Wednesday, February 15, 2006

Death with Dignity or Duty to Die? The Devil is in the Public Policy Details.

Guest blog by Kathryn Hinsch:

A headline story in the Seattle Times featured former Washington State Governor Booth Gardner and his desire to die in the same manner as he had lived his life; as a powerful man in control of his life. To that end, Governor Gardner is serving as the figurehead for an effort to legalize “physician assisted death” in Washington State. I urge all of us, as we debate the merits of this legislation, to examine these issues from every angle. Otherwise, like the politicizing and polarization of the embryonic stem cell debate, this important bioethical issue will be reduced to sound bites.

Most people fear death and decline, and this explosive topic touches some of our most deeply held beliefs. Much of the “assisted death” debate gets reduced to two questions: “Do people have a right to commit suicide?” and “Should we allow physicians to assist in hastening death?” But before we tangle with those tough public policy questions, it is important to ask “how might people’s different life circumstances impact the issue?”

Looking at these questions from a gender perspective will be imperative as we move forward in crafting new laws. There are some key facts that make a woman’s end-of-life decision quite different from a man’s—women on average live longer than men. Additionally, women are more likely to be impoverished, receive inferior health care, experience poorer pain relief, and are two times as likely to suffer from depression as men. Women, who have often lost their life partner by the time they face debilitating disease, may feel a stronger cultural pressure not to be a burden on their families. All these factors must be considered when crafting a policy to allow “physician assisted death.”

Looking at gender implications is just one step in a thorough public policy analysis of this issue. We also must look at the implications of physician assisted death for disabled, poor, and minority populations. From some groups, the fear that death with dignity could quickly lead to duty to die is not an unfounded fear and something we must be vigilant to prevent.

The point of this exercise is to highlight the fact that before we enact a law that would allow Governor Gardner to control the time and manner of his death, we must consider the implications of such a law on people who don’t share his life circumstances and may not have access to the same level of care.

Kathryn Hinsch is founder of the Women's Bioethics Project, a non-partisan, non-profit public policy think tank based in Seattle.

1 comment:

Debra Leigh Marais said...

Hi Kathryn,

Thank for an interesting and thought-provoking post. I do not know very much about either side of the ethical debate on the right to die. But I would imagine that the right to commit suicide and a physician's right to help a patient to die are two very different issues that should be treated differently in the ethical debate.

On the issue of "Should we allow physicians to assist in hastening death?", perhaps you could clarify for me the arguments against this. I assume that they have a lot to do with "where do you draw the line?" and with the potential for abuse should this right be legalized.

On the question of "Do people have a right to commit suicide?” my first response was, of course yes! But then thinking about it I realized that people who are in that situation may not be in a very rational place - and exercising their right to commit suicide is a tragedy that could have been prevented with timeous and effective help.

Debbie Marais.