Saturday, August 10, 2013

Dying with Dignity: a refutation of Gifford-Jones article in the Toronto Sun, August 3, 2013, p. 27



I have been having computer problems the last little while – in fact all my electronics are giving me difficulties one way or another.  The thing is, I am also waiting to see if a friend can help me re-format and re-install software on my old computer: something didn’t work right.  We can do that with computers: wipe the slate clean and start afresh, for the most part.

Not so with people.  People are much more complex – and valuable.  We don’t just junk them and start afresh; there is something inherent in the knowledge that when it comes to human relationships and frailties, we are in it for the long haul.  It is when we treat each other as objects of convenience that we run into trouble.  There is an example of a woman who had EI as part of maternity leave; then she found out that she had cancer and needed emergency surgery.  EI said no, and is still saying no.  Her MP also said he couldn’t help.  With help from an article in a newspaper, the government is now investigating her case.

Thomas Gifford-Jones has a column in the Toronto Sun newspaper.  On Saturday August 3, 2013, he put forth an opinion column, not backed by evidence, about how he thought that euthanasia was an idea whose “…time will come.”  He is in favour of euthanasia.  This is for the usual reasons: we don’t treat animals that way, people are dying in pain, their loved ones had died in pain and this was unacceptable, and he says “It’s incredible that we have a society for the Prevention of Cruelty to Animals, yet none for humans.” [p.27]  I suppose that equating humans with animals and dehumanizing them is a rational hallmark, but has he forgotten that groups like Right to Life, Campaign Life Coalition, Not Dead Yet, The Coalition of Physicians for Social Justice and the Euthanasia Prevention Coalition exist for their stated purpose of resisting ‘cruelty to humans?’ Someone’s not paying attention…

Then his article holds some ad hominem arguments and abuses his critics before the fact.  “But I can hear the howling and irrational fears that will descend on Quebec.”  That presents people in opposition to medically provided death as a) irrational and b) fearful.  By contrast, it presupposes that anyone in favour of medically provided death is therefore c) rational and d) thoughtful, and this is not necessarily the case.

He then states that in 1984 he was part of a group pushing for medically provided death, but “…[the] outcome was predetermined as several Roman Catholic senators served on the committee.  That’s akin to putting the fox in charge of the henhouse.  Besides, all the most credible witnesses I wanted to present had all died in pain.” [27]  So the argument is that we need this because people are dying in pain?  So why were these people dying in pain?  In 1984, I think we had pain management and most deaths would have been in hospital, where there is access to pain management specialists and trained doctors and nurses…

His statement also assumes that only ‘religious’ types are against this; in fact there are nonreligious reasons for not accepting medically provided death.  In addition, Jones writes that “hundreds” of “angry readers have expressed opinions about assisted death. … They were tired of ethicists and others who believed their own moral code bore the stamp of the Almighty and applied to all.” Apparently, these angry readers were not angry enough to present their stories to the Sun as current news, but it’s also interesting that Jones would invoke ethicists…are these not the people who would be quick to tell doctors that keeping someone in pain when there are options available is, I dunno unethical?  He is implying that ethicists are against euthanasia, which tells me he is not familiar with the work of Peter Singer.  So Jones has an issue with religious types and ethicists, not with those who oppose his views.

There’s a problem.  Jones then goes on to state “The critics of assisted death invariably use asinine reasons for denouncing it.” [27]  This is to abuse your opposition.  He then talks about the Nazis, who used the T4 programme to their own political ends.  Jones forgets that the Nazis inherited the system from the previous government; they formalized the use of death and it was ramped up.  Particularly, it was not ‘legalized’ in Germany until October 1932, when Hitler signed a retroactive order a month after the start of the Second World War.  Jones then says, “Nazi executioners never gave victims the choice of life or death.”  Like Tracey Latimer was given a choice before she was bundled into her dad’s truck?

In a telling statement, Jones then writes, “Critics also resort to the ‘slippery slope’ argument.  They howl the elderly and sick will be quickly exterminated.  But this has not happened anywhere in the world where this humanitarian option is provided.” [26]  There’s a problem here: that did happen in Nazi Germany, so it has happened somewhere in the world.  As well, the rising numbers of people each year who are killed, and not always after being informed, are rising in the Netherlands, where this ‘humanitarian option’ was only legalized in about 2001!

There have been instances of

People killed for convenience [Hendin]
People refused medical care and offered death [Oregon, 2000’s]
People killed by being forced into it [Hendin]
People being killed without their knowledge [Hendin, Smith]
People being killed because they were bed blocking [Recent cases, England and Brazil, as well as in Holland]
People killed at the request of family [Smith]
People being killed because they belong to an undesirable class  [The Ontario medical establishment no longer provides care for infants born before 24 weeks gestation, according to McIvor in her book After the Error, which was published this year.]

Jones then states that he would “…allow each patient to name a committee of trusted people who can then decide when it’s reasonable on humanitarian grounds to end life.  My committee would include my wife, children and my physician.  But I’d also add a veterinarian to apply the same logic he or she applies to end the life of a beloved dog in pain.”

Sarcasm of that last sentence quoted aside, we already have living wills and powers of attorney.  Those same ethicists who Jones argues with are also charged with helping families negotiate death, to borrow Tim Falconer’s odd phrase.  The problem is that doctors do not have to tell you or your family that there is a silent DNR order on your chart, and they do not have to inform you of that notation.  That has happened in Quebec, Ontario and Manitoba in recent years.  My sources on that are Wes Smith’s books Forced Exit and Culture of Death.

Jones is just as angry in this article as he accuses his critics of being.  I can be certain that in a debate he wouldn’t listen to reason on this issue.  His views are entrenched and that is a scary way to be: if he had a patient who didn’t want to give someone else the incredible responsibility of killing them, would he be respectful of that?  Probably not, from the tone of his article.  In addition, there are absolutely no concrete sources or supports for his emotional assertions in these issues, so it is hard to know what he is on about.  It is certain that he would not want to suffer, and he thinks that he will.

I have had some negative experiences in medical care as well, but I have also seen the best medical care given to my stepfather and my mother, both of whom are dead now.  They both got good care, and their situations were unique.  I have had accusations of being a drug addict and have been denied care on that basis.  The question I have is this: if someone decides that I am a drug addict and kills me without doing required tests, who do I complain to?  Oh, wait…

So this is a terrible thinkpiece because it required no thought on Jone’s part to come up with it.  He feels strongly, but he hasn’t clarified – and he should – if he is a member of Dying with Dignity or not.  Personally, this article is an archetype for all those buried fears that people have about their doctors, illness and our disposable culture, and it should not be taken as a majority view.  However, his argument from emotionalism is hard to refute: who would be in favour of suffering?  That emotionalism blinds us to the knowledge that there are options than suffering in silence and dying in pain: we have excellent palliative care and hospice, and we have dedicated and professional caregivers and those are the people of whom I am in awe.

The major flaw in this piece is that Jones ignores the experienced ebvidence from Holland, Belgium, Oregon and Washington where the flaws in the system were known and have been exploited.  Interestingly in Oregon, wit a population of about 3 million, there have been a proportional handful of cases where people have asked for death: in the tens or hundreds.  That suggests that where there is provision for death, people don’t generally take it.  So really we are discussing control not care, and that is dangerous when we are required to give up control to someone who might kill us, leaving our loved ones out of the loop and none the wiser.  It is that total silence after the fact which should stop the debates cold: we are going to see what problems arise when care is defined as killing and we ask healers to become executioners.
Gifford-Jones comes across as cranky and unappreciative in this article; I even think he is trying to be funny in parts, but that fails.  It would be interesting to know if he was a member of Dying with Dignity: at least that way there would be less hypocrisy on his part.  He would not stand so much as someone who had an apparent axe to grind if that were the case.  He does not speak for me, and I would never want him at my bedside.

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