Monday, October 10, 2016

Another way to improve any assisted dying legislation

A problem with attempts to legislate assisted dying is that they attempt to define in legislation what does and doesn't constitute a good enough reason to die, and thereby what does and doesn't constitute adequate quality of life. As life and death are infinite and complex, some things will almost certainly fall through the cracks.

At the same time, when legislation includes specific things that are considered acceptable reasons to want to die, some people who have those conditions or experiences but don't want to die sometimes take offence, as though society is telling them that they don't deserve to live.  And this push-back may lead legislators to be reluctant to include additional specific conditions, for fear of offending more constituents.

These problems could be mitigated with a single provision: if the patient wants to die because of the absence of a specific aspect of quality of life, and the patient does not have a reasonable chance of gaining or regaining that aspect of quality of life, the patient is permitted to die.

The advantage of this is it takes legislators out of the business of deciding what is and isn't deathworthy (or, depending on your perspective, lifeworthy). Each patient gets to set their own priorities.

In carrying this out, medical professionals should drill down and make sure they pinpoint the actual quality of life issue that's important to the patient, in case it could be addressed some other way.  For example, if a patient says "I want to die if I ever end up paralyzed," what exactly is it about being paralyzed that makes them feel it's deathworthy? Are they afraid of never having sex again? Are they afraid of being dependent on someone else to bathe them for the rest of their life? And are these things that actually happen if you're paralyzed, or are there workarounds that the patient doesn't know about?

If they pinpoint that what the patient actually fears is being dependent on someone else to bathe them for the rest of their life, the living will would be edited from "I want to die if I ever end up paralyzed" to "I want to die if I ever end up in a condition where I'm dependent on someone else to bathe me for the rest of my life," which not only addresses the actual problem, but also includes situations the patient didn't anticipate where they might end up unable to bathe themselves.  It would also tell the patient's medical team where to focus, so they can make a point of trying everything to enable the patient to bathe themselves.

In interviewing the patients to drill down and identify their actual concerns, medical professionals would need to be extremely careful not to be judgemental. They'd need to make very certain to treat every concern as completely valid, and not try to talk patients out of it or even react negatively if the concern sounds petty or shallow or superficial. I know this would be difficult for some corners of the medical profession where people see the direst aspects of the human experience every day and would feel inclined to laugh in the face of "I want to die if I can never again eat recreationally."

But if we can successfully legislate and implement a system where patients choose which aspects of quality of life they see as lifeworthy and deathworthy for themselves with the guidance and support of an empathetic and knowledgeable medical team, that will eliminate many potential problems of mislegislation.

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