Society shouldn’t be eager to hurry the finality of death

Death is inevitable, and, despite best estimates by mortals, the precise time of our death is truly unpredictable. Life is like a soap bubble — it can burst at any time. Take away just one among the myriad conditions required to sustain life — oxygen, water, food, a pumping heart — and we encounter death. The ability to permanently sustain a life is utterly beyond our control. Likewise, society should not seek to control death with a health care law that condones actively facilitating what cannot be undone.

Humankind simply does not have the capacity to judge which patients should die and when. Nor does a panel of physicians or nurse practitioners, or lawyers, or members of the community, or clergy. As an island society, we cannot even aptly build a public rail or stadium. Infrastructure failures aside, there remain too many human frailties in which we are utterly adrift: arrogance, jealousy, greed, fear, prejudice, misogyny, racism, xenophobia.

Any law — call it Physician Assisted Suicide, Medical Aid in Dying, or Death With Dignity, no matter — will open a Pandora’s box with a grave risk of the slippery slope. Medically assisted death could wind up being encouraged for reasons other than to relieve human suffering, including economic motivations.

The Trump administration already plans to curtail food stamps and shift the risk for the cost of health care. What’s more, if there is a wall at the southern border and the immigrant population shrinks, there will be a labor shortage and, with an aging population, not enough people paying into Medicare. Will there be calls for sound health and productivity as a condition for the right to life? Remember infanticide in Sparta? Will people be subtly encouraged to end it all when they have outlived their usefulness? It would certainly improve the federal budget if social benefits were curtailed for seniors and those with chronic disease. Perhaps the gravely ill who are undocumented, destitute, uninsured or who have the wrong ethnicity or religion will one day be more aggressively offered a facilitated death.

Some argue, “It’s my life. I want to determine my own exit, and I don’t want to suffer.” As mass consumers in a high-tech society, we expect immediate gratification and ready distraction, and avoid even the prospect of suffering at any cost. Today’s culture is removed from death, hence fears it and for this reason desires instant access to turn off the life switch.

As distinct from the traditional Polynesian voyagers who utilized star navigation and held a deeply connected view of the world, with a GPS mindset, change is something we resist, even fail to imagine. How often have we trusted only to later feel betrayed? How often have we mistrusted only to realize that someone is pono over time? I have treated countless patients who thought living was pointless but with thyroid hormones re-balanced, antidepressants on board, a new job or relationship, suddenly life was now worth living again.

In the business of facilitating death, hitting rewind is not an option. In this age of rapid scientific breakthroughs in health care including cancer, what if a facilitated death occurs and the next month a cure for their malady becomes available? To truly fathom the inevitable nature of continuous, dynamic change is to be reluctant to actively facilitate an untimely death. Rather, death should be allowed to happen in its own time.

Shouldn’t we have a law to facilitate death when a loved one is riddled with painful metastatic cancer or breathless from congestive heart failure? As a physician, my consistent experience is that the right dosing and combination of medications is highly effective at alleviating both pain and anxiety at the end of life. As death draws near, first eating, then drinking naturally stop. At that point death is just days away, and there is no need to rush it along.

The vast majority of health providers would still opt out, leaving prescriptions to a few practitioners who might offer them liberally. Understand, these medications are truly lethal, and there is no take-back provision if unused. Meanwhile, Hawaii combats extensive diversion of controlled substances while our teen suicide rate is nearly twice the national average. How will we feel when lethal prescriptions fall into the wrong hands to be used for suicide or homicide?

What’s more is that, in Hawaii, treatment for mental illness is limited, and even nationwide only 4 percent of those who request medication to die are assessed for depression. How tragic, the thought of mistakenly facilitating death in one with a treatable illness.

To be sure, we must be more measured in choosing interventional care if there is little chance for quality of life and more prepared to withdraw care that extends life artificially, but we should never pass a law that condones actively facilitating death by any means.

Ira “Kawika” Zunin, M.D., M.P.H., M.B.A., is a practicing physician. He is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.