Embracing Death With Compassion This Election Season

W.B. Yeats obituary @ Drumcliffe

But as the daylight succumbs to darkness,
And as the Stars exhaust their radiance,
Life bestowed returns to blankness,
The Law of Existence knows no defiance…

~Life Bestowed

Today is All Souls’ Day. In the Christian tradition it is the day when the souls of the faithful departed are commemorated. Serendipitously, it is two days before the denizens of the state of Washington vote on Initiative 1000 (I-1000) on the November 4 election. While Proposition 8 in California is getting most of the media attention I-1000 is the measure that really tests the ethical boundaries of one’s philosophy on life and death.

So what is I-1000? I-1000 or “Death with Dignity” is a measure that would “…permit terminally ill, competent, adult Washington residents medically predicted to die within six months to request and self-administer lethal medication prescribed by a physician.”

This is not just liberal vs. conservative political decision. It is a deeply moral and philosophical vote that transcends political affiliation. That’s why I took the time to read the details and listened to the pro and con arguments on the proposed measure. For me, this is a harder vote than the U.S. presidency.

In the end, however, I decided to cast a YES vote on Initiative 1000. Here’s my rationale on how I arrived at my decision:

#1. I filtered out the religious arguments.

To me, this is a matter of social ethics and philosophy rather than religious interpretations by some church hierarchy. Of course, people are free to fall back on their religious beliefs when making their decision, but this measure is best argued in a secular public square without the use of religious language (e.g. “the Bible says so…”). There are various religious views on suicide, but secular arguments against I-1000 are more reasonable and have more room for philosophical and ethical debates than religious convictions.

#2. I evaluated the measure whether it would be easy for people and health insurance companies to abuse it.

Opponents of I-1000 argue that there are no safeguards on the measure and there’s a possibility of abuse by insurance companies. Great points. But when I looked at the details of the specific provisions, I believe that there is enough safeguards to counter abuse.

Also, since I-1000 is modeled after 10-year old Oregon Death with Dignity Act, there is enough peer-reviewed independent studies stating that the “…Death With Dignity Act and related research and data analyses do not show evidence of abuse, neglect, manipulation of, or pressure on patients in vulnerable groups in the state of Oregon.”

#3. I put myself in the position of someone who has a dying loved one.

What if I have a loved one who’s dying? What if she’s terminal and that she would surely suffer a painful and gruesome death? I can’t bear the thought of seeing a loved one suffer a horrible death. If death is certain and my loved one specifically asks for eternal rest, then who am I to counter her decision? If she accepts death, then I have no right to project my own fear of death on her to make myself feel better.

#4. I put myself in the position of a physician.

Prescribing a lethal drug to a patient is against the Hippocratic Oath. I understand why there are physicians who are against I-1000. However, if I’m a physician, I would focus more on “doing no harm.” For terminal patients who only have a painful death to look forward to, I believe that it is more ethical to allow them to make a choice of relieving their suffering.

#5. I put myself in the position of the dying.

This is the easiest deliberation for me. Even the great Socrates drank his hemlock. I hope it doesn’t come to it, but if it do get afflicted with a gruesome terminal illness, I would like to have autonomy on how I die. I prefer to gather all my loved ones around my deathbed and tell them that I’m prepared to embrace death as I have embraced life. I would tell them not to grieve for too long, but, instead, celebrate the memories and the journey we’ve taken together. I would ask them to remember how I lived and not how I died. What is death anyway but a transformation of one form into another? This is where my Eastern-influenced philosophy and integral views on suicide kick in.

Initiative 1000 and the Moral Zeitgeist

impermanence @ chinese general hospital

Judging by the number of endorsements of I-1000 it seems like the moral zeitgeist in Washington tends to favor the measure. But who knows? Let the will of the people determine the outcome.

Regardless, I believe that our basic moral intuition would continue to drive us to explore ways on improving health care and care for the dying. Just because I-1000 is there doesn’t mean that people would fall in line to their oblivion. When faced with the choice between life and death, most people would choose life. I-1000 is for people who no longer have the option to choose life. I believe that it is more compassionate to give dying (conscious and sane) people the autonomy of choosing how they die.

That said, I never liked the phrase “Death with Dignity”. Aside from the stupidity of dignity when it comes to bioethics, I subscribe to Dr. Gregory House’s aphorism: “There is no dignity in death.” There is only acceptance and compassion.

But though the daylight succumbs to darkness,
And though the Stars exhaust their radiance,
Life bestowed will always be boundless,
The Law of Existence knows no defiance.

UPDATE: 11/04/2008 11:28PM PSTInitiative 1000 passes. Here’s to embracing death with compassion.

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