How to Debate How We Die

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During the recently concluded legislative session, the House was reportedly prepared to approve an end-of-life option, known by its supporters as "Death with Dignity." In April of this year, the Vermont Senate took up the debate, sort of, for the first time in the history of that body. The bill, having earlier been killed by a 3-2 vote in the Judiciary Committee, limped to the floor in the eleventh hour from another committee as a tacked on amendment to a bill banning use of tanning salons by minors. The stage was set for exactly what happened. Arguments over procedure mingled with set speeches for and against Death with Dignity. In the end, there was no vote on the amendment itself but only a vote against suspending the rules to allow discussion of the amendment. Technically, then, Death with Dignity still has not reached the Senate floor. But the April session gave a glimpse of the full debate that is certain to come.

On that day, "what if" filled the air: if we pass the amendment, what if this horrible thing happens, and what if this other horrible thing happens? Will the elderly become subject to pressure or abuse? Will the disabled now be in peril? Will suicide gain cachet, especially among young people confused by the state's apparent sanction of it? What if?

Sitting in the gallery, I wanted to say, "What if the bill's opponents took the time to read about Oregon's fourteen years of experience with this law?" None of these horrible things have happened in that state. Why, I wondered, would a senator raise hypothetical worrisome scenarios that have been invalidated by actual experience? Oregon citizens had the very same debate in the 1990s, and they had it without benefit of another state's experiment to guide them. After the Oregon initiative passed by a 51-49 vote in 1994, it faced injunctions, constitutional challenges, and even a legislatively mandated revote in 1997, in which voters reaffirmed their desire for this option at the end of life, this time by a 60-40 percentage. The law went into effect in 1998.

Fighting the Oregon initiative at every turn was the editorial page of the state's highest-circulation newspaper, the Portland Oregonian. But then in 2008, two months before neighboring Washington would vote on an identical initiative, the Oregonian declared, "Ten years' experience with Oregon's one-of-a-kind Death With Dignity Act has shown that our deepest concerns were unfounded. Safeguards built into the law appear to be working." The editorial listed all of the dread scenarios that had not come to pass, the very scenarios warned against in the April Vermont Senate debate. But then, oddly, the Oregonian editors nonetheless went on to urge citizens of Washington to vote against the initiative in their state (advice that Washingtonians reasonably ignored, passing it by a 59-41 vote). The Oregonian cited as grounds for its position a "basic unease with physician-assisted suicide," a statement that, however baffling you may find it, at least has honesty going for it. Which leads me to this: If a position on a controversial issue disregards or distorts available evidence, then evidence is not what underlies the position. If, in the end, opponents to Death with Dignity can only say that they just can't abide the image of a human being ending his or her life under any circumstances, or that they just can't stomach the notion of a physician participating in that process, then they should say that and nothing else. "The idea repulses me" is not much of an argument, but at least it is honest.

A 2010 documentary titled "How to Die in Oregon" follows some terminally ill Oregonians who take advantage of the Death with Dignity law in their final days. One of them, in his last words on earth, heartily thanks the voters of the state for passing the referendum that will make his end a peaceful one. Two of them, just before they slip into unconsciousness after months of suffering, comment with something like surprise at how easy the life-ending process is. To watch these scenes in the film is to experience "basic unease" and much more. The scenes are inexpressibly sad. And yet there is a hard-won peace in them as well. We will all lose in the battle against death, but if we have the option of controlling the time and the place and even the weapons of that battle, the knowledge that we have that option gives us comfort and a measure of victory. Since most Vermonters want this for themselves and their loved ones, it is the job of the legislature to bring it about.

David Carkeet lives in Middlesex.

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