Sunday, January 17, 2016

Sunday Long Read: The Goodbye Man

I don't always agree with Mother Jones writer Kevin Drum, but as he faces terminal cancer and discusses openly the prospect and politics of assisted suicide, I find him brave.

IN THE DECADE after Oregon's law took effect, the physician-assisted-suicide movement gained little ground. On a national level approval rates remained steady, with about two-thirds of Americans telling Gallup they supported the concept, but that seemingly strong support didn't translate into legislative success.

Some of the reasons for this failure are obvious, but among the obscure ones is this: Assisted suicide has long been a West Coast movement. During the late 1980s and early 1990s, California, Oregon, and Washington all had active legislative legalization campaigns—even if only Oregon's succeeded—and according to a 1996 survey, West Coast doctors received many more requests for assisted suicide than doctors in other parts of the country. No one is quite sure why, but outside of the West Coast, it was simply not a very prominent issue.

Another reason legalization failed to gain ground is rooted in semantics. Miles Zaremski, an attorney who has argued on behalf of such bills for years, is typical of assisted-suicide supporters when he maintains that in the case of terminal patients, "we're not dealing with the concept or notion of suicide at all." Rather, it's nothing more than aiding the natural dying process. Opponents call this Orwellian and worse. Public sensitivities reflect thislinguistic divide. Although that longitudinal Gallup poll has long reported two-thirds support for legally allowing doctors to "end the patient's life by some painless means," support historically drops by 10 points or more when they ask if doctors should be allowed to "assist the patient to commit suicide." So when legislation is under consideration, opponents fill the airwaves with the word "suicide," and public support ebbs.

A third reason is demographic: The assisted-suicide movement has long been dominated by well-off, educated whites. As early as 1993, Dick Lehr reported in a Boston Globe series titled "Death and the Doctor's Hand" that every doctor he talked to said that patients who asked about assistance in dying were typically middle to upper class and accustomed to being in charge. As one oncologist put it, "These are usually very intelligent people, in control of their life—white, executive, rich, always leaders of the pack, can't be dependent on people a lot."

In fact, one of the reasons Oregon was first to pass an assisted-suicide bill is likely because it's a very white state—and so are the patients who take advantage of the Death With Dignity Act. The 2014 report from the Oregon Health Authority says that the median age of DWDA patients is 72 years old; 95 percent are white, and three-quarters have at least some college education.

Aid-in-dying bills are a tougher lift in more-diverse states. Minority patients have historically been wary of the medical establishment, and not without reason. There's abundant evidence that people of color have less access to health care than whites and receive less treatment even when they do have access. If the health care system already shortchanges them during the prime of their lives, would it also shortchange them at the end, pressing them to forgo expensive end-of-life care and just take a pill instead? This fear makes the doctors who serve them cautious about discussing assisted suicide. "My concern is for Latinos and other minority groups that might get disproportionately counseled to opt for physician-assisted suicide," one doctor told Lehr. More recently, Dr. Aaron Kheriaty, director of the medical ethics program at the University of California-Irvine School of Medicine, explained to the New York Times, "You're seeing the push for assisted suicide from generally white, upper-middle-class people, who are least likely to be pressured. You're not seeing support from the underinsured and economically marginalized. Those people want access to better health care."

Finally, there's the fourth and most obvious reason for legislative failures: Assisted suicide has a lot of moral opposition.

It's difficult to ask to die with dignity when the country doesn't allow you to live with dignity in the first place, you know?  I'm glad Kevin lives in a state where this is possible, and I am glad he recognizes that in the end very few people are afforded this choice, the key word here being afforded, but to me it seems like some of those resources used for death could be used to give better lives to those who are struggling with it first.

That's just me.

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