Thursday, July 10, 2008

116. Who should decide end of life?

We recently learned that Shea, one of our beloved dogs, has bladder cancer. Although she has been responding very well to medication, we have been advised that her time is now measured in months, not years. After managing the grief that we have already suffered, and that which will overcome us when she is gone, our attention turned to her well-being. We want her to be as happy and comfortable for as long as possible. Like most dog owners, we do not want her to suffer.

The medication has actually been a rebirth; she is happier and more active now than she has been in several months. She is running and jumping like a puppy. She is also enjoying the special attention. But, again, we know this is short-lived, and we will be forced to deal with the life and death associated with all living things.

It is common for pet owners to euthanize their animals when it becomes obvious that they are in pain; when their quality of life has deteriorated beyond what any living thing should have to endure. It is well-regarded, by most, as the "humane" thing to do. Of course, this is just a guess on behalf of the pet owners, because we cannot ask our pets if they would want to live or die. Indeed, some of the decision-making process is selfish; it hurts us nearly as much to watch our animals in pain. Most pet owners will argue that they know their pets and know when it is time. I have little doubt that in many cases that is true. We know our Shea is a fighter, with a big heart. I would like to think that we will be able to recognize when she has fought all that she can.

That presents an interesting quandary, because many people will argue that it is not humane to assist in the suicide of a human being. If fact, in all states other than Oregon, it is illegal. In this respect, I have difficulty recognizing the difference between the humane euthanization of a pet, one who cannot tell you when the pain is greater than quality of life, and assisting the suicide of a human, one that often can clearly communication that they have made that same exact decision.

There are a number of arguments on both sides; some which hold some merit, others which are clearly biased. A 1998 University of Washington discussion on bio-ethics identified a number of arguments, specifically to the idea of physician-assisted suicide. In this case, a physician prepares a lethal dose of medication, but the patient/individual takes the last active step in committing suicide. But, even here there are several arguments on both sides.

The arguments against physician-assisted suicide include the sanctity of life. A religious argument headed by Thomas Aquinas condemned all suicide as harmful and in contraction with the idea that only God can take a life. They also argued that there is a difference between letting someone die and actively killing them, the passive versus active distinction. Most on both sides fear the potential for abuse, where burdened family members may encourage for assisted death rather than put forth the time and expense of a terminally-ill family member. Finally there are some physician issues, such as the integrity of the Hippocratic Oath and mistakes in diagnosis.

Those that favor the idea do so because of the respect for autonomy, the right to make one's own decisions. They also argue for justice, and as I have, compassion. There is the debate concerning the state's interest in preserving life, and the individual liberty of person to do what they desire when they are terminal and suffering. Finally, there is the argument about the openness of discussion. Here, the issue would be discussed and debated, for assisted suicide often happens already in secret or across the muddled line of comfort and death.

Personally, when faced with a difficult issue or forced to consider a complex situation, I attempt to reduce it to its simplest terms. In this case, if most people would agree that humanity rests with euthanizing a suffering animal, then I believe the same humanity should be extended to a human being- if he or she expressly and with due process chooses to end his or her life. While we should guard against any potential abuse, I think it takes a significant degree of superciliousness to decide for others when it comes to their most precious possession- life. Why not offer a painless option, and the ability to die with dignity- on your own terms? How can anyone be sentenced to suffer? For me, it indeed is a difficult issue, but not a difficult decision.

My little girl Shea was named after Shea Stadium, home of the New York Mets- which have always been my second favorite team after the Indians. We wanted our dogs to have "baseball names" and Shea, when we rescued her at about eight months old, was named Shelby. After great debate, we found Shea to be close enough not to confuse her, and yet keep our baseball theme. In a gut-wrenching coincidence, this is the last year for Shea Stadium- the Mets will have a new stadium in 2009.

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