I am very pleased to share a post from my thoughtful fellow-blogger Wayne Campbell. Wayne won a Certificate of Merit at the Press Association of Jamaica’s Awards 2015. This is a very thought-provoking but balanced approach to an issue I confess I have never tried to tackle; although it did cross my mind when my father was dying. He received palliative care – as described below. Please do follow Wayne’s blog, entitled “The Intersection of Gender, Culture and Education: Jamaica, the Next 50 Years!” (links below). Comments are, as always, welcome.
Death is not the greatest loss in life. The greatest loss is what dies inside us while we live. -Norman Cousins
Most if not all of us are afraid of pain, death and dying. The Bible says in Hebrews chapter 9 verse 27: It is appointed unto man once to die. However, despite this prophetic word there is a human desire to remain youthful and to live a life pain free. As a result we continue to search for the fountain of youth, whether by means of surgical intervention or from a specially formulated cream endorsed by celebrities to have that youthful appearance.
In many advanced societies, such as the United States of America and Europe the right to die has sparked controversy over the decades for both opponents and proponents of this issue. Opponents argue that the dangers of abuses warrant prohibiting physician-assisted suicides. There is concern that there could be pressure for large scale assisted killing of the disabled or the mentally incompetent.
Mercy killing or Euthanasia is legal in four states in the USA. Oregon in 1994 became the first U.S. State to pass a Death with Dignity Act, allowing terminally ill patients the option of choosing the right to die. Other states to have followed are New Mexico, Vermont and Washington. This practice is also legal in Belgium, The Netherlands, Switzerland and Luxembourg as well as the Canadian province of Québec. Given Jamaica’s strong Judeo-Christian traditions the issue of Euthanasia or physician-assisted suicide rarely comes to the fore in a meaningful discussion. Christianity teaches that suffering can have a place in God’s plan, in that suffering allows the individual to share in Christ’s agony and in his redeeming sacrifices.
It is fair to say that doctors often times face moral, legal and ethical questions as they care for their patients. However, they should be at all times guided by their Oath which is to help their patients, not to harm them in anyway.
In jurisdictions where Euthanasia is permitted a doctor does not face criminal prosecution if he/she assists a patient in dying by providing life ending medications.
Those who seek the right to die with dignity are usually those individuals suffering from terminal illnesses, such as cancers. In most instances chemotherapy and other treatments have become ineffective, leaving the patient in constant pain or the fear of dying a painful death.
In spite of all the advances we have made in medicine and technology there are some diseases which are incurable and inoperable. These diseases are usually accompanied with intense and unbearable, pain rendering the patient dependent on a constant dose of pain killers.
This discourse is not as clear as it appears. There are many grey areas and this is where the issue of Ethics comes in. The Hippocratic Oath written in the 5th Century by a Greek physician clearly forbids doctors to assist patients to die. In a modern day translation of a part of the Oath it says, “ I will follow that method of treatment which according to my ability and judgment, I consider for the benefit of my patient and abstain from whatever is harmful or mischievous. I will neither prescribe nor administer a lethal dose of medicine to any patient even if asked………..”. This clearly speaks for itself and therefore we should not even be having this discussion if doctors adhered to their Oath. However, we do not live in a perfect world. In fact we live in a pluralistic world with many ideas and religions competing for our attention.
Hinduism accepts the right to die for those who are tormented by terminal diseases through the non-violent practice of fasting to the point of starvation. Jehovah Witnesses also discourage their members from accepting blood transfusions. For the community of Jehovah Witnesses the issue of blood transfusion is a religious one. They avoid accepting blood transfusion out of a respect for God as the giver of life. They provide scriptures in both the Old and New Testament to support their stance, such as Genesis 9:4, Leviticus 17:14 and Acts 15:28-29.
Notwithstanding such a discourse, we must also look at the cross-section of law, medicine and ethics in order to fully understand both sides of the debate.
It should be noted that suicidal behaviour is not confined to the aged and elderly. Disturbingly, a 2013 UNICEF-funded special survey on Youth Suicide in Jamaica conducted by Jamaica’s Ministry of Health revealed that twenty per cent (20%) of high school students from grades 8-12 are at risk of suicidal behavior. This clearly indicates that the Jamaican State needs to strengthen their mental health capabilities, since for the most part our schools are ill-equipped to deal with suicidal students.
Many creations have been crafted to ease the confusion surrounding death and dying. Among them is what is called a Living Will. A Living Will can indeed become a useful instrument in adhering to the wishes of an individual. In many societies, citizens are encouraged to have a Living Will. A Living Will is a legal document ensuring that one’s wishes will be done regarding artificial life support in the event that one becomes incapacitated.
God does not need any help from us regarding when it’s time to depart this life. In fact God has given us the free will to choose. In fact there is an alternative to euthanasia in the form of Palliative Care. According to the World Health Organization (WHO), palliative care affirms life and regards dying as a normal process; it neither hastens nor postpones death; it provides relief from pain and suffering; it integrates the psychological and spiritual aspects of the patient.
It is time that as a society we revisit how we care for the aged among us. We need to develop a comprehensive policy on the elderly in Jamaica to take into account issues such as caring for the terminally ill, pain and estate management. We need to ensure that we do all that is humanly possible to facilitate those who are close to dying to be as comfortable as they possibly can.
Gender and Euthanasia
According to Professor Silvia Canetto of Colorado State University, the taking of one’s own life tends to be seen as a masculine act. She adds that when mercy killings occur they are usually administered by men for women, with two-thirds of those killed being females. While women are under-represented in suicide statistics, they are often over-represented in assisted suicide and euthanasia reports. In fact a descriptive analysis of the sixty nine (69) people who died with the assistance of Dr. Jack Kevorkian between 1990 and 1998 showed that seventy one (71%) per cent of the victims were women. Interestingly, forty three (43%) per cent were divorced compared with fifteen per cent of the men.
It can be argued that a critical component to understanding the apparent gender bias in euthanasia and assisted suicide is the traditional role of women as care givers. When a woman is no longer able to do what she has been socialized to do in a patriarchal society, she may see no reason in living and might choose to die as she now sees herself as useless, with a heightened sense of hopelessness.
Sidney Callahan offers a feminist perspective on euthanasia by stating that women will be affected most by assisted suicide simply because women live longer and have fewer resources at their disposal than men do.
Regardless of which side of the argument you support, the doctor’s role is not to assist his/her patient in dying.
In the words of Steve Jobs:
No one wants to die. Even people who want to go to heaven do not want to die to get there, yet death is the destination we all share. Death is very likely the single best invention of Life. It is Life’s change agent. It clears out the old to make way for the new.
In the words of Albert Einstein:
The fear of death is the most unjustified of all fears, for there’s no risk of accident for someone who’s dead.
Wayne Campbell is an educator and social commentator with an interest in development policies as they affect culture and or gender issues.