Dr. Stahl presents on physician-assisted suicide, opioid epidemic in November

Devan Stahl photoCenter Assistant Professor Dr. Devan Stahl gave three presentations this month at local and national events.

Dr. Stahl was invited to give a talk at Georgetown University on November 9 as part of their conference on “Physician-Assisted Suicide and Euthanasia: Theological and Ethical Responses.” In her talk, “Understanding the Voices of Disability Advocates in Physician-Assisted Suicide Debates,” she discussed the disability rights perspective on physician-assisted suicide (PAS) and how it relates to Christian ethics. The presentation argued for the importance of faithfully attending to concerns regarding PAS raised by disability advocates, and considered the ways that the Church has historically failed to offer full honor and respect to the lives of people with disabilities. By attentively listening to disability groups who oppose PAS, Christians may come to realize that they too participate in unjust structures and systems that threaten the lives and dignity of disability advocates.

On November 14, Dr. Stahl was the keynote speaker at the annual Ernest F. Krug III Symposium on Biomedical Ethics, presented by Oakland University William Beaumont School of Medicine. Her talk was titled “The Disability Rights Critique of Physician Aid in Dying Legislation.” Dr Stahl spoke to an audience of medical students and faculty about the disability rights perspective on physician aid in dying, and how it differs from the debates happening in mainstream bioethics. Over the past three decades, disability rights advocates have provided clear and consistent opposition to the legalization of physician aid in dying (PAD), which many believe threatens the lives and well-being of persons with disabilities. The presentation reviewed the common objections to PAD from disability advocates and considered what such objections reveal about the systemic failings of our current health care system.

At the American Academy of Religion Annual Meetings in Denver, CO, Dr. Stahl joined a panel of speakers discussing religious responses to the opioid epidemic. She discussed the ethical tensions that physicians experience when managing the opioid crisis, including whether and how to trust patients who request opioids, the validity of opioid contracts and drug screens, as well as the current legislative restricts on opioid prescribing.

Assisted Suicide’s Moral Hostages

Bioethics-in-the-News-logoThis post is a part of our Bioethics in the News series

By Tom Tomlinson, PhD

This isn’t exactly news, but some of you may remember a ripple of controversy surrounding a proposal before the Dutch legislature to legalize assisted suicide (AS) for people over 75 who meet certain other conditions, as reported in October in The New York Times.

I was reminded of it in December, when I stumbled over an item in the UK’s Daily Mirror. (Yes, I’m an avid follower of British tabloids.) The item features a video interview with a 65-year-old man with multiple sclerosis who explains why he would want this option as he becomes more disabled by his MS. He complains he’s losing sight in both eyes, and has difficulty reading or writing. As he loses his independence, he finds it more difficult to be happy with his life. “Where are all the things that make life a pleasure, besides the people that I love?” he asks. “They’re all gone, one-by-one they’ve been stripped away…. I don’t see the point of waiting until one is a virtual corpse that simply breathes.”

Now of course assisted suicide for terminally ill patients is itself a controversial topic, although majorities support it in the U.S., Great Britain, and Western Europe. One can expect that a proposal to expand AS to those who have a collection of chronic and variously disabling conditions just by virtue of being old will be even more controversial, and indeed vigorous opposition is expected in the Netherlands, and the adoption of the proposed legislation is far from certain.

Image description: this map shows the legal status of Physician Assisted Suicide (PAS) and Voluntary Active Euthanasia (VAE) around the world. The map is a project of the Kennedy Institute of Ethics at Georgetown University. Visit the map on the web to explore its interactive features or to view a text version.

Speaking as a gradually disintegrating 71-year old, here’s a tentative defense. It starts with remembering what the Stoic Seneca taught. There is no need to fear death, since once you are dead there is no you to be afraid or to suffer. It’s the dying that we should fear—which is to say, the living we experience before we are finally released by death.

So if AS is justified for those who are dying from a terminal illness, it is because the quality of the life that remains has become intolerable for that person. But the terminally ill aren’t the only ones who struggle with losses to their capacities and their ability to find enjoyment and meaning in the life they are living. The old may well suffer the same kinds of losses as the terminally ill, as a host of chronic but not (yet) fatal conditions chip away at what before could be taken for granted, as friends and family die or move away and the social world shrinks, as the future begins to lose its allure, and there is nothing more in particular we want to achieve or do. “Dear World, I am leaving because I am bored. I feel I have lived long enough,” read George Sanders’ suicide note. A flamboyant actor, Sanders may have wanted his last lines to be good ones. But there was a lot more to the story. Sanders had suffered many losses before his death, which may happen to many of us in our later years. Under some perhaps narrow conditions, why shouldn’t we have the option of AS?

A common reply to this argument is that killing yourself is an awfully extreme solution to such problems, many of which could be ameliorated in other ways: better, more available primary and palliative care, assistive devices, meals on wheels, age-appropriate social activities and networks, visiting nurses and social workers, etc., etc. Once all this is provided, the need for AS will evaporate.

Now these are all fine options to be pursued in the individual case—when they are in fact available. But too often, these alternatives are used as reasons to not permit the option at all—as an argument against a policy allowing AS.

But when they are not readily available to all, or are not effective in the individual case, those who after due consideration believe that AS would serve their interests become moral hostages to an ideal world: a world where every deeply felt need motivating a desire for AS can be met in some other way. When we’re fixated on the ideal, the person in front of us is sacrificed to our vision of a better world. Paradoxically, the real world becomes a worse place as a result.

So I think this style of moral argument is deeply problematic. And assisted suicide is not the only context in which it’s found. For example, parents of children with familial short stature may want to use human growth hormone for children so their child may grow to something closer to the average height, and perhaps avoid the real social disadvantages short people face (men especially). Now there may be lots of good reasons to object to this treatment—e.g., it’s expensive, it is a crapshoot whether it will increase height by any significant amount, etc. But this use of growth hormone is also opposed on the grounds that what really needs to change are discriminatory social attitudes toward very short persons. By all means, let’s work on that. But in the meantime, what about this kid?

Another moral hostage, as we await the Millennium.

tomlinson-crop-2016Tom Tomlinson, PhD, is Director of the Center for Ethics and Humanities in the Life Sciences in the College of Human Medicine, and Professor in the Department of Philosophy at Michigan State University.

Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, February 9, 2017. With your participation, we hope to create discussions rich with insights from diverse perspectives.

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Bioethics for Breakfast: Legalizing Physician-Assisted Death: Should Michigan Be Next?

bioethics-for-breakfastTom Tomlinson, PhD, and Ed Rivet, MPA, presented at last Thursday morning’s Bioethics for Breakfast event, offering opposing views on the topic, “Legalizing Physician-Assisted Death: Should Michigan Be Next?”

Physician-assisted death (also known as physician-assisted suicide) is now legal in four states, either through legislation (Vermont), ballot initiative (Oregon and Washington) or state supreme court ruling (Montana). With a favorable February ruling by Judge Nan Nash of the New Mexico Second Judicial District (now under appeal by the state Attorney General), New Mexico may be next. An attempt in Michigan in 1998 (Proposal B) was overwhelmingly defeated, 79% to 21%, despite pre-ballot polling that suggested overwhelming support.

In the discussion, speakers and attendees explored this debate and tried to decide: if another proposal were brought before Michigan voters, should it pass this time?

Tom Tomlinson, Ph.D.
Tom Tomlinson is Director of the Center for Ethics and Humanities in the Life Sciences and Professor in the Department of Philosophy, Michigan State University.

Ed Rivet, MPA
Ed Rivet is Legislative Director for Right to Life of Michigan.

About Bioethics for Breakfast:
In 2010, Hall, Render, Killian, Heath & Lyman invited the Center for Ethics to partner on a bioethics seminar series. The Center for Ethics and Hall Render invite guests from the health professions, religious and community organizations, political circles, and the academy to engage in lively discussions of topics spanning the worlds of bioethics, health law, business, and policy. For each event, the Center selects from a wide range of controversial issues and provides two presenters either from our own faculty or invited guests, who offer distinctive, and sometimes clashing, perspectives. Those brief presentations are followed by a moderated open discussion.