Taking Control, Full Control, of Your Life

I found this bit from a post on Dan Ariely's blog very interesting. I've read both his books "Predictably Irrational" and "The Upside of Irrationality". Both are delightful and insightful. I also find his life inspiring: while preparing "fire signs" (a common feature in ceremonies of youth movements in Israel) he suffered third-degree burns over 70 percent of his body from an accidental magnesium flare explosion. He learned many lessons from how he handled himself through this time.

Here is the bit of his post that I found most interesting:

As the American population ages, the debate about the ethics of physician-assisted suicide for terminal patients becomes more important.

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Outside of philosophical arguments, examination of an interesting finding regarding physician-assisted suicide – know as “The Oregon Paradox” – can add an interesting dimension to the debate. The paradox is the finding that when terminal patients in Oregon receive lethal medication (under Oregon’s Death with Dignity Act), they often feel a sense of greater wellbeing and a desire to live longer. In 2010, of 96 patients requested lethal medication, only 61 actually took it. Even more interesting are the many anecdotal accounts of terminal patients, upon receiving lethal medication, that feel a surge of wellbeing and a desire to persevere through their illness.

Why is this this the case? Looking at this question from an expected-utility perspective suggests that given the option to terminate their own life, terminal patients will decide how long they want to live by comparing the value they expect to gain from the rest of their lives to the expected intensity of their suffering. At the point where future utility is expected to be negative – that is, when the patient’s condition becomes so intolerable that living any longer is not worth the cost – the patient would choose to end life if the option were available.

The critical point from this perspective is that patients choose the amount of time they are willing to continue living with their illness, which will depend how quickly they deteriorate. If the rate of deterioration is slower than expected, then patients should delay terminating their lives; if the rate of deterioration is faster than expected, patients should desire to end their lives quicker.

But now let us say that patients have been prescribed lethal medication and have the option of ending their lives at any point of their choosing. As before, patients don’t want to choose a time too soon or too distant, but with the power to control the end of their lives they no longer have a reason to err on the side of haste! The patients can now wake up every day with the comfort of knowing that they do not have to suffer through pain or stress they might find intolerable.

Being given the option to determine the time of our own death can transform patients from powerless victims of their illness to willing survivors of it. Together, the importance of feeling in control and the ability to reduce (but not eliminate) uncertainty about rate of deterioration adds an interesting new dimension to the underlying ethical debate and seems to provide credence to the benefits of legalized physician-assisted suicide.

It is clear is that we need a greater understanding of the decision-making of patients at the end of their lives, and that with this improved understanding we can construct policy to better protect their wellbeing (for an interesting recent movie on this topic see “How to Die in Oregon”).

I'm a bit of a fanatic. I think people should take responsibility for themselves and have the freedom to make their own choices. On the other hand, I realize that some people really aren't competent to run their own lives (mental deficiencies, moral deficiencies, etc.) So I'm in a bit of a bind. I live under a grand banner about "the nature of man' but realize that there needs to be lots of find print and "lawyerese" to handle the fact that we are not all cookie-cutter the same. In short, I don't really have a simple clear answer to all of life's questions that can be printed on a cereal boxtop. I end up with slogans and qualifications. And I leave it open for debate and clarification. That's the best I think anybody can do.

I do know that even though euthanasia is "illegal" my mother in the 1980s told the doctor's "no heroic measures" for her father which was essentially the code words for "let him die". And with my mother, when she couldn't stand her disabilities from a flubbed brain surgery asked me to "get her out of here!", I did the paperwork to move her to a hospice where she was allowed to die. In effect I signed her death papers.

As Dan Ariely's piece above shows, the issue of euthanasia is not black-and-white as the noisy interest groups would make you think. It is complex. Ultimately it is best left to the family with state intervention only if it is clear that somebody in the family is manipulating things for their own interest and things are not being done in the best interest of the person who is dying. That is a broad rule that requires eternal vigilance and interpretation, but that is the glory of English common law. It is law that is "living" and constantly being reinterpreted as we learn more and as things change. Nothing carved in stone like the religious bigots would have you believe. Instead, a law based on the best judgments of your peers and an honest judge.