This is a very difficult topic for me, as it is for anyone who has lost a loved one to a painful and debilitating disease. So forgive the 'shotgun' approach, but I can't keep it together enough for a formal dissertation.
1) Oh, yes indeed, there are painful conditions for which no medical relief exists. The poster(s) who think there aren't should talk to an ICU nurse or a doctor--or someone who lost a friend to pancreatic cancer. The argument that sometimes it's simple mercy to let someone end the torment is powerful when you have seen what the victims of the current legal situation go through.
2) Fiona, your argument is that physicians should be encouraged to break the law--handling it 'privately and tacitly' as you might put it--and risk themselves or the patient's family members being charged with manslaughter or worse. A doctor convicted of homicide (manslaughter is a lower degree of homicide) will lose his license and livelihood forever. A family member might be imprisoned--would, at the least, have the expense and stress and shame of being arrested and going through a trial--adding to the burden already faced by the death of a loved one. If there are still some brave enough to risk it, does that make it the desired path?? Would it not be better to have a legal standard of when things are "bad enough" instead of making it each doctor's guess?
3) Oregon's "physician assisted suicide" statute has been in place for a number of years, and no landslide of depressed healthy people has occurred. (In fact, the statute requires that if depression is a concern, an evaluation be performed to exclude that as the sole basis for the drug request.) I cannot quote the numbers here, but we just recently (last year or the year before) approved a law in Washington State that was based upon the Oregon statute, and the numbers and example cases were presented extensively by advocates for and against the law. However, that law applies only when the patient is able to take the medicines for themselves and does not cover the case of the fully-disabled terminal case.
4) I cannot speak for anyone else, but I find the notion of being trapped in a pain-wracked, dysfunctional body, unable to end my own suffering and unable to legally request anyone else help me do what I would if I could only move my fingers--or swallow--horrifying. Once I've said my goodbyes, I want to just go into that good night...I think. I won't really know until I'm dying, will I?
5) Allowing administration of lethal drugs to an incompetent (physically) patient is, however, a matter that requires a great deal of building in safeguards, as many have argued. As long as the patient is able to indicate verbally or by, say, eye-guided computer, that they do truly understand their choice; as long as multiple doctors have determined that the the condition is terminal, will progress to death shortly, and includes severe pain; and as long as these evaluation are done without anyone who stands to gain from the death...I think provision should be made.
6) Mental illness is the ultimate slipppery slope, and--while it can cause acute suffering--I think may stay outside the list of conditions for which assisted suicide is legal. The reason for this is that, frankly, the sufferer by definition cannot be "in their right mind" as far as evaluating the likelihood of recovery, the amount of their suffering, or the quality of life they are going to have in the future. It is in the nature of mental illness to distort cognitive function and/or perception: Since we know that anorexics see themselves as fat when they are unhealthily thin, I think that that is demonstrably true. This makes informed consent impossible to come by.
The same is true for someone whose physical illness has damaged or destroyed their cognitive function; I would have to say that the threshhold for allowing, say, head-trauma victims to request lethal medication would have to be much higher than that of those with disorders that do not directly impact the brain.
7) The idea that "social pressures" would lead someone to request legal hurrying of their end is a straw man. There is already a wide variance in how well people cope with catastrophic illness. A number of families and doctors will take Fiona's "private" path to what amounts to assisted suicide even under current law; a number of others will fight for every breath, no matter how pain-ridden or expensive, because of their belief that life is sacred, or that God demands you to suffer as penance, or that courage is the measure of a man, or perhaps simple stubbornness. To my knowledge, no one anywhere is requesting a law that mandates anyone consider terminating their lives!
I believe the challenges are large, but surmountable, to make the acquisition of lethal doses of drugs legal but difficult; to investigate and prosecute any breach of such laws; and to offer the dying a chance to go in peace and without pain. And I believe we are less than merciful to require, as a society, that the dying suffer because someone somewhere thinks it wrong for them to receive surcease. I think making a doctor have to decide between risking his license and seeing a patient scream in agony is the worst kind of misapplied judgment; I think making a family have to risk prosecution for assisting a mother, a brother, an adult child to do what they cannot on their own when the end is a week or a month away, is tantamount to torture.
Anyone who thinks that "it's never okay" should have to listen to and watch their Mother gasping for breath, paralyzed from the navel down by the cancer that is erupting in every quadrant of her body; see her helpless, pleading eyes, and try to read the silent, moving lips. And live with that memory.
