Jun 22, 2018

contagion and quality of life

From the Kansas City Star:

A sensitive and impassioned opinion piece about the tragic deaths of Kate Spade and Anthony Bourdain, made more urgent and complex by noting the context of doctor-assisted dying.

One aspect of this conversation that hasn’t been happening…and that will delight no one, involves the research that shows assisted suicide is also contagious.

That’s right: Doctor-assisted suicide increases overall suicide rates among the non-terminally ill everywhere it’s made legal. Such laws have a measurable effect on those who aren’t dying, but who are suffering from depression.

A study conducted between 1990 and 2013 and published three years ago in the Southern Medical Journal found the correlation unmistakable: “Controlling for various socioeconomic factors, unobservable state and year effects, and state-specific linear trends, we found that legalizing [physician-assisted suicide] was associated with a 6.3% increase in total suicides.”

In Oregon, which legalized assisted suicide in 1997, suicide rates are more than 40 percent higher than the national average.

And wherever doctors could legally help their worst-off patients end their own lives, more of those in acute but treatable, transitory, psychic pain followed suit.

A study of New York cancer patients suggested that a high percentage of those terminally ill patients who expressed a “high desire for hastened death” themselves suffered from depression, so we don’t always know that even their final decisions are unclouded by a disease other than cancer.

Links aplenty in the piece. Many of my friends on the left think of assisted dying as a rather simple matter of “choice”—and it’s just more complicated. As the piece says, these laws are expanding and are lauded for their “compassionate” stance, but a rationale for dying that rests on the murky territory of “diminishing quality of life” is not something to be celebrated. It’s a rationale that’s historically been used to under-value the lives of people with disabilities: a situated and arbitrary definition of life worth living.

When does a life worth living cease to become so? When one can no longer eat and must use a feeding tube? A ventilator? When one loses mobility, or memory? What about pain—can one live with a little, but not a lot? How much is a lot, exactly? And then there is the monster in its own category that is depression. I know many people living with each of these conditions, and the thing I know is this: the view from outside is invariably impoverished. The human brain just lacks the imagination to fathom a life lived well that is so physically or neurologically different from one’s own. Living without capacities one has come to take for granted is only seen as loss of capacity, and therefore loss in total. A life no longer a life. But ask disabled people, and they will tell you: their lives are worth having.

And yes, yes, yes of course this issue is absolutely fraught; it has no clear answers in an era when life is co-extensive with machines and medicine. So, sustaining life is artificial; perhaps ending it must also be so. And it is, in many cases—whether we call it non-intervention or something else. But let’s be absolutely specific about the terms on which we grant such profound power, perhaps especially in a time when suicide rates are high.