tv Ethical Perspectives on the News ABC January 10, 2016 11:00am-11:30am CST
believe that such laws violate the sacredness of life, yet others see them as undermining the hippocratic oath that says doctors should first and foremost do no harm, and yet others fear a slippery slope that would eventually lead us to value some lives more than others. should iowa pass an aid in dying law? do we have an absolute right over our own lives? shhuld physicians help us to die on our own terms? or do we have a moral obligation to accept our lives and our deaths on terms other than our own will? we have a great panel on today to discuss these issues. to my left is becky benson, the director of the university of iowa pediatric palliative care program. thanks so much for being on, becky. becky benson: thank you. scott samuelson: francis degnin, a professor of philosophy at university of northern iowa. thanks for being on francis. francis degnin: thank you. scott samuelson: at the end, linda livigston, a pastor at ascension lutheran church, linda, thank
linda livingsto: it's good to be here. scott samuelson: okay, well becky, let's just start off with the big question. should iowa have a law that allows mentally competent, terminally ill adults to voluntarily request and receive drugs to end their own lives? becky benson: well, i think that's a very difficult question. i think my first answer to that would be that i don't think that that's the best solution to how do we take better care of people at the end of their lives. i think that putting more money and emphasis into palliative care programs and really i think we've become disconnected from the natural prprcess of dying in america and we like the idea of control. that's a very unifying principle for most americans is we like to control when things happen but i think that death is a mystery in some ways, and it happens on itssown timeline. i feel that we shohold have more people who can guide us through that process well, rather than try to wrench control over it. i think that without really discussing advance directives with people early on in their disease courses and making
very effective ways of helping them control symptoms towards end of life, that the easiest step might be to say, "yes, let's let physicians write these prescriptions and let people decide when they've had enough but i'm not sure that's really the best answer to the question. scott samuelson: can you just say a quick word, we might have to come back to it, about what you see as the romise of palliative care as a kind of first step, at least, before we even get to these other issues? becky benson: sure, i see palliative care as one of the fields that has expertise in how to manage symptoms and suffering that often come along with end of life or with a serious illness. i think that that's often what people are struggling with when they're deciding that they need this control or this way out of the dying experience. i think that even physicians are disconnected from the process of natural death. we're
involved unplugging people frfrm machines or sudden death but very few of us really experience natural death anymore, the way it can happen, and so we can't even describe what that should look like to familles and help them see that it can be a safe experience, even though it's a new journey for each of us when we go on it. scott samuelson: right, okay well you've put a lot of issues on the table we'll have to come back to but let's get francis in on the discussion with some terminology. maybe first and foremost you hear this issue discussed in lots of at here, that these laws are doing, and what's at stake in these terminological issues? francis degnin: well, the first thing i always wor about, i'm cautious about the word euthanasia because it means so many different things to different people. literally in the greek it means, good death, right, which would be a really cool thing. we have
better to have a good death than a bad death. very, very broad, it means a whole bunch of things and some people it means just narrow mercy killing. what i like to do is just when i'm talking to my students, i try to keep it as simple as possible. we have several different levels. at one level you keep the body alive at all cost. most people would agree that that actually is a violentntthing to do. you're causing people to suffer terribly. that's where palliative care, and again just to simplify the definition, i just think of palliative care is how do we provide comfort and pain relief from suffering, right? the second level would be something like allowing natural death and that's where palliative care also comes in very, very well, hospice, groups like ttt where basically we're keeping people comfortable but we're no longer aggressively trying to keep their bodies alive. it's because we know that perhaps either it's because the patient doesn't want it or because we've run out of our options, okay? the next level down i think of is physician
suicide differs from mercy killing because itits thth patient's decision and mercy killing it's not my decision; it's being done for me. stt samuelson: right. francis degnin: assisted suicide and this i ialso part of the reason why there's a lot of different questions around it where does it attack, for example, the integrity of the medical profession. mercy killing, i think, would challenge that but not assisted suicide because again, it's respecting the patient's rights. on the other hand, we have to avoid what i'm going to call also subtle coercion. if we don't have good palliative care, if we don't have good resources to take care of people, it becomes too easy to right that prescription. scott samuelson: right, it becomes a temptation for the patient to think that maybe i do need to let go here or have my life taken from me so i don't- francis degnin: correct. scott samuelson: become a burden on people or whatever. francis degnin: or just because they're suffering and they're not getting the help they
be slightly different from what you're thinking here and it's this, i think that in almost all cases, when someone asks for assisted suicide, thee's a need that's not being met that can be addressed. oregon has one of the highest rates of satisfaction around dying of any state in part because when it's the question gets asked about assisted suicide the conversation takes place and in that converssion we often find that other need and can address it. scott samuelson: our options become ... francis degnin: options become possible. scott samuelson: possible. francis degnin: i'm not willing to say that that's true for everybody. i think there are still going to be, well, i don't know, but i respect the fact that there may be some people out there for whom this is really what they want. i also want to respect that as well but i ant to make sure that every resource is exhausted first to protect them and provide a palliative death, a different kind, a good death that doesn't require this. scott samuelson: yeah, okay, well let's get linda in on this as well. i think we've heard a fairly convincing case thattwe should at least take steps to ease people's pain, to give them a sense of options, but does there come a
has a right to take their own life, to have a physician help them, to die painlessly, or is that somehow violating some sense of a sacredness of life? linda livingsto: i personally would welcome a law similar to oregon's that i think has safeguards to protect against all of those things that people were so worried about, the slippery slope. we have, for most of a century, made medical advances that have allowed people to intervene and take control to extend their lives. there are now a generation of people who have lived beyond what they know they would have because they had that bypass surgery, because they've been mobile twenty years longer than they expected because they have a new hip and two new knees. theee same people now, i believe, when diagnosed with a
good life and i do want a good death." when that is done prayerfully, from my point of view, when that is done in conversation with family, and in consultation with physicians i think there is an opportunity to provide death with dignity that does not violate the sacredness of life in any way, that becomes a celebration. my understandin g of the statistics in oregon, are hat the people who have taken advantage of that law have predominantly died at home. the ability to be at home, surrounded by family, in what is a much more natural situation than the majority of the people who die in the united states, becomes part of the goal for these people. i am open to those
you were saying, it sounds like you're saying we've already sort of being of life and death. we've already been able to extend life one way so this is a kind of natural response to that, that we we can push the back date of death, perhaps we also can bring it forward a little bit when we no longer see the life as being one that is going to provide us any kind of meaning. does that, i mean, becky, you were talking about the kind of respecting the mystery of life. does that worry you at all that if we start to take control of when we die that it somehow overrides some of that sense of, the sense of mystery and how ultimately the line between life and death is not in our power? becky benson: it worries me a little bit, to be honest, because i'm a physician. i sometimes am in the role of telling somebody how long i think they have. i'm the type of person who then
are actually pretty bad at predicting. there are certain standard course. scott samuelson: yeah. becky benson: there are many others with lots of fluctuations and particularly when you go as far as six months out. that's fairly difficult for us to tell with any certainty. i know plenty of people who who lived two years, five years, and even longer. i know others who our best guess was six months and they lived for two weeks. really we struggle. the closer it gets to the actual time of death, i think, the better we are but i would confidence guestimate of what time they have left is, and then make decisions that that. about the case thatatlinda, i take it, was referring to that says, "okay, you know i've already had some major surgeries. i've lived longer
i've had my fair innings," as we sometimes say, and so yeah, maybe i don't know if it's going to be six months or two years but it's going to be sometime soon. why shouldn't i be allowed to say, "i'd rather be on my own terms? i'd rather know that it could be at home. i'd rather it be painless rather thaadragging out." becky benson: yeah, i think another interesting thing about the oregon data that actually speaks to this point is that not everyone who requests to fill a prescription actually uses it. linda livingsto: yeah. becky benson: in fact, i think it's around a third who actually go ahead and use it. the rt, i think, want that as a back up in case the dying proccss becomes- scott samuelson: becomes too much. becky benson: too much. too much suffering. i think really our job as healthcare professionals and as physicians in particular isiso help people
experience. it saddens me when i hear people say things like, "i don't want to starv to death," which really is part of the body's natural way of dying the last weeks of life sometimes. we've become so distanced from that, that it seems horrifying to us. i think we need to be better at helping people to understand what a natural process looks like aa that we can support them. i can totally understand that people who have been told they might experience seizures or their lungs filling up with fluid. these are scary things but we do have ways of treating those symptoms nd helping even those deaths be good deaths. i'm not also one say that i would never, ever consider this but i think it really should be for those few people who sort of want autonomy and dignity above
some other need, whether it's that they are depressed or they're worried about their family, that we can help be addressed in that space to take the stress and anxiety and help them achieve the sense of well being even when they're dying. scott samuelson: i want to hear what you have to say about this too, francis. we often talk about things like euthanasia or physician assisted suicide as somehow violating the sacredness of life. it's playing god. we take some of what becky's saying. we could even just talk about it in terms of we humans, we don't really know what's going on here. we can't predict and so should we not, at some level, at the most basic level of life and death, respect that line and say we can't ultimately draw it? it is not in my hands to say when i die. that perhaps that's not as bad as taking someone else's life but it is still a kind of act of murder in some ways to determine when the line between life and
drawn. francis degnin: i think question is who gets to make that decision, right, because i certainly wouldn't want to make that decision for somebody else. even, we run into this question of playing god all the time in the hospital. when i see patients and the patients say, "well, if you turn off theeventilator aren't we playing god?" well, we were playing god by putting them on the ventilator in the first place, right? scott samuelson: right. francis degnin: turning off the ventilator, i think is a much easier decision under the right kinds of conditions. scott samuelson: yeah. francis degnin: because then we're kind of admitting our humility before god. scott samuelson: right. francis degnin: now, this is a little stronger because we're taking a positive action. scott samuelson: right, so that's this idea of letting die-
somehow perhaps- francidegnin: letting die- scott samuelson: different from- francis degnin: as opposed to taking it and there's a big difference there. becky benson: yeah. scott samuelson: taking a life. francis degnin: it gets a lot harder. this is why i think we need to do everything possible to address the other concerns and also to make sure that there's not things that they haven't thought about, right? that it's not just a temporary depression. that it's not something like that. ultimately i'm not going to take away, if somebody is thoughtful, and if they're spiritual, if they're prayerful about it, if their relationship with god tells them that this is okay, i don't wan to take away that coice from them but i do want to make sure that every other alternative has been exhausted first. scott samuelson: right, right. well, you mentioned, linda, some safeguards about this and you seem to be on the same page in terms of saying, this should be a very, very serious decision. linda livingsto: yes. scott samuelson: done, as you put it, prayerfully or at least in light of the big issues that are going on,
last resort. it should not be done lightly. can we have a law that mandates that people make the decision? linda livingsto: no, obviously not and i think that- francis degnin: well, thoughtfully though. scott samuelson: or thouutfully- linda livingsto: tughtfully.ott samuelso kthe cision? linda livingsto: the safeguards of oregon, i think, require that it is a thoughtful es that mean? what's- linda livingsto: nltation, not only with one ctor but with cd physician who together are making a ruling onmpetency, omenenal health. ancis degnin: and terminal. nda livingsto: yes, e rminality ofe diagnosis. becky benson: to the best at we can- linda vingstoyeah. becky benson: come up with. nda lingsto: yeah, i think therare people who are- francis dein: ll, ere's also a waiting period. nda livingsto: right. francis gnin:t has be multiple requests whtness.inda livingsto: ltiple verbaleests and aquest inghting. scott samuelson: right. linda livingsto: separated by, i think, fifteen ys. ancis degnin: fifteen days. linda livingsto: it really- scott samuelson: right, so it can't be a light decision. linda livingsto: requires a oughtfulne ss- scott samuelson: right. linda vings: on the part of peopleo are going through that process. scott suelson: then, okay, so thateems very reasonable buthen what out meone who says, "well, i have is chronic illness that isdebilitatg. it's not terminal but i don't want to live with this rever. wham i different om the person who a doctor hasgiven a year and the doctor could be wrong anyway? why n't i also have thright to ke my life?" here's where i think people start to worry about- linda liingsto: that slippery slope.
linda livingsto: yeah. scott samuelson: why is it so important that the illness is diagnosed as terminal and isn't just, i'm in a lot of pain and i don't really want to continue with that? nda livingsto: i think the concern on the parts of a lot of people is that laws like this, and thus far i don't think the concern has been born out, but the concern is that a right to die with dignity might become a burden of a duty to die. i don't want my family to be burdened- scott samuelson: right. linda livingsto: with this prolonged, potentially scott samuelson: right. linda livingsto: expensive end of life. scott samuelson: right. . inda livingsto: safeggards that say that we will protect against that, it won't become an issue of easily pushing people toward that decision. pastorally i have been with people who, becaase of the treatment they're receiving, can make a choice. a person on kidney dialysis can decide to discontinue that dialysis and within a
people who are taking medication that is life supporting can make a determination to discontinue their medication. the danger with that, of course, is that it might not lead to death. it might lead to a stroke, a heart attack. it might lead to debiliition but not death and so there's a fearfulness, i think, on the part of a lot of people who would say, "if i could be certain that within a couple of weeks i would die if i discontinue my medication," we might see choice. in the hospital, i remember just a contact i h with a family that was so poignant to me. the father, grandfather was dying, had been diagnosed terminally ill with cancer, best guess of the doctors was he would die within seventy two hours. now we're a week and a half in. the family has
hard and difficult. i was in the room with extended family and one son was just clclarly so agitated and i invited him out and went into a consultation room to talk. i said, "what can i do to help you?" he said, "you can get my family out of that room and i will take care of this." i said, ell, i can't do that," and he said, "i know but if that were my dog i could take him behind the barn. that's my father." he was so passionate and what i was able to do was give him permission to leave the hospital, to not have to be there through every prolonged breath that he had been watching for a week and a hhlf.
benson: i think those are often more distressing for the family. i think a lot of times we can get a sense that the patient, by the way their face is, is actually at peace but family because we're not used to watching and death takes its time. that process takes its time and that's not something we're accustomed to. when it happens on tv it's not drawn out like that so it's just very different from what we're used to. i think one of the questions that you've bn asking is what's the difference between if you have a terminal diagnosis or if you have a chronic diagnosis that's causing a lot of suffering? i can't fully answer that but i do think that i've heard people who have terminal diagnosis say, "i'm not suicidal. i'm not requesting death. i don't want to die but my disease is killing me and i want to have some control er that process. scott samuelson: right. becky benson: versus somebody who might live years
continue on with their current treatments or even if they don't have treatments but they're suffering in one way- scott samuelson: right. becky benson: existentially often. scott samuelson: yeah, and i'm, i have to say i'm sympathetic to the distinction that you're drawing and it does seem to me a legitimate one, but at the same time it does seem a troubling one to draw at some level because we're all going to die and there's going, in some cases, to be some pain before it happens. te person who's saying, "okay, i'm forty five years old and i have a chronic illness and that might mean i'm going to die in thirty years and it's going to be thirty years of suffering," versus the person who's eighty and they're told they're going to die in six months. i don't know. it's, to me, it's a little bit of a difficult distinction. i know, francis, you're- francis degnin: it also gets more complicated because, and this is threason we talk about physician assisted, is because many people when they try to commit suicide on their own are unsuccessful. scott samuelson: right. francis degnin: they merely injure themselves or
themselves and greater suffering down the road. scott samuelson: right. francis degnin: it's a hard one. i know nuland is going to, you know nuland who wrote the prize winning book, how we die, he's going to say yes to both of your cases. scott samueeson: right. fraracis degnin: i think it's really difficult, more difficult with the chronic because you also say, "well, what if we find a cure?" scott samuelson: right. francis degnin: what if we find a real treatment for them? scott samuelson: right. francis degnin: sometimes we do but also sometimes we donn. scott samuelson: right. francis degnin: again, it comes- it's difficult but nuland writes basically either in a devastating, extreme old age, or i believe a devastating illness, that may or may not be terminal. scott samuelson: right. well, but so then what about then the doctor issue? it seems like a doctor not to someone. francis degnin: that's also a misunderstan ding of the hippocratic oath. scott samuelson: okay. francis degnin: the hippocratic oath was actually not common among greek physicians. it tradition and so forth. they actually, when they made the oath not to help in suicide, actually that was to set samuelson: from- francis degnin: what was thought.
right. francis degnin: even biblically, the bible doesn't say suicide is wrong. in fact, perfectly okay. it's rather, the notion that it's wrong in the bible comes from st. augustine who says that, is life itself and therefore to commit suicide is to reject it," but it's not even biblical. scott samuelson: okay, well fair enough but could not one say that while of course there have always been traditions that have allowed suicide that there is a powerful tradition that says it's wrong? francis degnin: that's true. scott samuelson: you can go back to augustine, there's a religious tradition that at some of wrong relationship to life itself. okay, and so do that but then the question is should a doctor then also be part of that? linda livingsto: i semantics get tricky- scsctt samuelson: right. linda livingsto: because there are those who are opposed to palliative care because they believe it is passive euthanasia, slippery slope. francis degnin: that's a misunderstan
the e y, too because the problem with the slippery slope argument is it's used to say because that end is so bad we need to go as far as we can in this direction. scott samuelson: right. francis degnin: the place of least violence is always somewhere on the slope. the place of- but there's always a bit of a gray area. scott samuelson: right. francis degnin: we're not going to be perfect about that. scott samuelson: right. francis degnin: the argument's often misused but it's not what it- the slippery slope argument works really well as a caution to be careful where we are on the slope. scott samuelson: that seems right to me but again i'm coming back to this issuuof does a doctor have any kind of, i mean i take it, it would be a kind of moral dilemma, at least for many doctors to say, "i'm going to use drugsp to take this person's life." becky benson: it certainly is, yes, and the american medical association and most medical associations are not supporting death with dignity or aid in dying at this point because of that realization that it can be a harr that's irreversible. many palliative care physicians, in fact, would say, "we need to do everything we can to support a
help them with in their dying in an active way, such as prescribing something or they can use to take within the healing realm that a doctor would espouse of theeselves." scott samuelson: yeah, francis degnin: that's also a reason why no doctor should be required to do this, i know, because then it's not necessary but let me push the palliative care issue one steppurther. there's also, i think, a really important thing that many people misunderstand, even some doctors misunderstan d, often times when we're doing palliative care we actually hasten death. the difference in palliative care is this, we're doing enough to relieve the suffering, if it incidentally happens to hasten death, that's acceptable and that's also by this us supreme court washington versus glucksberg decision. it's legal in all fifty states but some doctors are afraid to give enough pain medication because then they're afraid it's assisted suicide, which is not considered assisted
intent, and it's a large amount given, and also taken by the patient, in order for that purpose. yeah, in palliative care there are times we do hasten death a little bit. scott samuelson: right. becky benson: although recent studies have shown that good palliative care alongside curative treatment is actually more likely to be life extending- francis degnin: that's true. becky benson: and to improve quality of life so i think, you know i don't want people to shy away from palliative care and i think if we gave people the option of having hospice as easily as in some states they can get a prescription for a life ending medication, if they had the same availability of hossce, i think that would really be a much better way to address this issue of how to ease suffering at the end of life. francis degnin: right, hospiccshould not be the last six months. there are place where palliative care is even where a person might need six months of it to help them to get back to a normal life. it's a much richer field. becky benss: yeah, well, i have about ten more questions that i want to get to but i'm afraid that we've run out of time. i
becky, francis, and linda for a really stimulating conversation. i feel like these are important issues for us to think about. we sometimes want to put death out of our minds but perhaps, since we all have to face it in many different forms perhaps, it's importtnt to bring it kind of to the forefront of consciousnes s. i really appreciate the conversation. i hope it's one and communities. thank you very much and we'll see you next time on ethicalal perspectives on the news.
i'm bob bruce, over the next 30 minutes, jeff johnston and brock will layout a road map for a trip to the ultimate destination of a successful retirement. let's begin. >> from tloft right, gary speicher, president of financial planning services, spike, good morning. >> good morning, robert. >> how are you? >> i'm up for a a day now. >> all right. jeff johnston is here from premier investments of iowa. jeff, good morning. >> how you doing? >> well, thank you. i shouldn't speak for these guys.