Painful Choices

On October 24, Texas put Bobby Hines to death.  He was the thirty-third prisoner to be executed in the United States in 2012.  Eleven more are scheduled this year.  In 2011, thirteen states executed forty-three prisoners.  (Texas provided 32% of the 2012 executions and 30% of those in 2011, but I digress.)  All of these executions were performed by lethal injection, most using a three-drug cocktail: first a general anesthetic to put the prisoner to sleep, then a muscle relaxant to stop breathing, and finally a drug to stop the heart.  The process is designed to cause little or no pain while ending what the state has determined to be a life unworthy of life.  It’s all very humane.

Natural death is another matter.  Patients dying of terminal disease may spend days, weeks, or months in extreme agony.  While their medical attendants may provide palliative treatment to reduce pain, these treatments do not necessarily eliminate discomfort.  Further, these patients may suffer mental anguish or psychological trauma if they are aware of the goings-on around them but are unable to communicate.  Many such patients, especially those with slowly progressing diseases, are able to plan how they will receive this care as they reach the end of their lives.  Yet only three states–Oregon, Washington, and Montana–currently permit terminally ill patients to enlist the assistance of a doctor–or anyone else for that matter–in planning their own death.  Oregon and Washington permit physician-assisted suicide; the Montana Supreme Court has ruled that a physician may not be prosecuted for prescribing lethal drugs.  Massachusetts may join Oregon and Washington next month, pending the outcome of a ballot initiative.  (Interestingly, the three states that currently permit physicians to assist in suicide all have capital murder statutes, though Oregon has not performed an execution since 1997.)

This is curious.  We go to great lengths to ensure that those convicted of capital crimes, ostensibly the worst of the worst of humanity, are comfortable and pain-free even as we kill them.  But, in the name of protecting human life, we do not allow innocent people, who may be suffering unbearably, who may have endured excruciating psychological pain knowing the physical pain was coming, to plan to die in similar comfort.  The logic is lost on me.

Advances in medicine have resulted in doctors’ ability to fairly accurately determine when life is nearing an end.  The modes of progression of many terminal illnesses are well known.  Those about to undergo excruciating deaths from disease are fully aware of the pain that is coming and the death that will result.  Yet most states require these terminal patients to suffer as they die.  They should have options.  The circumstances should be extremely limited, and safeguards against abuse should be robust.  Many doctors would have ethical qualms about actively ending a life; these should be respected.  But when a willing doctor is available and a patient is truly suffering, shouldn’t the dying patient be allowed to die as he wishes?  If I lived in Massachusetts, I would vote yes.

Here are a couple of related pieces that I came across over the past week:

(Note:  data on execution numbers was from the Death Penalty Information Center,; I did not attempt to verify the numbers from a second source.)

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