Media-Assisted Suicide

How coverage of the “right to die” keeps us from dealing with death.

By Marissa Kantor

This is not a piece about Harriet Miers’ evangelical beliefs. This is not a piece about physician-assisted suicide. This is not a piece about federalism and states’ rights. This is a piece about how the media — both the left and the right — is plagued with inaccurate reporting about Gonzales v. Oregon, muddled with here-and-there references to Harriet Miers, because they are asking the wrong questions. This is, in the end, a piece about death and our societal inability to face it.

Death has gotten a lot of attention lately. Natural disasters work in terms of numbers — body counts and casualties. We can name the killers — Katrina, Rita — and thereby come a step closer to blaming someone, but we can’t conceptualize hundreds and thousands of lives lost. The media zooms quickly to the human-interest story: the diabetic man stranded on his rooftop without insulin for days; the orphaned child in need of love and a teddy bear, to be sent to this address.

But there is a more tangible number that is floating around these days: 208. This is the number of Oregonians who, since the Death With Dignity Act took effect in 1997, have chosen to end their lives by ingesting lethal doses of drugs under the care of their physicians.

Oregon’s Department of Human Services website offers details on the Death With Dignity Act, and more specifics on the requirements for qualifying for physician assisted suicide. To qualify, a patient must be at least 18 years old; an Oregon resident; capable of requesting and communicating healthcare-related decisions; and diagnosed with a terminal illness with less than six months to live remaining. Once a physician has verified these criteria, there is a protocol that must be followed which includes two oral requests with a mandatory 15-day waiting period in between; a written request; confirmation of the patient’s prognosis and ability to make decisions.

But “dying with dignity” has climbed the charts and secured its place in a much larger discussion that has, ironically, very little to do with the death itself. It has metastasized into a turf war and a religious war, into a moral argument and a discussion on the role that politics should have in individual lives. It has even morphed itself into a discussion of whether or not Harriet Miers is a real evangelical Christian, and what that means for right-to-life supporters.

A bit of background first though, to understand how this train was derailed: In 1997, the Federal government, under the jurisdiction of the DEA, wrote a statement saying that the Oregon Death With Dignity Act violated the Controlled Substances Act of 1970 because it was an improper use of federally controlled drugs which did not constitute a “legitimate medical purpose” (even though the act was passed before physician assisted suicide was even considered). Attorney General Janet Reno disagreed, stating that “there was no evidence that Congress meant for the DEA to have the novel role of resolving the profound moral and ethical questions involved in the issue.” In 2001, then-Attorney General John Ashcroft began his appeals, which were prolific and intense, culminating on November 9, 2004, when the Supreme Court agreed to consider his appeal. With the current Attorney General Alberto Gonzales, the case has become Gonzales v. Oregon. And it just so happens that it will become a landmark case — the first one to be heard under Chief Justice Roberts. And if Harriet Miers is confirmed before a ruling is issued, Sandra Day O’Conner’s vote (which could be the swing vote) will not count, and new arguments will be heard.

The only problem is, the media have confused us. We have once again been led to believe that all this legal stuff is mired in the question, “Do we have the right to die?” What is at stake is not that at all, but rather a states’ rights discussion that takes us back to the days of John C. Calhoun and his proposal for nullification. Can a state refuse to acknowledge a federal law? Or, can the feds force a state to disregard their laws in favor of a national policy? A few of the more blatant examples:

The Miami Herald published an article “Right to Die Under Attack” on October 7. The first line will suffice: “This week, the U.S. Supreme Court heard the case of Gonzales v. Oregon, the culmination of the Bush administration’s long fight to overturn Oregon’s popular Death With Dignity Act.”

An op-ed in The New York Times, entitled “The Right to Die,” begins, “The John Roberts Court will hear its first high-profile arguments today, when the justices take up a case involving doctor-assisted suicide…But the Bush administration has tried to override this law by threatening to prosecute doctors involved in such cases.”

And Associated Press writer Gina Holland describes the fight this way: “New Chief Justice John Roberts stepped forward Wednesday as an aggressive defender of federal authority to block doctor-assisted suicide….The justices will decide if the federal government, not states, has the final say on the life-or-death issue.”

Perhaps the greatest offense of all involves word manipulation that, unfortunately, is not so uncommon: “Roberts said that the federal government has the authority to determine what is a legitimate medical purpose and ‘it suggests that the attorney general has the authority to interpret that phrase’ to declare that assisted suicide is not legitimate.”

I would argue that the level of danger and potential harm to individual liberty in these egregious errors of reporting are more serious than the case itself. There’s no denying that the issues of physician-assisted suicide and right-to-life questions are being put on trial in the Supreme Court right now. Or that how Harriet Miers will vote — if confirmed — has become an inexorable corollary to the discussion.

Across the spectrum we have all latched on to a different narrative of fear. Social conservatives fear that Harriet Miers’ votes might not be in line with her faith; liberal-minded folks know that they should fear something when the words “evangelical Christian” and “Constitution” appear in the same sentence. And some of us just fear because, these days, it’s easier to fear than to have faith.

But what if we are stuck being forced to choose sides in a debate that is posing the wrong question entirely? What if we are measuring the wrong things right and the right things not at all?

We are a society afraid of death. We are afraid to talk about it, afraid to acknowledge that one day it might actually happen to us and to the people we love. It makes sense that to legislate the right to die is difficult. Add suicide to the discussion — even if it is physician-assisted — and Americans, it seems, just cannot cope.

A recent poll conducted by the National Opinion Research Center reports that 60% of respondents believe that persons with an “incurable disease” should be allowed to commit suicide; the number drops to 15% when the person in question is “tired of living and ready to die.” A recent Gallup poll found that 80% of Americans think that suicide is morally wrong, while just over half agree that physician-assisted suicide is morally justified. The differences here are so nuanced and so strange as to reinforce the former point: We do not know how to deal with death. A change of three words and our opinions are reversed.

But what if, as Dr. Ira Byock asks, “both sides are wrong?” What if the issue of physician-assisted suicide serves instead a greater cultural purpose of diverting our attention from the real discussion we should be having — a discussion about death and how to care for those who are soon to experience it.

In a conversation with Dr. Byock, author of the book Dying Well: Defining Wellness through the End of Life and director of palliative medicine at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, the issues were refocused.

“They ask me whether I think legalizing physician-assisted suicide is right or wrong, and there goes the discussion,” he told me. “We’re so far from being able to address the ‘tough issues’ — the ones that deal with existential annihilation, the ones we work hard to stay psychologically away from. We’re so far from talking about how we would want the people we love, our friends, neighbors, and eventually ourselves to die. That is the discussion we need to have in this country.”

So why have we been led so far astray? Byock attributes some of the blame to the Catholic Church and its right-to-life contingency, calling them “woefully irresponsible” in only giving “half a stance.” Instead of telling us what a morally wholesome way to die would be, they have only stated what they are against.

“The Pope says it is immoral to take away Terry Schiavo’s feeding tube, but he forgot to finish the sentence and say what a morally acceptable way would be for her to die. What happens when she aspirates? When she gets pneumonia? Do we put her on a ventilator? For how long?”

Medical schools and their educators, says Byock, are also to blame. Very little palliative medicine is taught in medical schools, and the emphasis is still on curative medicine, not caring. Byock calls us “a culture lost at sea, at night, in a storm, that knows we need to get the hell out but that doesn’t have a compass point toward which to direct our efforts.” If doctors could write lethal prescriptions for patients, argues Byock, then what? The next day we would still have serious inadequacies in physician education, and our nursing homes will still be horribly understaffed.

Dying Well contains its own play on words. “The word ‘well’ is first assumed to be an adverb, defining the dying experience. But it can also be an adjective, which is more culturally challenging. Can a person be well when they are considered to be dying? Can they become more well?”

Byock thinks so. Socially, emotionally, spiritually. We could rethink the last chapter of our lives and make it healthier if we could ask the right questions.

In a recent New York Times Magazine article, “Will We Ever Arrive at the Good Death?,” Robin Marantz Henig comes closer than any journalist has in a while in portraying the confused and conflicted debate about palliative medicine and hospice care. What she does not do, according to Dr. Byock, is take it to the next level: What would a culturally mature approach, based on our values, look like?

To answer this question we come back full circle, to Gonzales v. Oregon, and the media’s tendency to misrepresent an issue, and then come out either pro or con, with little in between.

“It’s time for us to grow the rest of the way up,” says Byock. “To acknowledge we’re mortal. Get over it. Get on with talking about how we can care well for one another.”

I asked him what he’d like to scream to both sides right now.

“Stop yapping and go feed someone in a nursing home. There are literally thousands of people starving in nursing homes…not because there’s no food. Because there is a shortage of nurses and people can’t eat on their own.”

And to the pro-lifers, he advises: “To be truly life-affirming one needs to affirm all of life, not only its beginning, but its end. To do less than that is frankly not to honor the full breadth of our human condition. If God gave us life, God also gave us death. To be life-affirming is to honor all of it.”

We need to demand greater accuracy from the media, and greater depth of discussion from ourselves. By reading only the myriad articles that portray Gonzales v. Oregon as a right-to-die case, or tales of the day when God tapped Harriet Miers, we stay comfortably removed from our own mortality.

But then again, that’s just one mortal’s opinion.

Marissa Kantor is a graduate student at New York University. Her last piece for The Revealer was “The Geena Factor.”

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