II

WHY ASSISTED DEATH?

The memory of her agony is etched indelibly in my mind. When I met her, she was doubled over in pain, kneeling at the side of the bed as if pleading with God for mercy. Her cancer had invaded the bottom of her spine, rendering the bone fragile and unstable. The bottom of the spine had collapsed inward, crushing the delicate nerves at the base of the spinal cord. And so she was in agony, finding only minimal relief by kneeling and doubling over. She had been in that position for days, unable to sleep and without relief, and had now come to the hospital for help. With tears of exhaustion and desperation, she pleaded for relief.

That night I struggled to manage her pain, trying different drugs and doses. Finally, with a continuous infusion of hydromorphone (a morphine-like drug), I was able to achieve some control of the pain. I remember going to check on her in the middle of the night. She was finally lying on her side, comfortably asleep. I slowly exhaled a sigh of relief. I was only a young resident at the time, and her pain had made a powerful impression on me. Indeed, I have rarely seen such a severe pain crisis any time since. Pain robbed that woman of her dignity; it left her desperate and broken in spirit. So long as she was in agony, she could think of nothing but freedom from the pain. The relief of her pain restored her dignity, allowed her to breathe, to rest, to be human.

The Indignity of Suffering

It is sometimes said that we fear dying as much, or even more, than we fear death itself. The possibility of enduring raw physical agony on the journey toward death fills us with real apprehension. In truth, medicine has powerful tools at its disposal to relieve or control physical suffering, and modern palliative medicine is entirely devoted to maximizing comfort and dignity for patients as they journey toward death, holistically addressing physical, emotional, and spiritual needs. But many people are still largely unaware of the possibilities of effective pain and symptom control for the dying, and it is a sad travesty that training and resources are still not sufficient to ensure universal access to high-quality palliative care even in some developed countries. Hence, in our imagination, the journey toward death retains the specter of uncontrolled suffering, and the possibility of a “death with dignity” by having your doctor cause your death in the manner and timing of your choosing seems like an appropriate means of avoiding needless suffering. We don’t want pain, suffering, and dying to rob us of our dignity.

Dignity is a big concept; it concerns our sense of our own value, the value that others perceive in us, and how we should be treated in accordance with that value. Of course, you do not need to have your life ended by your doctor or to commit suicide in order to die with dignity. But the essential argument for physician-assisted death is that the option of physician-assisted death gives patients the confidence that they can avoid suffering and thereby maintain their dignity up until their very last moments. By offering to cause the patient’s death upon their request, we allow patients to take control over the manner and timing of their death, so that they need not live in fear of suffering during the dying process.

Defining Physician-As