Close to Home: Provide adequate care, not help with suicide

Assisted suicide is about choice, right?

But wait a minute, let’s think a little bit more about the legislation now pending in Sacramento. So much has been in the news lately about the benefits of assisted suicide, urging the passage of Senate Bill 128, the proposal that would permit its use in California.

The proponents have consistently portrayed the issue as one of personal choice. Competent people should be able to make a choice about when to die, they say. I know personal choice is a big issue for many of us, but in the case of assisted suicide, the issue is much more complicated than that.

It has become pretty clear from the Oregon experience that pain is not the primary reason people opt for assisted suicide. Studies have found that pain is the primary reason in only 22 percent to 27 percent of reported cases. Loss of autonomy, lack of involvement in community and loss of dignity all consistently rank at the top of the list. Where pain is the primary issue, oncologists and pain management specialists agree we can do a much better job of addressing pain than we have been doing.

The loss of autonomy and dignity and the inability to participate in community activities is directly related to our health care system. That system does not provide the level of in-home personal support and medical care that people at the end of life need to remain independent.

These are people who may need specialized medical care, or an aide to help them urinate, move their bowels and bathe and dress. Many are people who have had disabilities for some time, are living on the edge of complete dependency, marginalized by society and fearful of not being offered life saving treatment.

And for those recently disabled due to illness, what does the ailing mom or dad do when they cannot imagine relying on a spouse, daughter or parent to help them perform those very personal tasks of daily living? What do they do when they cannot access the in-home care they need?

Our fragile medical system is being increasingly concerned with the bottom line - how much is this treatment going to cost?

We know from studies, for example, that one out of every four Medicare dollars is spent on services for the 5 percent of beneficiaries in their last year of life.

The possibility of future Medicare cuts is real, and where will the money come? Where are our priorities? We are setting ourselves up to deny people care at one end and making it easier to put them away at the other.

Too many questions remain. Assisted suicide may a tempting option, but it’s not a real choice, not when your options are limited to a nursing home - which no one wants - or an unwanted dependency on family and friends, equally repugnant.

The debate here is not really about pain or an individual’s right to choose, but about the kind of a future we want for any of us who may be nearing the end of life.

Do we want to live out lives as independent as we are able, as comfortable as possible, with our dignity intact, with the in-home supports and medical care we need - including palliative care to the degree necessary?

Or do we offer a lifespan shortened by a public policy that denies us those opportunities, yet gives us a way out with a little pill. When does a right to die become a dignity to die?

Stan Kosloski, a wheelchair user, is a member of Californians Against Assisted Suicide. He lives in Petaluma.