law

assures that moral authority resides with individuals. … To assume moral agency for our own important life decisions from the time we achieve decision-making capacity to the time we die, that is what dignifies us as human beings, not the decision that we make.

Choosing to take life-ending medication prescribed by a doctor is not suicide when you are already facing an imminent and painful death, said Coombs Lee. She referred to Tom McDonald, a cancer patient who testified before California’s Senate Judiciary Committee when it was considering a right-to-die law (the law did not pass.) McDonald told the committee he would rather end his own life peacefully with doctor-prescribed drugs than face a death that, according to his doctor, will involve him drowning in his own blood when his tumor ruptures his pulmonary artery. Coombs Lee remarked at the Pew event: “I think McDonald deserves a right to determine the memories that his family will be left with when he dies.”

Parallels: Entering the World, Leaving the World

Far from such rarefied Washington D.C. discussions, a very different yet strangely similar debate goes on, this one among pregnant women on messages boards at popular sites like iVillage and BabyCenter.

The question facing those in advanced pregnancy is often this: Whether or not to hasten the birth of their child. Medical inductions are on the rise in the U.S., as are elective Cesarean sections. Parents talk about their desire to control the circumstances of the birth, for any number of reasons, such as avoiding perceived health risks or scheduling the birth for family convenience.

For those who believe in “natural childbirth,” however, something is not quite right about elective inductions or c-sections. Proponents argue that children should come in their own time, not on someone else’s schedule. And, as in the end-of-life debates, for religious people, there is just something that feels like God’s will about letting birth happen “naturally,” even if it’s messy or painful or inconvenient.

The debate about elective inductions and c-sections tends to swirl around the pragmatic question of whether they pose any risks to mother or child, just as the right-to-die debate tends to focus on issues like oversight and use-rates. But the philosophical issue at the heart of both debates is: Does human power threaten divine power? Is there a limit to what humans should be able to control? People are generally comfortable with hastening or intervening in other biological processes — pulling out baby teeth or installing a Pacemaker — but when it comes to birth and death, the issue seems to become more fraught.

Inevitably every woman in late pregnancy has to make certain decisions about how and when to have her baby (and there are some further interesting parallels between “birth plans” and living wills, and how both are often ignored or deemed irrelevant in the actual event,) but in this case all the options are legal.

And this is the nub of the right-to-die debate. You may believe that choosing to end your life under any circumstances is tantamount to an immoral or illegal suicide, or you may believe that the very value of your life is represented in your own choice to die peacefully. But should your own preference become law?

As Leon Kass acerbically noted during the Pew Forum discussion, anecdotes make bad policy. How can you create a law that gives everyone a chance to do what they think is right? If you’ve got a good answer to this one, please let the rest of us know — advice is needed.

Note: While ReligionWriter does contract work for the Pew Forum, including work related to the right-t0-die  event transcript, the above posting represents only her views, and not the views of the Pew Forum.