Observations From Below: The Unstoppable Force and the Immovable Object

I’m no philosopher.  But lately, I have been wrestling internally with an ancient philosophical question.  What happens when an unstoppable force meets an immovable object?  In other words, what happens when you believe in two contradictory concepts?  One core belief of the disability community is that we have the right to self determination.  Another core belief is that we have the right, just like everyone else, to have the best possible life for ourselves.  Most of the time, these two beliefs work very well together, and then sometimes they don’t.

In one famous case in 1984, a woman named Elizabeth Bouvia, a quadriplegic almost completely paralyzed due to cerebral palsy, entertained the thought of suicide.  She was living in a great deal of pain due to degenerative arthritis and was isolated from her family and estranged husband.  She decided to check herself into the Riverside General Hospital in California, where she had planned to kill herself through starvation.  The doctors refused her request, and began to force feed her against her will.  She contacted the ACLU, which assigned her legal representation.  When in trial “the court ruled in favor of the hospital citing that while she had the right to determine her life, society did not have the obligation to assist her in committing suicide.”  She appealed the judgement twice, and the Supreme Court eventually ruled in her favor, deciding that she was mentally competent and had the right to refuse medical treatment from the hospital.  Despite her victory in court, and following a morphine drip regimen to ease her pain, she decided to keep on living in hopes of dying of natural causes.

The Bouvia case has perturbed me for years.  I first read about the case in Paul Longmore’s book, “Why I Burned My Book and Other Essays on Disability.”  What bothered me most this case, is that physically I am similar to Mrs. Bouvia.  If I wasn’t lucky enough to be born into such a strong family, society might have convinced me to make the same decisions.  Society did her wrong, as she lived mostly in institutions throughout her life.  She observed society’s misunderstanding of her disability.  She was an educated woman with a college degree, was entered into grad school, and for a short time had a husband.  She could have been encouraged to continue her good life, instead the court and the media at the time continually reinforced her desire to give up.

It’s true that people with disabilities have bad days, especially when you first acquire that disability.  The father of the independent living movement, Ed Roberts, tried to commit suicide in the same manner that Bouvia attempted.  After contracting polio at age 14, living most of his life paralyzed from the neck down and living in an iron lung, he attempted numerous times to starve himself.   After dropping from 120 pounds down to 50 pounds, followed by his nurse giving up and quitting on him, he experienced an epiphany.  The next day he decided to eat, and went on to become one of the most important civil rights leaders of all time.

The reason why I wanted to write this blog now, is because this month California became the latest state to legalize physician assisted suicide (PAS) in certain situations.  I’m glad to see that the law has several stringent rules regarding who can ask for assistance in this difficult situation.  The patient must be mentally competent, at least 18 years of age and a resident of Washington, Oregon, California or Vermont.  The patient has to be diagnosed by two doctors, who both agree that the patient has a terminal illness with the prognosis of having less than six months to live.  The patient must also give two verbal requests at least 15 days apart from each other, as well one written request.   Only then can the doctor prescribe the approved medication, which must be self-administered by the patient.

Here’s where my problem lies.  Like many other disability advocates and organizations, I worry about what some people call the “slippery slope” argument.  That is the idea that if we’re not careful how we legalize PAS we might accidentally open the door to various other types of euthanasia, a practice that is illegal and forbidden in most countries and religions.  Euthanasia is the process of intentionally killing an individual who is suffering from a terminal or painful disease or one who has been placed in an irreversible vegetative state.  There are three different types of euthanasia that I’ve found:  1) Voluntary euthanasia, where the patient and the physician work together to come to a final solution, always pending approval of the patient.  2) Nonvoluntary euthanasia, in which a physician ends the life of a patient, usually placed in coma, without the patient’s consent.  3) Involuntary euthanasia, which is performed by the physician, against the wishes of the patient.  PAS and voluntary euthanasia are similar in the same aspect that both practices include a consultation with a doctor, and that they both lead to death.  The biggest difference between the two, is who actually administers the final measures to bring about death for the patient.

Proponents of PAS rightly point out that the practice is still not all that commonly utilized, even in states where it is legal.  Currently PAS is legal in Washington, Oregon, California, Vermont and Montana (the only state where it has to be approved by the Supreme Court).  Proponents are also quick to call attention to the strict guidelines which are meant to prevent the slippery slope towards euthanasia, voluntary or not.  Although I disagree with PAS in most cases, I’m not arguing against its legality in the states where it’s approved.  Even though the Department of Health monitors the law in each state, I still think it would be wise to keep an eye on the restrictions, because these type of safeguards have a tendency to weaken.  As Dr. Edmund Pelligrino maintains,“Assisted suicide is a half-way house, a stop on the way to other forms of direct euthanasia, for example, for incompetent patients by advance directive or suicide in the elderly. So, too, is voluntary euthanasia a half-way house to involuntary and nonvoluntary euthanasia. If terminating life is a benefit, the reasoning goes, why should euthanasia be limited only to those who can give consent? Why need we ask for consent?”

That’s how I roll…unassisted