Click here to read the other posts in this series first.

I’ve come to accept that someday I will die. Probably. Unless… no, definitely. Someday I will definitely die.

It may be my choice, or it may not. If it is, I wonder how I’ll know for sure. I suppose when life is all drudgery and pain, and nothing can induce the occasional moment of joy or happiness, and there’s no hope of recovery, then it’s time.  I’m a long way from there. May never get there.

In the first three parts of this series, I’ve laid out the case for legalizing physician-assisted dying. It won’t come without some risk. It won’t be perfect. But the benefits are so much greater than the drawbacks. It is an inherent human right to choose your time and method of death, and doctors should be authorized to assist when certain criteria have been met.

A handful of countries including Switzerland, the Netherlands, and Belgium have some form of physician-assisted dying. In the United States, Oregon, Vermont, Washington, and California have Death with Dignity laws. In my state of Maine, a Death with Dignity bill passed the House in 2015 but failed in the Senate by one vote. Supporters are looking to reintroduce the bill in 2017.

I have a particular interest one aspect of these laws. If I ever get to the point where physician-assisted dying makes sense for me, I wouldn’t meet the criteria in some of these jurisdictions. Often, a doctor must assert that the patient’s expected lifespan is less than some amount, usually six months. People with slow, degenerative diseases might find life unbearable for many years, not just a few months. I don’t consider physician-assisted dying laws suitable if they have one of these lifespan restrictions in place.

My friend and fellow blogger, The Wheelchair Kamikaze, recently summarized the progressive MS situation in one of his posts:

“In my many conversations with other people with Progressive MS, I’ve found that most have formulated some sort of escape plan, some in only vague terms but others down to the last detail… most of the people who have related their thoughts and plans with me find them not self-defeating but rather self-empowering, bracing them to suck it up and fight on secure in the knowledge that if the fight becomes just too brutal and the climb too steep they’ve given themselves permission to call it a life. And in that there is no shame.”

Let’s take end-of-life planning out of the shadows. No one should have to starve themselves, ask their friends or relatives to assist them, suffer an unnecessarily excruciating death, or worst of all experience a botched suicide attempt. We need physician-assisted dying laws that are thoughtful and inclusive.

What can you do to help?

Ideally, everyone who reads this will become an activist in the cause. Here is a link to a list of supporting organizations.

I recommend this one: https://www.deathwithdignity.org/

For those who don’t want to become activists, the next best outcome is that readers at least quietly, privately empathize with an individual’s right to choose when and how to die.

If you remain opposed to the legalization of physician-assisted dying, I hope you now accept that those of us in favor of it come from a place of compassion, protection, and respect. If that’s all these blog posts have accomplished, our time here has not been wasted.

Click here for Physician-Assisted Dying – Part Three – The Arguments in Favor of Legalization

Can we justify physicians becoming involved in the hastening of a patient’s death? The Supreme Court of Canada thinks so. In a 2015 TED talk, Grace Pastine discusses the issue of physician-assisted dying in Canada. If you have a few minutes, it’s worth watching.

I’ve changed my terminology from physician-assisted suicide to physician-assisted dying. The latter term seems to carry less baggage.

To be clear, this discussion is about public policy – should physician-assisted dying be legalized? This is not about the personal decision individuals might make about whether to exercise this option.

Here are the most common arguments against legalizing physician-assisted dying, and my thoughts on each one.

Any Form of Suicide is Against God’s Will

In most faith traditions, orchestrating your own death is considered a sin. Only God gives life or takes life away.

Because the United States is a secular democracy, not a theocracy, this argument applies only to personal decision making. It has no place in public policy making.

Legalizing Assisted Dying Would Invite Abuse – the Slippery Slope Argument

There’s a disability rights group, called Not Dead Yet, that actively opposes the legalization of assisted dying, precisely because many of them would be potential candidates. They fear legalization would lead to pressure on individuals within the disabled community and other vulnerable groups to agree to be euthanized when that’s not their preference. Some folks even fear that legalized, physician-assisted death could come to be viewed as a cost-effective way to treat the terminally ill.

This is a legitimate concern, but not a reason to disqualify physician-assisted dying. Slippery slope arguments are problematic. According to yourlogicalfallacyis.com, these arguments take the form of “You say that if we allow A to happen, then Z will eventually happen too, therefore A should not happen.”

The website goes on to say, “The problem with this reasoning is that it avoids engaging with the issue at hand, and instead shifts attention to extreme hypotheticals. Because no proof is presented to show that such extreme hypotheticals will in fact occur, this fallacy has the form of an appeal to emotion fallacy by leveraging fear. In effect, the argument at hand is unfairly tainted by unsubstantiated conjecture.”

Slippery slope arguments can be used to build the checks and balances into a system, but not to argue against the system itself.

Advances in Palliative Care Make Assisted Dying Unnecessary

Hospice facilities have become better at what they do. Death can be made comfortable and painless.

This is true some of the time, but not all of the time. There are too many cases when it was impossible to provide a relatively comfortable and dignified natural death.

The Logistics are too Messy

When does the assisted death option legally come into play? What if the patient’s mental state is unclear? What provisions would we need in order to weed out unscrupulous family members who are just tired of taking care of grandma, and are pressuring her? Which medical methods are acceptable? Must a patient be in imminent danger of death, or is quality of life sufficient reason for euthanasia? Wherever society draws the lines, the first person on the other side of the line will cry “foul.”

Yes, the logistics are complicated, but can be managed. If rule makers are compassionate and open-minded, systems can be developed that fairly address the needs of most individuals. There will always be someone just on the other side of the line whenever public policy is made. This is not a justification to stop making public policy.

What If They Find a Cure the Day after I Die?

What a horrible shame it would be if people practiced physician-assisted dying when they didn’t need to. Medical advancements occur every day. How can anyone be sure that their situation is hopeless?

This is another legitimate concern, but one of personal choice, not public policy. Patients would have to accept this risk. But it’s a small risk. Instances of unforeseen medical advancement are rare. Most ailments that would lead to assisted death have existed for some time, and will continue to exist.

Another version of this argument is, “What if an individual would have gone into remission had they not been euthanized?” Checks and balances can be put in place so that only patients who are unlikely to experience remission, and only people with diseases that aren’t likely to be cured in the near future will be allowed to undergo physician-assisted dying.

In my next post I’ll discuss the arguments for legalizing physician-assisted dying, also referred to as Death with Dignity.

Click here for Physician-Assisted Dying – Part One – An Uplifting Subject?

Click here for Physician-Assisted Dying – Part Three – The Arguments in Favor of Legalization

I know readers who have faced end-of-life situations in their families recently, or will be in the near future. If this topic is too near and dear to your hearts then perhaps you should skip these next few posts, but please return afterward.

To be clear, I’m not there yet – not even close. I still find life eminently worth living. But this may not always be the case, and that’s why I’m addressing this controversial and sobering subject.

Death is not my greatest fear. Life is, or at least a certain type of life. Two examples:

1. The pain and mental anguish associated with a long, drawn out death.

2. Becoming a prisoner in a body that no longer allows me to interact with the world around me in a positive and meaningful way.

I don’t know how to define item 2, but I think I’ll know it if/when I get there.

These are the types of things I worry about. But they wouldn’t be as frightening if I had some say in the matter – if I had some control over the circumstances of my death, should I ever get to the point that I want to exercise such control.

If either of the two situations above were to occur today, I would have no legal recourse to choose when or how to end my suffering. Not only that, but at least in my case, I would have no practical recourse either. I would be in such compromised physical condition that I would be unable to end my life without assistance from others. I don’t have the strength of will that one of my fellow MS bloggers exhibited a couple of years ago when he made the conscious decision to starve himself to death. Nobody should have to resort to that.

In subsequent posts, I’ll present some of the perceived advantages and disadvantages of legalizing physician-assisted suicide. I’m sorry for those of you who visit this blog primarily for its uplifting posts. But frankly, reducing my current anxiety by giving me more control over my end-of-life decisions is an uplifting subject to me.

Click here for Physician-Assisted Dying – Part Two – The Arguments Against Legalization