Wednesday, May 21, 2008

Roles vs. Reality in "Right to Die"

The award-winning movie Million Dollar Baby (2004) aired as an AMC television premiere last weekend (May 17th & 18th). That movie deals with hard struggles and choices in living, right up to the end of life.

The network's promotional summary does not give away the ending.

Veteran boxing trainer Frankie Dunn (Clint Eastwood) has devoted his life to the ring but has precious little to show for it.

When Maggie Fitzgerald (Hilary Swank) enters Frankie's gym in search of a trainer, he regards her as a dubious prospect, and isn't afraid to tell her why: She's too old, she lacks experience and technique -- and she’s a woman.

But for Maggie, boxing is the one thing in life that gives her meaning, and she’s not giving it up.
But now, four years after the release on January 28, 2004, of Million Dollar Baby, it is no secret that the plot involves an end-of-life decision affecting one of its central characters who has struggled through life.

Most folks consider that one's "right to die" is a personal issue, and many desire the ability to expedite an end-of-life decision. Still, only half of us have stated our philosophy or decisions in written health care directives, despite our ability under state law to do so.

Health care directive or "living will" statutes in every state (except Oregon), however, do not create -- either in a patient or in an incapacitated patient's designated surrogate -- the ability to make a decision consistent with a "right to die", or authorize "physician-assisted suicide" consistent with such a desire & decision.

This limitation of the law lies at the heart of the movie's climatic crisis of conscience and compassion.

Consider, in this context, the results of a survey released on May 15, 2008, described in an article entitled "
Adults Surveyed Favor Doctor-Assisted Suicide", posted by Eldr Magazine (also available in a press release posted by PR Wire here).
ELDR magazine and today released the results of a national survey on the "right to die" issue or what some call "physician-assisted suicide."

It reveals that over 80% of adults say the right to die is a personal decision, not that of government or religion; that two-thirds want physician-assisted right to die legal, as in Oregon; that half of U.S adults could eventually face a right to die caretaker role for a loved one; and that only half of adults over 60 have a living will or health care directive. * * *

The article explained why and how the survey was undertaken.

The survey is in conjunction with ELDR's Summer issue cover article, "Perfect Ending," which tells the story and reflections of a physician who had clandestinely given patients, who were terminally ill and in great physical pain, the means to end their lives. The physician profiled is not identified.

"A painful or prolonged death is something everyone worries about," said Dave Bunnell, editor-in-chief of ELDR. "Yet too few of us plan ahead to be prepared for this possibility. Our survey is telling people if they act now, they can be in charge. You don't have to leave this entirely to fate." * * *

The article summarizes other results from ELDR Magazine's "Right To Die" National Survey:

  • Half of American adults (49.1 percent) have parents, close relatives or friends in their senior years for whom they might eventually be considered a guardian caretaker or legal trustee.
  • 82 percent want the option, if they were suffering at end-of-life, of being sedated into unconsciousness, even though this might hasten their death.
  • 93.6 percent want artificial life support stopped if they were in a persistent vegetative state, where mental functioning had ceased and it was highly unlikely they would regain consciousness.
  • Fewer than 25 percent have a living will or advance health care directive which states their wishes if they were incapacitated or in persistent vegetative state. Only half of those over 60 do.
The raw data (questions & responses) is displayed on a separate webpage, "Survey Results: The Right to Die".

The survey's results were cited in a Time magazine article, dated May 16, 2008, entitled "A New Fight to Legalize Euthanasia", by Kathleen Kingsbury.

Should we be allowed to determine when we die? Euthanasia may be an issue long debated in the U.S., but thus far voters in only one state, Oregon, have legalized the practice of physician-assisted suicide. But a popular former governor is determined to make Washington State the second this November.

Booth Gardner, who served as Washington's governor for two terms in the 1980s and '90s, is now leading a ballot initiative that, if approved, would allow doctors to prescribe lethal doses of narcotics to terminally ill patients who want to end their own lives.

The campaign is personal for Gardner. Diagnosed more than a decade ago with Parkinson's disease, a debilitating condition, his first reaction was "how can I take control over this," he says. "Then I realized that there was no way I could. I wanted to change that."

Gardner has repeatedly said he would end his own life if given the tools to do so legally with dignity. "It is my right as a human being to decide for myself," he adds. * * *

If you have not yet experienced the emotions generated in an end-of-life or right-to-die setting, you can watch Million Dollar Baby, which will be rebroadcast by AMC on Tuesday, May 27th, at 8:00 p.m EST, and again on Saturday, June 7th, at 8:00 p.m. & 11:00 p.m.

Update: 05/21/08 @ 7:00 pm:

John R. Price, Esq., of the Perkins Coie law firm in Seattle, Washington, sent me an email message in response to this posting, which is thoughtful & insightful:
[Links added]
Thanks for your [posting] regarding end-of-life issues and Washington Initiative I-1000.

Earlier this month I helped organize a lunch time presentation on the right-to-die by Kathryn Tucker, Esq., the legal director for Compassion and Choices, Portland, Oregon. Kathryn is also an adjunct professor at the Lewis and Clark Law School in Portland (while she lived in Seattle she held a similar position at the University of Washington School of Law). An article she has written on the history of right-to-die legislation will be published in the June issue of the Michigan Law Review.

As Ms. Tucker points out, the object of the initiative is to assure terminally ill competent adults the right to die peacefully at a time of their own choosing -- it is, I believe, not fairly characterized as "euthanasia", which carries some negative implications.

The data regarding the experience with the Oregon initiative are very reassuring -- and reflect low usage of the process. From what I have read and heard, there have been no complaints that the process has been abused or misused. Indeed, the requirements of the Oregon law and I-1000 are quite stringent in order to provide strong assurance against the process being abused.

The article in Time mentions the earlier, 1991, Washington initiative, but doesn't provide much background about the vote. In fact, up until the time of the vote, it was widely thought that the 1991 initiative would pass. It was narrowly defeated after Dr. Kevorkian "dispatched" two Michigan residents a couple of weeks before the vote -- which received wide publicity in Washington and was thought to have been a major factor in the defeat of the initiative.

Institutionally, the Catholic church opposes I-1000, as it opposed the 1991 initiative, although the position is not shared with many parishioners.

For those who would like to read a thoughtful philosophical piece on the right-to-die, I recommend Ronald Dworkin's book, Life's Dominions [1994, available through Random House, Amazon, among other booksellers]. Dworkin was, and perhaps still is, Professor of Jurisprudence at Oxford and a member of the law faculty at NYU. [Links added.]
See also: Book Review, "Life's Dominion: An Argument About Abortion, Euthanasia, and Individual Freedom", by Richard A. Epstein.