Dr Diane E. Meier is one of America’s
leading palliative care physicians. She is Director of the Center to Advance
Palliative Care (CAPC) at the Mount Sinai Medical Center in New York City and
is the recipient of numerous awards. She was once an advocate of assisted
suicide, but has changed her mind. Here are some remarks she made last month at
a community seminar in Vermont.
Questioner: If we had a fully implemented palliative care model
in this country, working as we think it should be working. . .Is there a need
for policies . . . such as “Death with Dignity”? Is there a correlation
or relationship between those two, – some people would say, you don’t need
Death with Dignity if you have a good palliative care model. I was
curious as to your thoughts on that.
Dr. Diane
Meier: I, as a young
person, was strongly in favor of legalization of assisted suicide. I think I
was somewhat naïve at the time, you know, kind of doctrinaire about my
commitment to patient self-determination and patient autonomy. And as I got a
bit older and had more experience taking care of patients and families, and
realizing that autonomy was not really relevant to the human condition – We are
all parts of families and parts of communities and critically dependent on one
another in ways that notions of self-determination and autonomy pretend don’t
exist –
Bob Butler, whose photo I showed you, said to me when
I was writing stuff in favor of assisted suicide that there’s an old Chinese
proverb that: “Suicide reverberates for seven generations.” The harm to
families when someone decides to leave, rather than having to leave, is
substantial and has been understudied.
What’s also very interesting is that the movement to
legalize assisted suicide is overwhelmingly driven by the ‘worried well’ – by
people who are so terrified of the loss of control that illness and death,
dying and death bring – that there’s a sort of reaction formation: “Damn it,
I’m gonna take control back” over something that’s so terrifying. But, for
millions of years, humans have lived and died in their families. And it’s not
that scary. It’s pretty natural, like birth.
And when you look at – “What do sick people want?” –
Sick people almost always want to continue to live. And it took my experience
with sick people who, if it were me, I’d say, “I want assisted suicide,” and
they still want to live. Overwhelmingly, people want to live, in spite of
conditions that the “worried well” would think are intolerable.
I don’t know how many of you saw the Bill Moyer’s
series “On Our Own Terms: Dying in America”? I don’t know if you remember that
patient with Lou Gehrig’s disease whose wife was taking care of him and Moyers
went back repeatedly, and the first time he said, “Well, if I’m in a wheelchair
all the time, that’s it, I’m outta here.” So, Moyers goes back six months
later, he’s fulltime in a wheelchair, he can’t do anything for himself, and,
“It’s okay.” Then he says, “Well, if I have to get to a point where my wife has
to change me and bathe me and I can’t take care of my own business, I’m outta
here.” He goes back six months later, that’s exactly what he needs and
life is still worth living. Because people adjust, people are remarkably
resilient. And life is precious, and your vision of what’s worth
tolerating changes.
And legalization
of physician assisted suicide in a society like ours, which is entirely driven
by overwhelmed, overextended doctors chasing the dollar, is pretty scary –
because the patients who might opt for this are the ones who really need
thoughtful, extended conversations about what is motivating you to want to die
at this point, and the differential diagnosis is long. And I can promise you
that the overwhelming majority of doctors have neither the training nor the
time to engage in that kind of careful discussion with seriously ill patients.
And I do
believe that real access to palliative care that is timely, that is high
quality, would essentially eliminate the need for that and the fear that drives
people to vote for these ballot measures.
~ Thanks for the tip from Wesley J. Smith
at Secondhand Smoke; True Dignity Vermont, Apr 5
