We discuss in this column mysteries not problems. Mysteries cannot be solved the way problems can be solved. We lay siege to problems, but mysteries envelope and implicate us. One of the mysteries we have confronted recently is the mystery of pain and death. Is there a point at which pain is so intractable that we ought to acknowledge the right of a patient to end his or her suffering by taking a fatal dose of some barbiturate and bringing to a self-inflicted end, the agony of dying?
I have taken the position that God owns our bodies and that such a decision is neither our right nor the right of a physician whose only mandate is to heal. I do agree that medical procedures at the end of life that have no therapeutic value can be ended so as to let death take its natural course.
However, a compassionate and wise reader who is a physician has a different approach to this enduring mystery.
Dear Rabbi Gellman: After reading your column "Death is in the hands of a higher power" (Jan. 26), I feel the need to respectfully take issue with some of your opinions. I will state at the outset that I am a strong supporter of medical aid in dying, which is now legal in nine states and the District of Columbia and is being actively considered by legislatures in many other states. While palliative care for terminally ill persons who are suffering can produce good results for many, there are many who are close to death and are needlessly enduring unbearable suffering despite all medical and palliative interventions. The pending Medical Aid in Dying legislation in New York, which is essentially very similar to that in jurisdictions where it is now legal, contains the following provisions.
1. The patient must be 18 years old or older and must voluntarily apply to be included in the program.
2. The patient's physician must determine that the patient has a terminal condition and the mental capacity to make an informed decision and is not being coerced into applying for the program.
3. The patient's physician must refer the patient to a consulting physician to determine that the patient has a terminal condition, has the mental capacity to make an informed decision and is not being coerced into applying for the program.
4. If either of the two physicians feels that the patient does not have the mental capacity to make an informed decision, the patient must be referred to a mental health professional for evaluation.
5. Those with dementia and other conditions that impair their decision-making capability are not eligible.
6. If accepted into the program, patients are given a prescription for a life-ending medication, usually a barbiturate.
7. If, and when, the patient reaches a point where suffering has become unbearable despite all medical and palliative interventions and he/she decides to use the medication, it must be self-administered orally.
8. No patient can be forced to participate. No physician can be forced to participate.
I believe that this is a very humane way to meet the end-of-life needs of some terminally ill patients. The number of patients who choose medical aid in dying is actually small, and only about a third of those given the medication actually use it. The vast majority of those who do are within weeks or days of dying of their illness, and most are under hospice care. For those who don't use the medication, knowing that they have that option, if conditions warrant, provides them with great peace of mind. The beliefs of those who object on religious and/or moral grounds must be respected. However, not everyone believes that death is in the hands of a higher power and those who don't should not be restrained by those who do. — Sincerely, Dr. Y
Notes from MG:
1. The immaturity of one under 18 could also apply to one over 18. Eighteen is just too arbitrary.
2. I have no idea how they might determine if someone was in fact being coerced.
3. I like the requirement of two doctors' opinions, but this just clogs up the medical establishment with more paperwork.
4. I have no idea how a mental health professional could overrule two physicians.
5. What if dementia is part of the terminal illness?
6. How do we know that the patient will actually die from the pill?
7. I like the idea that physicians are not involved in giving the pill, but they are involved in prescribing the pill.
8. Physicians may be forced to participate and so might patients. It is very hard to determine coercion.
This is a tough issue and there are compassionate views on both sides of this enduring mystery.
SEND QUESTIONS AND COMMENTS to The God Squad at email@example.com or Rabbi Marc Gellman, Temple Beth Torah, 35 Bagatelle Rd., Melville, NY 11747.