On “Granny Killing,” Euthanasia, the Right to Life & the Right to An Afterlife

by Dr. David Gruder

According to Ceci Kennedy of the Washington Post, "a campaign on conservative talk radio, fueled by President Obama’s calls to control exorbitant medical bills, has sparked fear among senior citizens that the health-care bill moving through Congress will lead to end-of-life ‘rationing’ and even ‘euthanasia.’"

She reports that "the controversy stems from a proposal to pay physicians who counsel elderly or terminally ill patients about what medical interventions they would prefer near the end of life and how to prepare instructions such as living wills. Under the plan, Medicare would reimburse doctors for one session every five years to confer with a patient about his or her wishes and how to ensure those preferences are followed. The counseling sessions would be voluntary."

Kennedy goes on to say that "on right-leaning radio programs, religious e-mail lists and Internet blogs, the proposal has been described as ‘guiding you in how to die,’ ‘an ORDER from the Government to end your life,’ promoting ‘death care’ and, in the words of antiabortion leader Randall Terry, an attempt to ‘kill Granny.’"

I want to make two points here. One is philosophical and the other is deeply personal.

Philosophically, calling reimbursements for a patient’s doctor to confer every five years about their Advance Directive a "Kill Granny" campaign is the equivalent of lobbying against the elderly having the right to health freedom and saying the elderly are not entitled to informed consent regarding their Advance Directive choices. I don’t know what to call wanting to deny our elderly these rights other than profoundly disrespectful of our Constitution’s commitment to protecting personal freedom.

I believe this kind of thinking is a symptom of a larger phobia we have in our culture about dying. Since we all die, why should we NOT be enouraged to develop conscious relationship with that inevitability, and be helped to take responsibility for deciding when to continue or discontinue medical intervention in prolonging our life? That’s what an Advance Directive is all about. Leaving it to someone else to make these decisions for us is NOT the exercise of personal responsibility that conservatives are, in my opinion, right to emphasize. It is the prohibition of it!

I am deeply affected by this issue on a persona level. My 84-year-old mother is currently in failing health.She is, in part, being kept alive with the help of a pacemaker and a long list of medications. When mom elected in 2002 to pursue this combination of conventional treatments in conjunction with complementary healthcare options, she made her own right choice at that point in time. This was because she felt her quality of life at that time was more than good enough for her to feel good about continuing to live.

Now, seven years later, she has deteriorated to such an extent that she no longer feels that way. As I write this post, mom is now on the verge of preferring death to life.

In traditional societies, the elderly were honored as elders and they were also honored for their right to determine when their time on earth was done. Death phobia didn’t widely exist because death was accepted as part of the rightful rhythm of life. People’s right to self-determination about when to stop seeking treatment was more important than medicine’s ability to keep them alive. Today it tends to be the other way around: if we CAN keep someone alive we SHOULD keep them alive. This attitude reflects a cultural death phobia that is harming my mom at this point in her life.

I am deeply blessed to have a mother who is keenly aware of all of these issues and who talks about them freely. This is in part because she has a degree in gerontology (the study of growing old), and she was at one time the director of volunteers for her county’s Hospice when she still lived in New York (she has lived near my wife and me here in California for a number of years).

I am also in emotional pain as I watch my mother feel increasingly imprisoned today by the very medical resources that were so useful to restoring and maintaining her quality of life seven years ago.

I love mom dearly. I in no way want her to leave AND I completely support her right to decide when it’s time for her to leave. I don’t want mom making this huge a decision BY herself even though I honor and support her right to make this decision FOR herself. Mom needs full input from medical professionals she trusts and she needs to feel free to talk about her dilemmas and her choices with her family… without fear of being manipulated to stay too long OR die too soon. Fortunately, she is doing both.

I can assure you that no one in my family wants to "Kill Granny." Everyone in my family wants "Granny" to be accorded the dignity to decide for herself when to continue to use medical assistance to further prolong her life and when to use medical assistance (in the form of Hospice… or, yes, even legally assisted suicide) to move toward her death.

My mom and I have had many conversations about all this, at HER request, beginning fifteen or twenty years ago. At that time I told her that she would: 1) Have my full support for however long she decided to live; 2) Have my full support when the time came that she wanted to die; and 3) Have my full support in her discovering what SHE wanted should the time come when she was not sure which way she wanted to go. I also told her that the one thing she needed to know in no uncertain terms was that I would NOT assist her in suiciding should she ever decide that the time had come for her to die.

I fully understand mom’s wishes and am fully committed to honoring them even though her beliefs and mine are not identical. My job is to serve her wishes not to make her serve mine. Each time mom has had a life-threatening medical crisis between when we first had that conversation years ago and now, I have always reminded her about my deep support of her right to decide to live or die and to decide how she will live or die, and that it is my right to decide what the limits of my support must be should she decide to die. Mom, in turn, supports me in my right to decide this.

If my mom and I lived in a state in which the elderly were accorded the right to be responsible for when they die, I would gladly humanely assist her in her choice to die… as long as I was satisfied that she had really thought things through in a fully considered and level-headed way. Or, if she became incapable of doing that, if the criteria she previously set forth in her Advance Directive were clearly met.

I don’t have that luxury here in California. I have made it fully clear to mom that I won’t put my own personal freedom (or consequently my ability to enjoy my marriage with Laurie) at risk in order to illegally assist her in dying should the time come when she might want that. My mother fully understands and fully supports me in my decision.

But, mom is now at a point in her gradual slide toward inevitable death when I wish California did grant her the right to die with dignity, and the medical assistance to do this humanely when the truly proper time for HER arrived. That is what would truly support my mom’s religious beliefs. I don’t get to offer her this in California, and as much as I disagree with this, my position and my boundaries remain as firm today as when she and I first had this conversation years ago.

I passionately believe in my mother’s right to life, with medical assistance if needed and if she wants it, AND I believe in my mother’s right to an afterlife, with medical assistance if needed and if she wants it. All I can say to anyone who would want to deny my mother of either of these rights is that personal and religious freedom are among the cornerstones of our great democracy-centered republic. Allowing any one religion or ideology to define personal and religious freedom for us all replaces our Constitution with tyranny. This includes our relationship with life and our relationship with the afterlife.

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  • Anonymous
    August 2, 2009

    The Declaration of Independence extolled the unalienable rights of individuals, including the right to life. I am one of those who has been talking to folks about the right to life, including the implications (of the Roe v Wade era denial of personhood to an entire class of humans) for national health insurance.

    The end-of-life counseling provision wasn’t even on my radar when I started emphasizing this, and it is not the main evidence that has buttressed my argument since then. The explicit Obama administration proposal to apply cost-benefit analysis, using expected years of life remaining as a weighting factor, to decisions about who receives health care, ought not be ignored by anyone interested in why folks are concerned about the way our elderly will be treated in government-run health care.

    Rep. Poe of Texas gave an example on the House floor (Congressional Record, 2009-07-30, p. H9060) of the types of denial of care that can be expected: an 83-year-old in Sweden was denied back surgery because she was too old. She was told to use pills to control the pain, instead. Well, the pills didn’t work, so she found a way to pay for the surgery independent of the government system.

    I very much prefer a system that emphasizes the unalienable right to life, rather than a government-run system which emphasizes the responsibility to die as a way of rationing health care dollars.

    Best wishes,

    Steve Schulin,
    Maryland Independent Party
    Candidate for Congress – Maryland’s 4th District

  • David
    August 3, 2009

    Hi Steve,

    One of the biggest deficits I see in so many elected representatives across the political spectrum a preference to spouting spin over checking facts, in much the same way that so many media commentators do today.

    It seems to me that the two biggest unmet needs citizens have today from their elected and appointed government officials are to:

    1. Find the political and ethical courage to sincerely join with one another in passionate dialogue about each issue’s relationship to constitution’s deeply paradoxical mandate, which is to BOTH preserve individual freedom AND promote the common good (not one over the other); and…
    2. To co-create solutions based on BOTH that mandate AND on true facts pertaining to the issue rather than ideologically-based spin about the issue.

    This is the shared vision that enabled our constitution’s framers to co-create that amazing document… despite — and partly thanks to — their fiery differences. Since this problem-solving strategy was good enough for them, it’s time that we once again made it good enough for us too.

    I can’t encourage you strongly enough to check your facts more carefully before you pass along information to others like what you wrote in your response to my post. Political Fact Check (www.FactCheck.org) is one of the nonpartisan fact checking organizations I look to for help in separating fact from spin. I strongly recommend that you make a priority of doing the same instead of relying so heavily on spin being promoted by those who share your ideological orientation.

    The following is the fact checked version of the information about which you wrote:

    I hope you will join me in making facts more important than spin.

    All the best in your quest to have voters elect you to public office,
    David Gruder

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