Thursday, August 09, 2007

God week continued: Roman Catholics, disability activists 1 : assisted dying activists 0

I do apologise for the lengthy and seriously tendentious headline of this blog entry, because the story underneath it is actually important. So, here's the background: a couple of members of the California Assembly introduced a bill permitting the legalization of assisted dying for terminally ill competent people who have less than six months to live. Of course, predictably, the Roman Catholic Church campaigned against the measure. I have a hunch that you just might be familiar with its arguments (dignity of human life, infinite value of life those living this life do not actually consider worth living - stuff like that). In any case, the bill was defeated partly or primarily because disability rights (lobby) groups in California sided with God's lobby group. Their argument is an interesting one based on a factual claim.

What they're saying, basically, is that disabled people's lives are already curtailed by secretive and not so secretive cost cutting byHMOs. They worry that once physician assisted dying becomes legal, HMOs might, in their usual secretive and not so secretive ways, withhold care sufficiently from patients in order to ensure that these patients choose (arguably not so voluntarily then) physician assisted dying as a way out of their misery.

Well, I am - in principle - very much in favor of assisted dying and indeed some forms of euthanasia. But, equally, I do think this argument merits serious consideration. We know that not only for-profit health care operators tend to display corner-cutting behaviors but also non-profit public health care facilities. The latter might well argue that overall utility is better served when under circumstances such as those described at the beginning of this blog entry, the lives of those affected are cut short by a few weeks or months.

There are various interesting aspects about this. One is the diversity of responses one gets from disabled folks on this issue. In California disabled people were found on both sides of the divide, suggesting that for some, despite worries about abuse, access to a dignified death is more important than the possibility of HMOs aiming to speed up the meeting with God (or the encounter with nothing, or ... who knows). My hunch is that this is a perfectly reasonable expression of different values, but also possibly of different life experiences. Those disabled people who made already bad experiences with their HMO are anxious as they have seen what these operators are capable of doing, while those who did OK are more concerned about controlling their process of dying.

The other aspect that I find worth thinking about is the 'what if the anxious folks are right' type argument. It seems to me that they're saying that things, by way care for the disabled, are already pretty bad. If that is a true representation of the facts of the matter (and I do not know whether or not that is the case), it seems to me that assisted dying might be preferable to languishing at the hands of a lousy HMO. Dying people might be better off if assisted dying was available to them under such circumstances. This is not to say that one should not undertake steps to prevent such suboptimal care from happening! So, in response to this worry, the answer seems to be that we should both improve the care provided by HMOs to disabled dying people (possibly to disabled people - period!), and that the implementation of this ought to be more tightly monitored. It does not seem to be a particularly good reason to prevent those dying disabled people who wish to access assisted dying from doing so. The objective should be to ensure that those who don't want assisted dying are not made to ask for it by means of unacceptable levels of care.

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