Early in my medical career, I was shocked to learn that intensive care units are full of patients who never expect to leave the hospital alive. Facing advanced disease and collapsing organ systems, they rely on the miracles of modern technology to pump their hearts, help them breathe, close their wounds and filter their blood for as long as possible.
Many patients and their families understandably wish to delay death. Others find the experience torturous: the ever-mounting costs, the endless cycle of interventions, the literal and figurative sterility of the hospital environment. Some doctors and nurses secretly wonder whether these practices are in the best interests of their patients. I am one of them.
Some years ago, I began to advocate a revival of the medieval practice of ars moriendi, or the art of dying — a more accepting, less fearful, more community-based approach to the end of life. I believe that in many cases, it is wise to forgo life-extending interventions for the sake of a higher quality of life and a better death.
Given my views, you might expect that I would celebrate the Medical Aid in Dying Act recently passed by the New York State Assembly and now awaiting action in the New York State Senate. But this bill, like similar legislation that facilitates dying in places such as Oregon and Canada, is not about dying well. It is about relieving society — government, medical systems, even families — of the responsibility to care for those who need the most help: the mentally ill, the poor, the physically disabled.
The New York bill defines “aid in dying” as a medical practice. If a patient qualifies, a doctor can prescribe a lethal dose of drugs that the patient may self-administer to end his or her life. Labeling this a medical practice confers a kind of legitimacy on what is also called, more accurately, physician-assisted suicide.
When it comes to conventional suicide, it’s no secret that people who suffer from depression are at greater risk. There is no reason to think that depression is any less of a factor when it comes to physician-assisted suicide. Yet the New York bill, which is modeled on the Death With Dignity law enacted in Oregon in 1997, does not even require a mental health professional to screen patients for depression unless one of the doctors involved determines that the patient’s judgment may be impaired by a psychiatric or psychological disorder.
