A life worth living? It depends!

By Judie Brown

It is always interesting to follow the trends in other countries, particularly when the subject is ending the life of a loved one due to severe disability or serious illness. There have been two such cases in the news in England over the past week.

The first is the case of Frances Inglis, http://blogs.telegraph.co.uk/news/georgepitcher/100023240/murderer-frances-inglis-might-expect-mercy-in-sentencing-but-not-in-her-conviction/ who was convicted of killing her 22-year-old brain-damaged son with a massive dose of heroin injected into his thighs and arm. During her trial, Inglis claimed her act was one of compassion, sensing that her son's condition was not going to improve. Neither the judge nor the jury was moved, however, and Inglis was sentenced to life in prison for murdering her son.

A second case that received attention this past week is that of Kay Gilderdale, http://www.telegraph.co.uk/news/newstopics/politics/lawandorder/7074532/Kay-Gilderdale-watching-my-daughter-die-was-like-having-my-heart-ripped-out.html who was recently cleared of charges that she killed her 31-year-old daughter, Lynn. Suffering for 17 years from chronic fatigue illness, Lynn Gilderdale had tried to take her own life in the past. This last time, however, when her attempt to commit suicide failed, her mother took matters into her own hands and helped her daughter kill herself.

In December of 2008, Kay Gilderdale admittedly gave her daughter a massive dose of sleeping pills and antidepressants and she also injected air into her daughter's veins. During her trial, Gilderdale stated, "You are torn apart. You have one part of you wanting to respect your daughter's wishes and understanding everything they have been through."

It took the jury two hours to find Gilderdale innocent of killing her daughter. The ruling resounded in the pro-life community with shock, not only in the United Kingdom, but in the United States as well. This is evidenced by the comments of several people who blogged on the British web site, the Guardian. One individual, "mariagorgeous," claimed that there was nothing wrong with Gilderdale's actions, and argued that there is no evidence to indicate that a "slippery slope" is evident when people like Gilderdale are not sentenced for a crime. In response, http://www.guardian.co.uk/society/joepublic/2010/feb/04/assisted-dying-radar William Toffler, M.D., National Director of Physicians for Compassionate Care Education Foundation http://www.pccef.org/ , wrote,

Mariagorgeous questions the concept of a "slippery slope" and charges that those opposing assisted suicide "don't offer a shred of evidence that this is the case." Apparently she is not aware of the Dutch experience where two separate government studies (1990 and 1995) document approximately 1000 patients each year who lives are ended "without request." [Hendin H, Rutenfrans C Zylicz Z. Physician Assisted Suicide and Euthanasia in the Netherlands. JAMA. 1997; 277: 1720–1722] http://jama.ama-assn.org/cgi/content/summary/277/21/1720?ijkey=24076388a0f21f01ea0aa073f76de04258045469&keytype2=tf_ipsecsha

In one such case, a patient with breast cancer who specifically did not want her life to be taken by euthanasia had her life ended by her physician who justified ending her life stating, "It could have taken another week before she died. I just needed this bed."

Furthermore, as a practicing physician in Oregon, I have witnessed increasing callousness toward those who have a limited prognosis. Such was the case with Barbara Wagner, a retired school bus driver who in 2008 had recurrence of her lung cancer. She wanted the medical treatment recommended by her medical oncologist — a drug, Tarceva, produced by Genentech. The Oregon Health Plan wouldn't cover the drug, deeming it too expensive for a person who statistically would have less than a 5% chance of living for five more years. In the same letter to Barbara denying her the treatment she wanted, the state offered her full coverage for assisted suicide!

There is no doubt that proponents of such acts do not perceive any harm in them, nor do they think that opposition to them is justified. It is quite clear that more and more citizens are in agreement, which is why those in favor of such acts are making progress not only when it comes to the severely disabled, but with those who are elderly or seriously ill.

Bernadine Healy, M.D., http://www.usnews.com/topics/author/bernadine_healy former director of the National Institutes of Health, recently analyzed the end-of-life questions in the context of government-controlled health care. She points out: http://www.usnews.com/articles/health/bernadine-healy/2010/01/06/medicare-after-health-reform-not-your-parents-plan.html

One way to reduce spending is to move the incurably ill into palliative care. Hospice is beloved for offering pain relief, comfort, and spiritual and emotional support to the dying, mostly from cancer. But hospice spreads its wings more broadly under health reform. Medicare will offer its services free to patients not on their deathbed but in slow, irreversible decline due to failing hearts, lungs, brains, or immune systems. This can be dicey: It's hard to say, as hospice does now, that death is not accelerated when patients with end-stage lung disease get morphine or those with advanced Parkinson's receive sleep-inducing drugs for so-called terminal sedation. To some, this is a humane choice that also conserves resources. To others, it is slow euthanasia.

Clearly, what lies ahead is not your parents' Medicare but something new. A place where government will trump doctors, and it will be sold as safer, better, less wasteful care.

Note, please, that in the scenario Dr. Healy is suggesting, it would be a legitimate part of health care reform to take actions similar to those of Inglis and Gilderdale. The startling difference would be that such actions would not be crimes, but rather incorporated into the national framework of a "right to privacy." Obviously, helping someone die sooner than later would be clinically practiced as part of a larger cost saving program as well. It's rather interesting that Dr. Healy would mention such things as terminal sedation, since this is the very type of problem that has been publicly debated by many for years. It, as with any medical practice, can be abused or totally legitimized for the wrong reasons. Think about abortion.

Writer Mary Ann Kreitzer recently expounded on the subject based on the personal account of what a friend experienced when her father was killed by terminal sedation, calling it "abortion for the elderly." http://lesfemmes-thetruth.blogspot.com/2010/01/terminal-sedation-abortion-for-elderly.html

While it is clear that we pro-life apologists cannot condemn sedation across the board, it is equally obvious that some degree of prudential judgment — that has nothing whatsoever to do with cost saving or utilitarianism — has to come into practice. As Eric Chevlen, M.D. and pain control expert, recently told Wesley J. Smith: http://article.nationalreview.com/410156/hazardous-pathway/wesley-j-smith

In close to 30 years of practicing oncology and palliative care, I have treated hundreds of patients with opioids to relieve pain, accepting some level of sedation as an unavoidable side effect rather than the goal of therapy. But I can recall only a handful of times in which I felt that the best way I could reduce the patient's suffering was to intentionally diminish his level of consciousness.

In addition, British oncologist Karol Sikora, M.D., http://www.dailymail.co.uk/debate/article-1248090/In-37-years-cancer-doctor-Ive-patient-asked-euthanasia.html wrote,

In all my 37 years as a cancer doctor, I have never had a patient who asked for euthanasia. In my line of work, it is not an issue. People don't want to die. And, usually, we can make patients comfortable, thanks to modern drugs.

Registered nurse Nancy Valko has warned of the abuses that come about when actions once believed to be criminal in nature are slowly introduced into the practice of medicine as simple steps that can "help" the suffering patient and his family. In her article, "Is Palliative Sedation Becoming Another Form of Euthanasia?", she defines the strategy of the euthanasia movement this way: http://lifeissues.net/writers/val/val_33palliativesedationeuth.html

As assisted suicide bills have regularly failed in state legislatures in the years since Oregon passed its assisted suicide law, euthanasia supporters have had to change tactics, although not their ultimate goal of choosing death as a constitutional right. The outreach to medical groups like hospice and palliative care organizations is particularly disturbing.

Euthanasia supporters have been successful in getting some medical and nursing groups to change their official positions from opposition to assisted suicide/euthanasia to neutrality on the issue. And now, almost all of the mainstream media accepts death by withdrawal of treatment as humane and legal for the severely brain-injured. It was just a matter of time before that vulnerable group of people expanded to include people with lesser disabilities and now even the fully conscious but terminally or "hopelessly" ill person.

But as everyone really knows, it is virtually impossible to starve and dehydrate to death painlessly. The idea of terminal sedation to make such a death possible thus becomes essential to the process.

[State legislative proposals] are not only incremental steps to the goal of legalizing euthanasia. They are also a crucial part of the effort of "right-to-die" groups to reeducate the public, especially doctors and nurses. ... When an induced coma with self-starvation and dehydration is seen as proper medical treatment for anyone, the whole rationale of ethical health care is turned on its head.

When medically vulnerable people are given the option of a legal, doctor-assisted premature death, can we be surprised when we discover that none of us is permanently safe from the same fate?

When is a life worth living? It depends ...

In a society where the human dignity of each individual without exception is respected in the law and the culture, such a question would not even be asked.

© Judie Brown