Michael Wolff’s family’s tragic circumstance is a manifestation of our society’s pervasive medicalization of death. Since the mid-20th century, technological innovations in medicine—CPR, EMT, MRI, organ transplants, ICUs, pacemakers—have kept patients alive for a much longer time than in previous eras. The average age of death in America in 1900 was 47 years; in 2000, it was 78 years. This means, as Wolff points out in his mother’s story, that one takes a very long time to die—with all the attendant ethical, financial, and personal pain and suffering that accompanies this new reality.
Wolff’s essay is, at its core, a plea for euthanasia—voluntary or involuntary. He would like to have a “Dr. Death,” as Kevorkian was called by medical professionals, rather than the doctors he is surrounded with now. They are the new breed of medicalists in America who believe that the first medical principle, “do no harm,” prohibits them from Kevorkian-type medical action—even in the absence of any quality of life for the patient and the caregivers.
The medicalization of death means that competent people who face catastrophic, terminal conditions—late-stage cancers, ALS, debilitating neurological illnesses—are left without any reasonable quality of life for their final days. For these patients, life ends when their illnesses begin. They demand a dignified end to their life: death with dignity. For nearly one half century, advocates for death with dignity have argued that the U.S. Constitution grants and protects citizens’ liberty to die with dignity. At the same time, the opponents of this idea—many religious organizations, much of the medical profession, various right-to-life and disabled patient groups, and conservative politicians (and U.S. Supreme Court justices)—have successfully blocked such a constitutional interpretation of the “liberty” clauses in the Constitution. In addition, with the exception of two states (Oregon and Washington State), every effort to pass legislation enabling terminally ill patients to die with physician-assistance has been defeated.
Moreover, opponents of the right to die with dignity fear that broadening the Constitution or passing bills allowing death with dignity will inevitably lead to euthanasia and then to a (Nazi-like) government-ordained eugenics program. This is the classic “slippery slope” argument that has been used throughout history. Wolff raises an equally profound issue, one that is mired in complex questions having to do with the exponential increase in health care costs in America (especially for caring for the elderly), a lack of government programs that can adequately deal with the problem, and with new (and costly) developments in medical care that continually prolong life, even of this means a loss of meaning and quality for many individuals. Is it time for we as a society to rethink the essence of our personal beliefs in the sanctity of life, beliefs rooted in profound religious or humanist principles? This is the heart of the problem; there are no easy solutions.
Howard Ball is the author of At Liberty to Die: The Battle for Death with Dignity in America.