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Story available at http://www.billingsgazette.net/articles/2009/01/04/news/state/18-ethicists.txt
Published on Sunday, January 04, 2009.
Last modified on 1/4/2009 at 1:11 am
Ethicists, ministers, doctors debate issues associated with assisted suicide
By ED KEMMICK
Of The Gazette Staff
David Karnos retired last year after teaching philosophy for 31 years at Montana State University Billings. Every year, he taught a class on death and dying, exploring end-of-life subjects including euthanasia and physician-assisted suicide.
If we think such discussions are new, he said, it's worth remembering that the most famous philosopher in history, Socrates, killed himself by drinking hemlock in 399 B.C.
"We've argued about it for 3,000 years," Karnos said.
In Montana, the age-old debate over end-of-life decisions took on a new urgency early last month, when a state district judge ruled that Montanans have a right to doctor-assisted suicide.
Judge Dorothy McCarter of Helena, presiding over the case of a Billings man who had terminal leukemia, ruled that Montanans who are mentally sound and terminally ill have a constitutional right to end their lives by taking doctor-prescribed medication.
The plaintiff, Robert Baxter, had been treated with multiple rounds of chemotherapy and was suffering from numerous disorders - including chronic fatigue, nausea, night sweats, persistent infections, swollen glands and serious digestive problems - caused by the disease and the treatments he had undergone.
He had petitioned the court for the right to assisted death if his suffering became unbearable. As it was, he died of natural causes on Dec. 5, the day McCarter issued her ruling.
That hardly settles the matter, though. Attorney General Mike McGrath immediately announced that the state would appeal the ruling to the Montana Supreme Court, seeking to have it overturned. At least one legislator, meanwhile, plans to introduce a bill during the 2009 Legislature that would codify McCarter's ruling and make doctor-assisted suicide legal in Montana.
Whatever the official outcome is, the process of making end-of-life decisions surely will continue to be a difficult and vexing one for patients, their families and their physicians.
"There's no easy answer," Karnos said.
That assessment fairly well sums up the views of other people who, like Karnos, spend a lot of time thinking about and dealing with end-of-life issues.
The Rev. Milous "Mike" Repka is a Presbyterian priest who served for 11 years as the Protestant chaplain at St. Vincent Healthcare and for 25 years as the ethicist on the Institutional Review Board, charged with approving medical research projects at St. Vincent and Billings Clinic.
Repka said his thinking on the subject is grounded in the Gospel of St. John, which speaks of the abundance or fullness of life. Repka's first wife died of cancer, and he had to make the decision in her last days to discontinue the extraordinary efforts to keep her alive.
Repka came to the decision after concluding that what his wife was going through "was not the fullness of life." That decision involved the withdrawing of support, not assisted suicide, but "It was one of the most difficult decisions I ever made," he said.
Repka said he might be willing to end his own life if it lost its fullness. As a Christian who believes in life after death, Repka said, he is not afraid to die.
"My decision would be between two fullnesses of life - fullness of life here on earth or fullness of life in eternity. And I would like to make the decision myself." At the same time, he added, he would never hold it against his physician if he decided his medical ethics would not allow him to assist in Repka's death.
Sister Catrina Bones, vice president of mission integration at St. Vincent Healthcare, said neither the hospital nor the Catholic Church could support physician-assisted suicide.
"To move in that direction would be totally contrary to everything we believe in," she said.
For the church and for her personally, Bones said, the whole question goes back to Genesis and the creation of human beings in the likeness of God. That gives everyone an inherent dignity, Bones said, and it colors her relationship with everyone she comes into contact with, and it affects how the hospital treats its patients and its employees.
The church believes that every patient should be allowed to live with dignity until dying a natural death. She said the church stance is similar to that of the American Medical Association, which has stated that physician-assisted suicide "is fundamentally incompatible with the physician's role as healer."
Bones also referred to a set of ethical guidelines for Catholic health care services published by the U.S. Conference of Catholic Bishops. It says that because a person "has the right to prepare for his or her death while fully conscious, he or she should not be deprived of consciousness without a compelling reason."
Karnos had something similar to say, except that it was from a Buddhist perspective. He said he believes in personal autonomy and the right of a person to decide when and how he will die, but he also admires the Buddhist idea that you should be able to transcend pain, to overcome it in order to be in possession of all your senses when you open the final door.
"It's better to die with a free mind than a clouded mind," he said. "Suicide is closing it." Karnos said he was not "present" at his birth and would like to be present at his death.
"If there's something there, I want to see it," he said.
The finality of assisted suicide also concerns the Rev. Richard Vettel-Becker, an Episcopal priest and director of spiritual services for Rocky Mountain Hospice.
He said physician-assisted suicide "takes away a few paragraphs of the final chapter" of life and makes it harder for the dying to say goodbye to those they leave behind. Vettel-Becker said he would never extol the "redemptive value of pain," but "there is a redemptive value of being alive with the ones you love."
And for the loved ones of the deceased, he added, suicide inevitably adds "an additional complexity to their grief."
Dr. Deric Weiss, chairman of the Ethics Committee at Billings Clinic, said he and many other doctors see themselves as advocates for patients, and they believe they should do what the patient believes is best.
"If that is the only remaining option, a lot of us do feel that should be accepted," he said of physician-assisted suicide.
Weiss said one retired doctor on the Ethics Committee said he would have opposed physician-assisted suicide 30 years ago but "now sees this as something he would be willing to accept."
If Montana were to pass a law legalizing physician-assisted suicide, he said, it would have to spell out specific criteria for determining when it is allowed, as do existing laws in Oregon and Washington, the only states with such laws on the books. The statute in Washington is so new it won't take effect until March, but in Oregon it has been in place since 1997.
http://www.billingsgazette.net/articles/2009/01/04/news/state/18-ethicists.prt