Death and dying are inevitable and a natural part of life’s cycle. But rather than medically extending life, research shows that many Americans want the option of being able to retain autonomy in their final days if they are terminally ill and suffering. Death with Dignity Legislation has brought that choice to nine states across the country, but not all doctors support that option. Palliative care expert Dr. B.J. Miller talks with KCRW’s Jonathan Bastian about the ethical considerations of this controversial law, and why we shouldn’t make it too easy to give up on life.
The following interview excerpts have been abbreviated and edited for clarity.
KCRW: The American Medical Association and other groups within hospice or palliative care have questioned and even opposed this legislation. Why?
BJ Miller: “There are a couple major reasons. There are those who will invoke a moral or religious plane based on their belief systems — that it’s not for humans to decide when they die, it’s up to the creator and that we're stepping on toes by usurping that responsibility or that freedom. So there's a religious underpinning and that’s a big one.
Another big one in the medical establishment are those who read our oaths. The Hippocratic oath is most well known. … There are other oaths that clinicians take, but some people's reading of those oaths have life and death pinned against one another, that we physicians are duty bound to support life and to forestall death, at pretty much any cost. That's one read of our role in medicine.
I disagree with that. When we separate death from life, when we put them in an oppositional frame of reference, we're doing the subject a disservice. So I have my misgivings about that attitude but that's one major thread.
Another is, and this has been the position of my field of hospice and palliative medicine … there's some concern that this law will open up the ‘slippery slope.’ That if we make it too easy to get off the planet, then we're going to take our boot off the neck of the system to actually get better.
I have some feelings about this and I agree in some ways. Why would we jump to making it easier to die, to end your own life, rather than doing everything we can as a society to support someone, to finding meaning and peace and being loved in this life, so that you don't have to wish for death? We are so far from doing everything we know how to do, to make life more powerful and make a better case for living another day.
There's an expediency. You're in trouble, you're going to die soon anyway, let's just get you off the planet. And if we get too casual about that line, there's some sense that I'll just start choosing to die, and if we have a rough spell … we'll just throw in the towel. So there's some concern around this sort of ‘slippery slope’ phenomenon that it somehow steals or usurps the tension that's vital for getting our systems to actually improve. So those are some of the major misgivings.”