Right-to-die supporters, opponents look to dignity of patients

A month ago, 29-year-old terminal cancer patient Brittany Maynard ended her life in Oregon and in doing so revived the debate over physician-assisted suicide.

Though only five states offer a legal path to ending one's life, Maynard's situation made headlines nationwide, opening a division between supporters and opponents.

Bambi Robinson, assistant professor of philosophy at Southeast Missouri State University, specializes in medical ethics and considers herself a supporter of the so-called right to die.

Robinson also explained that while it may not always be a politically tenable position, the majority of medical professionals would be in favor of legislation similar to that of Oregon's as well. Former editor-in-chief of the New England Journal of Medicine Marcia Angell wrote in The Washington Post in October reaffirming her own support for legal avenues of physician-assisted death after having watched her husband denied such a choice after being diagnosed with terminal cancer in February.

"There's really no debate in the medical ethics community," Robinson said. "[Doctors] support it."

Opponents, on the other hand, often point out that taking steps to end a patient's life -- or enabling the patient to end their life themselves -- contradicts one of the fundamental tenets of medicine: that physicians should first do no harm.

But paradoxically, Robinson explained, advances in medicine have changed that precept's ostensible meaning. She argues that there comes a point where the marginal gains from prolonging a terminal patient's life no longer serve the patient's best interests.

"You have to ask yourself: When the patient is dying, where is the harm?" she said. "In medical ethics, we tend to argue that the harm is forcing [the patient] to live even if she's in pain or lacks dignity."

But therein lies the rub: namely, what does it mean to die with dignity?

Many people's objections to aid-in-dying measures are rooted in theology. Christian theology especially asserts the intrinsic value of human life, regardless of medical condition. Father Patrick Nwokoye is an instructor of religion at Southeast Missouri State University and also leads the Catholic Campus Ministry Center, and says what many fail to realize is that a person's worth comes from simply being a fellow human.

"[A person has] dignity because [he or she] is a child of God, first and foremost," he said. "It doesn't come from whether or not you can do this or do that."

To him, the growing acceptance of right-to-die philosophy is an ill portent.

"Our culture is developing an increasingly utilitarian perspective regarding the value of life," Nwokoye explained. "A person's worth is becoming more and more dependent on a person's usefulness. It is a tragedy when we devalue human life in the name of rights and freedoms."

The argument is not so different today than it was a decade and a half ago when the actions of Dr. Jack Kevorkian sparked outrage nationwide.

Perhaps it should come as no surprise that a zeitgeist that consistently errs on the side of individual freedoms -- illustrated in the burgeoning legalization efforts in drug policy and marriage equality -- would greet the issue more receptively this time around.

But Nwokoye cautions against reckless pursuit of freedoms, since on a broader level, may inadvertently lead to an immoral status quo.

He said it is profoundly sad that someone like Maynard would find themselves in a mindset where they believe they can and should end their own life.

As if to illustrate the frustrating nuance of the issue, aid-in-dying advocates' rebuttal offers the opposite stance by the same token. Where some object to patients making the choice for themselves, others object just as staunchly to authorities making the choice for them.

Robinson pointed out that society operates on a generally accepted right to self-determination. Manifestations include do-not-resuscitate orders and the ability to refuse treatment, among others.

"It's based on autonomy," she said. "It doesn't mean that you can do whatever you want -- generally it's limited to [not] harming other people. But autonomy is the backbone of medical ethics."

She went on to explain that palliative care, while reasonable and appropriate in theory, is not always so in practice.

But Nwokoye pointed out there is a special kind of dignity in bearing suffering with grace. He argues that legalizing assisted suicide sends the wrong message to future generations.

"It tells people that we should not have to face any difficulty in life," he said. "But is that the best way to deal with problems? I don't think so."

Saint Francis Medical Center and Southeast Hospital declined to comment on the issue.

tgraef@semissourian.com