Medical Aid in Dying: Burdened by Suffering and Loss of Dignity

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This article is in response to the From Our Readers article, “Affirming Dignity: Arguments Against Medical Aid in Dying” by Joshua C. Briscoe, MD.

First, a comment on a rhetorical maneuver: discussions of Nazi medical atrocities, while dramatic, have no relevance to medical aid in dying (MAID). Likening it to barbaric and involuntary medical experimentation and murder is equivalent to saying that voluntary vasectomies and tubal ligations should be banned because of past forced sterilization programs. Apples and oranges.

The bulk of Joshua C. Briscoe, MD’s discussion centers on burdensomeness. Noting the impact of technological progress and overvaluing efficiency constitutes useful social commentary. Indeed, as he notes, technological advances in medicine contribute to the protracted decline towards death of many individuals that has triggered an interest in MAID.

However, his assumption that the cult of efficiency is an important reason why individuals choose MAID requires evidence. In my experience with dying patients, their sense of being a burden is of a more personal and less sociological nature. They feel burdened by their own suffering and loss of dignity, as they define it. They may also feel they burden those they love, and not just for pragmatic reasons. They are frequently concerned with the pain their loved ones will experience watching them suffer through a protracted and painful death. These kinds of burdens are real and important to the individual. To say that no person can in any sense or degree ever be a burden is naïve and invalidating of an important dimension of human experience.

Dr Briscoe argues that giving a choice about whether to continue living may itself be an unwelcome burden on the individual, as if it is unfair to hold one responsible for that decision. We are responsible for every other major life decision we make… what makes this so different? Why is it better to make doctors or legislators responsible for this decision? This argument resembles that notorious defense of slavery that posits that the slave is happier if free of the burden of having options and just does what they are told. Besides, if a given person truly wants to be free of the burden of these kinds of tough decisions, they are free to entrust themselves to those opponents of MAID who will be happy to tell them the right way to live and the right way to die.

Dr Heinrichs is a psychiatrist in Ellicott City, Maryland.