Turning death into a consumer product

Recent proposed legislation and court decisions in the UK avoided the direct issue of assisted suicide, instead concentrating on the issue of relatives and friends accompanying suicides to the Dignitas ‘right to die’ clinic in Switzerland. Rather than tackle the issue of assisted suicide head on, the Dignitas discussion attempted to circumvent opposition to legalising assisted suicide by setting up a narrowly legalistic question: if it is okay to assist a suicide by accompanying a loved one to a clinic in Switzerland, why is it not okay to assist a suicide here?

The discussion in the United States shows a similar bent towards circumventing the central question. Not surprisingly, given the haphazard way that President Obama’s healthcare reform is being constructed, it has become a battlefield for proponents and opponents of legalising assisted suicide. Instead of assisted suicide, however, we have the seemingly anodyne discussion around advance directives.

On 14 July, representative John Dingell and eight fellow Democrats introduced HR 3200, the healthcare reform bill, in the House of Representatives. The bill includes Section 1233, ‘Advance Care Planning Consultation’, which requires Medicare (the government programme to provide healthcare for all those over 65 years of age) to pay for one session of end-of-life counselling session every five years. The basis of the euthanasia controversy is whether this five-page amendment in the 1,000-plus page bill that discusses ‘advance care planning consultation’ amounts to an argument that people should have the ‘choice’ to die.

An immediate response ensued from some who agreed with Sarah Palin’s talk of ‘death panels’. Republican representative John Boehner said that the House’s healthcare reform bill could be ‘a slippery slope for a more permissive environment for euthanasia, mercy killing and physician-assisted suicide because it does not clearly exclude counselling about the supposed benefits of killing oneself’.

At an American Association of Retired Persons event on 28 July, President Obama answered questions about these claims. A woman named Mary, from North Carolina, asked: ‘I have been told there is a clause in there that everyone that’s Medicare age will be visited and told to decide how they wish to die. This bothers me greatly and I’d like for you to promise me that this is not in this bill.’

Obama, whose position on assisted suicide has been non-committal, responded by saying it was a good thing that is ‘a useful tool I think for a lot of families to make sure that if, heaven forbid, you contract a terminal illness, that you are somebody who is able to control this process in a dignified way that is true to your faith and true to how you think that end-of-life process should proceed… But, Mary, I just want to be clear: nobody is going to be knocking on your door; nobody is going to be telling you you’ve got to fill one out. And certainly nobody is going to be forcing you to make a set of decisions on end-of-life care based on some bureaucratic law in Washington.’

Betsy McCaughey, former lieutenant general of New York, has been active in attacking Section 1233, appearing on radio shows saying that the proposed counselling would teach the elderly how to ‘decline nutrition, how to decline being hydrated, how to go into hospice care… all to do what’s in society’s best interest or in your family’s best interest and cut your life short’. McCaughey appeared on Jon Stewart’s talk show where – depending on one’s perspective – Stewart either ‘slapped her down’ or McCaughey got the better of him (judge for yourself here).

However, not only conservatives and ‘right-wing wackos’ (as Jim Geraghty of National Review described himself) are disturbed. Charles Lane of the Washington Post recently voiced his own worries about the subject. Arguing against liberal pundits that Section 1233 was ‘purely voluntary’, Lane pointed out that doctors are mandated (and paid) to have the discussion with every patient every five years. Patients may refuse but many will bow to white-coated authority. The content of the counselling session the doctor is supposed to initiate, like the rest of the healthcare bill, is a complex game of ‘fill in the blanks’. The doctor ‘shall’ discuss ‘key questions and considerations, important steps, and suggested people to talk to’. Like who? Jack Kevorkian?

The discussion around Section 1233 reveals how the ground beneath the discussion about assisted suicide is shifting in the US. It is increasingly unreal in its treatment of death. If only, many reason, we could pay for ‘miracle’ drugs, we would not need to fear terminal illness. To limit the costs of medical care appears to threaten the hope of living forever (or, at least, of constantly putting off death). Marketers for these drugs often cynically encourage the illusion that the drugs are miraculous. Yet all – even the fabulously wealthy – die.

However, the surprisingly frenzied pro-1233 case (McCaughey is referred to as ‘that death-panel bitch’ by some liberals (1)) contains the same illusion. Though many will see this as increased freedom of how we die, it is based on the same illusion that state intervention will somehow sweeten the bitter pill of death. The result is that, increasingly, the end of life is becoming regulated.

In the past, the situation was straightforward: doctors would treat patients as far as they possibly could. When they could no longer treat patients effectively, they would withdraw treatment and the patient would die of the underlying cause. Dying became the province of religious counsellors and family, and the individual (no longer a patient) ensured a good death by making peace with family, friends, or perhaps enemies. A good death referred to acceptance in the individual and use of the time left.

Now, under the term ‘non-abandonment’, only patients or clients – not individuals – will die. A ‘good death’ will be either ensured by the state offering as many miracle drugs as exist (with the promise of more just around the corner) or providing ‘choices’ to the patient right through the process. Whereas the second approach at least accepts that death will happen, it assumes that we will not be able to cope with whatever happens.

The implication of this change in attitude underlying both sides of the debate on Section 1233 (and certainly not restricted to the US) is wholly negative. It fosters the sense that we are pathetic individuals who cannot cope with the realities of life (of which death, with taxes, is one) without the government either providing hope in the form of miracle drugs or coaching us through the whole process. As Daniel Callaghan has pointed out, it saddles doctors – representatives of the state in this instance – with ridiculous responsibility; it appears to be choices made by medical personnel, rather than the disease itself, that afflicts the patient.

Section 1233 is undeniably a step down this road and should be resisted. But both sides of the debate foster the unreal attitude towards death that invites the state to intervene in the whole process. And that is the real problem.

Kevin Yuill teaches American studies at the University of Sunderland in England, and is author of Richard Nixon and the Rise of Affirmative Action. Read a review of the book here, or buy it from Amazon(UK) or Amazon(USA).

(1) See, for instance, Jon Stewart VS. The Death Panel Bitch, on YouTube.