Responses to Life after Death with Dignity: The Oregon Experience
With the many articles I have read in this journal, few have disturbed me as much as Pamela J. Miller's Life after Death with Dignity: The Oregon Experience (May 2000, Pp. 263-271). Let me set my biases on the table. I have worked with people with mental illness and homeless people for more than 20 years. I also have been involved in several hospice situations, including one that led to the death of a loved one this year. Much has been written about the value of self-determination in our profession. I must remind my profession of another value at the core of who we are, that there is dignity in all individuals whether they are elderly, have a mental illness or disability, or are dying of a terminal disease. If we lose sight of this value, our profession will lose its true heart and soul.
I have been at the bedside of a teenager who attempted suicide, and when his stomach was being pumped and he was waking up from the effects of the overdose, he spit in my face and pleaded that we let him die. An elderly man with a history of mental illness was brought to the hospital with a case of constipation. It was decided that he would be kept overnight to be sure he could be restarted on his medications. To my shock a DNR was placed in his chart. When I questioned the doctor why, I was told, "His quality of life is not worth preserving."
The patient-assisted suicide option poses a direct threat to what we as social workers should stand for. All life has dignity--those who are vulnerable, those who are suffering, and those whom society would like to ignore. Miller's comment: "The evolution of the Death with Dignity Act was almost like a living laboratory for social workers who appreciate the ebb and flow of policy, practice, and politics" was cold, frightening, and discouraging. Thomas Jefferson once said: "In terms of fashion go with the flowing stream; in terms of principle stand like a rock." Maturity lies not in enjoying the "ebb and flow" of changing policy and practice, but in standing fast to all the values of our profession.
The focus of social work in a hospice situation should be to enhance the quality of life as much as possible, to use the present technology to limit the pain and suffering, and to prepare the individual and the family for the reality of death. If we now see people with terminal illness as an expendable population whose despair and depression is grounds for the ending of their lives, we have changed drastically as a profession.
If patient-assisted suicide becomes one more area for social workers to see as part of their role as clinicians, then we should abandon our right to advocate for those who are vulnerable or oppressed and those who society feels "their life is not preserving." The day this happens I will turn in my license, discard my MSW diploma, and find a different career. Social work as it has been dreamed and conceived for many generations will no longer exist.
Mark Thomas Paul
It is not the personal perspective of the author that is shocking or appalling, but what is inferred as "shoulds" for the social work profession and all present and future social workers--that is, the impression (if not mandate) that we must actively support and assist in enforcing each and every law that is passed by a government, regardless of its moral or amoral prescription, and that we must act in our everyday work with a sense of "self-determinism," which is defined as an absolute right to choose life and death, our own or that of another. It is interesting that the author does not invite discussion about this issue (pro or con), but rather passionately suggests application and further refinement of what is believed to already be "right." Sounds like promotion of a philosophy of moral relativism and the passive denouncement of any and all objective sense of reality or truth. Many a society and government has self-destructed, taking with it many innocent victims in the name of its "so-called" laws of pro per conduct or what was prescribed and enforced as "right." To ask (or tell) social workers to follow in this way is akin to asking us to jump off a cliff into a deep chasm, thinking we are walking peacefully into a serene, bright, pleasant valley.
Robert R. Fournier
I was pleased to see the article about Oregon's Death with Dignity Act by Pamela Miller reporting on "The Oregon Experience," because as she writes so correctly, this is an issue involving social workers in a variety of settings. However, some of her questions and concerns seem surprising in view of the extensive literature on this issue and the well-supported efforts to pass similar legislation in Oregon's neighboring states which were widely studied and reported.
Numerous polls reveal that physicians have been helping terminally ill people die long before this became a legalized option in Oregon; the practice is far from new. Because social workers and other professional hospice staff reported dealing with requests for such help and were actively involved with developments in the Right to Die movement, it is hard to believe that "many service providers and health care professionals were caught by surprise."
In conjunction with increased technology and the ability to prolong the dying process, there has been growing concern about the rights of people with terminal illness and their ability to maintain control over their dying process. The Hemlock Society was founded in 1980 in California and developed chapters throughout the United States. Their membership and leadership have always included many social workers who were and are eager to support the autonomy of the dying patient.
It was difficult to understand the tone of Miller's analysis of the law, because medical practice is dictated by professional standards and the state medical associations. A mental...