[1994 journal entry] The problem of denying finitude is found on the opposing sides of the physician-assisted dying debate. To seek control of the dying process can be a denial of finitude. To oppose control of the dying process can be a denial of finitude expressed in terms of casting the reality of finitude into the context of the infinite.
[Note: In 1987 my collaborative work with my close friend and the first physician with whom I had a collaborative relationship -- Tom Elkins, MD -- shifted to the University of Michigan when he became the gynecology division chief for the medical school’s Ob/Gyn Department. One of the several research projects we conducted studied the end-of-life hopes and preferences of 108 gynecologic cancer patients receiving care from the division’s oncology service. Dr. Kevorkian’s assisted-dying cases took the national headlines soon after we had completed the data gathering re the 108 gynecologic cancer patients. A junior faculty member in the Michigan Ob/Gyn Department from Holland, where euthanasia had been openly discussed since the early 1970s, arranged introductions for me at Amsterdam Medical Center and at Leiden University. In 1992 I began making annual research trips to Holland to track the end-of-life care being delivered by a cross-section of Dutch physicians who represent the full spectrum of judgment in Holland re euthanasia.
In 1994 the Michigan legislature formed a commission to address possible ways to respond to Dr. Kevorkian and the subject of physician-assisted dying. I was asked me to submit a statement to the commission based on my study of the Dutch experience. I closed my statement as follows with some observations that develop in more detail the thoughts in this 1994 journal entry.]
[Note: In 1987 my collaborative work with my close friend and the first physician with whom I had a collaborative relationship -- Tom Elkins, MD -- shifted to the University of Michigan when he became the gynecology division chief for the medical school’s Ob/Gyn Department. One of the several research projects we conducted studied the end-of-life hopes and preferences of 108 gynecologic cancer patients receiving care from the division’s oncology service. Dr. Kevorkian’s assisted-dying cases took the national headlines soon after we had completed the data gathering re the 108 gynecologic cancer patients. A junior faculty member in the Michigan Ob/Gyn Department from Holland, where euthanasia had been openly discussed since the early 1970s, arranged introductions for me at Amsterdam Medical Center and at Leiden University. In 1992 I began making annual research trips to Holland to track the end-of-life care being delivered by a cross-section of Dutch physicians who represent the full spectrum of judgment in Holland re euthanasia.
In 1994 the Michigan legislature formed a commission to address possible ways to respond to Dr. Kevorkian and the subject of physician-assisted dying. I was asked me to submit a statement to the commission based on my study of the Dutch experience. I closed my statement as follows with some observations that develop in more detail the thoughts in this 1994 journal entry.]
The main character in Albert Camus’ novel The Plague is an exemplary physician, Dr. Rieux. While faithful to the task of fighting against the plague, Dr. Rieux recognized that the people of Oran only experienced their communal ideals (e.g., mutual respect, compassion, integration, justice) in their response to the suffering indiscriminately imposed by the plague. When the plague eventually receded, Dr. Rieux could not celebrate with the survivors in Oran because he knew they would soon slip back into a shallow and socially irresponsible pursuit of personal pleasure and gain.
The Paradox: To fight against disease, injury, and death is to fight against the very experiences that force us to engage the most fundamental truth about our humanity – i.e., our finitude.
Until a very few decades ago, human beings could do little more than appeal to divine providence or attempt to manipulate fate when threatened by disease, injury, or death. Modern medicine has fueled a shift away from that resignation for Western societies. Is it possible that patients expect the curative/corrective interventions of medical professionals to rescue them from having to face their finitude? If so, physician-assisted death could be for them the final denial of finitude, particularly if requested as a preemptive action rather than as a last resort in the struggle with human frailty.
