It is unlikely that the terribly misguided legislators in the New York State House and Assembly who think legalizing doctor-assisted suicide is a good idea would allow themselves to be convinced otherwise based on religious and moral grounds. But perhaps they will be swayed by a new study about the Netherlands.
Dr. Scott Y. H. Kim, a psychiatrist and bioethicist at the National Institutes of Health, looked at records of most of the cases of doctor-assisted death, or euthanasia, for psychiatric distress from 2011 to mid-2014, and his study was published in the journal JAMA Psychiatry. Its findings have rightly caused concern even among people and groups not inherently opposed to what essentially is assisted murder.
The Netherlands, like Belgium and Switzerland, permit doctors to help people with severe psychiatric problems commit suicide. Other countries, including Canada, are currently debating similar measures. What the recent Dutch study found was that in more than half of approved cases, the patients declined treatment that could have helped them, and that many cited loneliness as an important factor in their decision to take their lives.
What is more, people in the Netherlands who received assistance to die often sought help from doctors they had never seen before. Many patients, in fact, availed themselves of a “mobile end-of-life clinic” — a travelling resource staffed by a nurse and a doctor, and funded by a euthanasia advocacy organization.
In the Netherlands, the disease must be “intractable and untreatable,” but, according to Dr. Paul S. Appelbaum, a professor of psychiatry, medicine and law at Columbia University, “evaluating each of those elements turns out to be problematic.”
“The idea,” he noted further, “that people are leaving their treating physician and going to a clinic that exists solely for this purpose, and being evaluated not by a psychiatrist but by someone else who has to make these very difficult decisions about levels of suffering and disease … seems to me like the worst possible way of implementing this process.”
The problem, though, goes beyond implementing the process, or even the process itself. It is the very idea that making suicide an option is ethical in the first place.
Five states in the U.S. — Oregon, Vermont, Montana, Washington, and California — permit doctor-assisted suicide for the “terminally ill,” although, to date, only if the patient is an adult and deemed mentally competent. “Terminally ill,” though, is a judgment that covers a broad span of illnesses, including many that can be managed for considerable periods of time. And “mental competence” is a fluid term.
New York is now considering joining those states. Lawmakers are considering two bills in the current legislative session that would allow a physician to prescribe a lethal dose of medication to a terminally ill patient.
Those bills, too, require that the patient be mentally competent and have less than six months to live. But both determining mental competence and how long a patient can be expected to live occupy the grayest of areas. And what’s more, and more important, human life has inherent meaning and value, and ending it, even if the one ending it is the victim, is murder.
There is, unfortunately, financial incentive to help people die rather than continue expensive treatments. As Diane Coleman, president of Not Dead Yet, put it: “There’s a very deadly mix between our current cost-cutting health care system, an aging society and legalizing assisted suicide, which would, if it were public policy, if it were considered a regular treatment … be the cheapest treatment.”
New York Assembly member Amy Paulin, however, contends that “We New Yorkers deserve that choice,” and Assembly Health Committee Chairman Richard Gottfried agrees.
“I don’t see any meaningful philosophical, or clinical, or ethical or religious difference,” he asserts, “between patients saying, ‘Stop life-sustaining treatment’ … and a patient having the right to say, ‘I want medication that will enable the suffering and the pain to come to an end’.”
Well, we do. The distinction is philosophical, clinical, ethical and religious — at least in the Jewish religion.
While contemporary society may — as some societies have done over millennia — choose to value life only if it is happy, productive and not painful, a truly enlightened society recognizes, as the Torah teaches, that life has inherent value.
Diseases and pain should be treated with the best medications available, and the despondent should be helped to see their lives as meaningful.
Nor should one ever give up hope.
Chazal (Brachos 11a) teach us that when Chizkiyah Hamelech had fallen ill, and Yeshayah Hanavi came to inform him that he should instruct his household, for he will not live.
Yet Chizkiyah did not despair. Having learned that he was being punished for his failure to marry, he sought to rectify this omission immediately.
“Now, give me your daughter [in marriage],” he said to the navi. “Perhaps in my merit and yours virtuous children will be born.”
Yeshayah informed the king that in his view, it was too late for such a step. “The decree has already been passed,” he said.
“Son of Amotz,” Chizkiyah told Yeshayah Hanavi, “end your nevuah (prophesying) and go, for I have received [a mesorah] from the house of my father’s father: Even when a sharp sword rests on a person’s neck, he should not refrain from praying for mercy.”
The navi agreed to the historic shidduch, Chizkiyah married Yeshayah’s daughter and fully recovered from his illness.
Making it possible for patients, even “terminal” ones, to choose, or be convinced to choose, death over life is simply wrong, and every effort must be made to stop this dreadful phenomenon.