Sunday, March 27, 2005[posted by jaed at 7:30 PM]
The first and the last
First they advocated the right of patients to order treatment withdrawn. I considered it a good thing, because I believe the right to refuse treatment is absolute. And I was right in this: respect for a person's rights and dignity absolutely requires that they not be treated against their will.
(I did sort of notice that most of the people who were speaking in favor of "the right to die" had a lot to say about "lives that weren't worth living", and not as much to say about "the right to refuse treatment", but I ignored that. After all, no one would use that argument to withdraw treatment from someone who wanted to live but whose life was deemed not worth living.)
Then they urged living wills to prevent unwanted treatment when the person was unable to speak or decide for himself. And I thought it good, because again it displayed respect for the person's right to refuse treatment, and made its paramount value respect for such rights.
(I was a little uneasy about the difficulty of predicting one's wishes, and I did wonder what would happen if the present-tense, somewhat-incapacitated person disagreed with the past, fully-competent person who had authorized withdrawal of treatment. But I trusted that in such conflicted situations, the doctors would not withdraw treatment if there was a reason to continue it, and would err on the side of life rather than death. The opposite wasn't even thinkable to me.)
And over time, I saw the debate become more and more about the sincere belief that ending a life deemed not worth living is an act of mercy, and less and less about patients' autonomy.
And I saw a long slide in the locus of control, at the end of which those who deem are no longer the patients, but the doctors, the committees, and the professional bioethicists.
Then they came for the hopelessly comatose on full life support, and I said nothing because they had no consciousness nor prospect of any.
(And full life support is very intrusive, and turning it off is letting nature take its course. And they probably would have agreed, if they had been conscious.)
Then they came for the terminally ill, and I said nothing because these people were about to die anyway, so where's the harm?
(And besides, they were on a respirator, a very intrusive form of medical technology. And they might have agreed, if the doctors had asked, but they didn't want to subject their patients to such a troubling decision.)
Then they came for those in terrible pain but not dying, and I said nothing because such awful pain must be worse than death.
(And besides, while they might have been helped with adequate pain medication, they might then become addicted, a fate surely worse than. And even if they didn't agree, the families agreed, and surely this should be a family decision, not just a personal one.)
Then they came for the brain-damaged, and I said nothing because they weren't really aware anyway, not like a real person is. I was sure. Fairly sure. The TV said so.
(And besides, these people couldn't eat on their own anyway without the feeding tube, and that's medical technology, isn't it? And even if they didn't agree, and most of the family didn't agree, the next of kin and the doctors all agreed.)
Then they came for those so severely disabled that their lives were not worthy of living, and I said nothing because "no one would want to live like that anyway".
(And besides, denying food and water was merciful. Even if they did cry with hunger and thirst, and ask for water, it was better this way. And the hospice bioethics committee agreed.)
Then I got hit by a truck one afternoon, and my life changed.
But not for very long.