In a mostly favorable review of Atul Gawande's Being Mortal: Medicine and What Matters in the End, Marcia Angell criticizes the author for not taking a stand on the questions of physician-assisted suicide and euthanasia. Her own position is clear. She has for a long time argued in favor of laws, such as exist in Oregon and a few other states, allowing doctors to write prescriptions for lethal, orally-ingested medications that would enable terminally ill people to end their lives. The death earlier this year of her husband, Arnold Relman, who like her taught at Harvard Medical School and (again like her) formerly edited The New England Journal of Medicine, of metastatic melanoma, caused her to come out in favor of euthanasia for patients who, "in the agonal stage of dying," become too ill to take the oral medication themselves.
I haven't read Gawande's book, but I recently heard him talk about these issues on NPR, and he does indeed seem to be conflicted. Angell criticizes him pretty aggressively:
Why, moreover, does Gawande simply assert that the one in thirty-five assisted deaths in the Netherlands are too many? Given the prevalence of terrible deaths from cancer, as Gawande describes so well in his book, why is it not the right number? In Oregon, the number is one in five hundred deaths. Is that the right number? The problem, it seems to me, is the dreadful disease, not the number of patients who choose to bring about an inevitable death a little sooner.
One detects in even so short a passage what Angell likes about the book. Gawande puts before the reader the grim facts about what the end of life is like for a lot of people. Though Angell doesn't explicity say so, I think she thinks that more people would come around to her view if they knew what she knows about the end stage of some of the diseases that are relatively common causes of death in our country.
Speaking as one with no special expertise, it seems to me grotesque that people in the pink of health should declaim against permitting people who are desperately ill from ending their lives. I mean, whose life is it? I think a more defensible opinion would hold that, while I doubt I would ever choose to end my own life, I don't really know but that in miserable and hopeless circumstances I might change my mind, and anyway, other people should be free to make their own choices. The usual sort of arguments you hear on the other side are not very persuasive. If the comparatively enlightened approach adopted in the Netherlands had brought on dystopian horrors, I think we'd hear more about it. Angell points out that the Center to Advance Palliative Care recently gave Oregon, which has for thirteen years now permitted physician-assisted suicide, a straight A in their state-by-state report. It's not as if permitting suicide is functioning as a substitute for the best pain management care available.
The roster of states that permit physician-assisted suicide is interesting: Vermont, Montana, New Mexico, Washington, and Oregon. All but Montana are blue; all but Vermont are in the West, where there are comparatively few Protestant fundamentalists and the Catholic Church has less influence than in, say, Angell's native Massachusetts, which in 2012 narrowly rejected a ballot initiative that would have made it the sixth state to allow assisted dying. Since Gawande, a surgeon at Massachusetts General, says that he'd support a law like Oregon's "if given the opportunity," Angell wishes he'd divulge how he voted.
Her husband, apparently as tireless as she till about 90, gave this interesting interview a few months before his death.
