A Time to Die

SIDNEY CALLAHAN’S editorial on physician-assisted suicide was extraordinarily disappointing ("A Time to Live, A Time to Die," July-August 1997). It was not just that I disagreed with its conclusions, but it seemed cavalier in its treatment of facts.

For example, it asserted, "Persons need never die in extreme physical agony." However, the literature in this field suggests that at least 10 percent of pain is not controllable. There is massive evidence that much care today is inadequate even in instances of potentially controllable pain.

The Dutch experience raises issues that should concern all of us on any side of this issue. One thing that Callahan glossed over is that Holland does not have in place the legal framework that is proposed for the United States. What is happening there is more akin to the "lack of grounds for prosecution" that seems to be emerging from the trials of Dr. Kevorkian and from the less public exercise of physician-assisted suicide by hundreds or thousands of other physicians. I for one would like the safety of statutes and review panels rather than the de facto decriminalization of physician aid in dying.

Callahan stated obligations to the self and to the community, which need far more examination in this debate. Such examination must, however, take into account not just such issues as pain management, personal dignity, personal and familial economic choice, but also our society’s diverse belief systems and values.

Most of all, people need a safe context in which to discuss their wishes, fears, and needs at the end of life. If their religious institutions and the laws of the society give them that, it may well be that there will be fewer rather than more suicides driven by medical conditions. I don’t feel that Callahan’s absolutist position moves us in this direction.

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