Inconvenient bodies.

Medical ethics is a hot topic in my world these days.  What do we do when our bodies rebel?  Who decides what we, and others acting in our interests, are permitted to do in response to our inconvenient bodies?

This morning I was doing some online reading, and found this article about physician assisted suicide.  I’m concerned about how vague the proposed parameters are for the introduction of this practice into the Canadian healthcare system.  I understand and sympathize with the reasoning behind the introduction of the practice, and its purported intent to relieve terminal suffering and even to prevent premature suicides in patients facing degenerative illnesses, but I believe that its widespread acceptance will have the unfortunate effect of stunting the development of new and comprehensive methods and protocols for supporting people experiencing chronic illness or pain, palliative patients, and people dealing with severe and continued psychological suffering.

As a person who lives with depression and anxiety, I fear the repercussions of an individual, feeling  hopeless and without options, having medical professionals agree with their assessment of their situation, and essentially confirm to them that their life is not worth living.

Certainly, if assisted suicide is going to become an option in Canadian healthcare, I would like to see it restricted to majority-age individuals who are facing a demonstrable physical incapacity to end their own lives, should they choose to, without such assistance.  The broad terminology of “intolerable,” “grievous,” “irremediable,” suffering admits extension beyond such narrow cases.

Will doctors be permitted to offer assisted suicide as an option to their patients (as opposed to the patient bringing it up)?  Given the authority afforded doctors, could this be viewed as coercive? Will healthcare professionals be penalized for objecting to the practice?

We are uncomfortable, and ill-equipped to deal with suffering, and what is often the drawn-out process of dying.  Broad availability of assisted suicide will exacerbate this discomfort, and that is something we as a society cannot afford now, especially in a population experiencing higher life expectancies wherein more of us will contend with age-related health issues.  We need to develop and hone methods for coping with and alleviating suffering, both psychological and physical.  We need to deal, honestly and straightforwardly, with bodies that malfunction and decay.  I believe that to truly accord dignity – in life and in death – to the suffering, we need firstly to tend these bodies, however they fail.  Bodies, people, are not disposable.  Assisted suicide, if we are to admit it into our healthcare system, should be nothing other than the most extreme contingency plan.

The language of self-direction and choice is prominent in our discourse about assisted suicide and also abortion.  Abortion was the topic of another article I happened upon this morning.  I have no desire to argue about whether or not abortion should be legal.  It is legal in Canada, and I am going to work from that reality.

I personally believe that people who oppose abortion on moral grounds ought to spend their energy supporting health and social initiatives, such as access to maternal healthcare, maternity/parental leave, and contraception, so as to make abortion unnecessary where possible.  As a person who deals with infertility, however, I find the language of “choice,” in reference to family planning and parenthood specifically, and our health and bodies more generally, to be disingenuous and misleading.  This denies us the resources to deal with life’s uncertainty, particularly as relates to bodily suffering.

In the article linked above, the author makes three statements that I find particularly problematic.

“My husband of 20 years and I became parents when we had built a home to nurture our children.”

It is not clear whether or not the author intends to convey that she and her spouse had built a home in a psychological sense or in a financial/material sense.  I suspect that what is intended here is probably something of both.  While it is not ideal to raise a family in poverty, we should, as a society, have supports in place so that no one has to make the choice to have an abortion based solely on their financial stability.  In a society where abortion is legal, it should truly be a choice.  A choice is a truly a choice if it is free of coercive influences, such as the threat of poverty and social stigma.
“This means all Americans, men and women, should be free to decide whether and when to become parents.”
“May abortion once again be accepted for what it always has been: a necessary component of responsible family planning.”
When it comes to our bodies, we do not always have a choice, and everything does not always go according to our plans.  I am not able to choose to be pregnant, or stay pregnant, however much I would like to.  I don’t mean to say that because I want to be a parent no one else is allowed to make the choice to have an abortion, or that the lack of choice in one area of health means we shouldn’t expect it in others.  I only mean that the concept of choice in parenthood does not include the reality of infertility, or of any physical ailment.  The language of choice, simply, does not tell the whole story of bodily life.
Furthermore, I think we do ourselves a disservice when we portray control and choice as the ability to direct our lives so as to ensure a given outcome.  Our ability to control our bodies should protect us from physical violation or interference (assault, rape), and allow us to make informed, uncoerced decisions as to our heath care (which, in Canada, allows us to choose to have an abortion if we wish).  There are aspects of our bodies that we cannot control, however. No one chooses to be stricken with ill health. I cannot control my height, or the unreliable functioning of my thyroid and ovaries.  I can, and do, make the choice to pursue treatment for the latter two conditions, but there remain aspects of my body that are beyond, or at least resistant to, my control.  I have to make peace with these unplanned and unexpected parts of my life.  I have enjoyed the support of the medical system in Canada in alleviating the symptoms, and effects where possible, of my sometimes inconvenient body.  I want to trust that the medical establishment here will continue to offer support and treatment to improve my physical and psychological capacity to enjoy my life and to pursue what I hope for out of it.  I want this kind of healthcare for myself and for others.
There are few guarantees in life, and I am concerned that the language of choice papers over that reality with an illusory, inflated conception of control, making it difficult for us to accept bodies that we cannot wholly control and direct according to our choosing.

One thought on “Inconvenient bodies.

  1. I agree with a lot of what you’ve written – except that I think the language of personal choice and self-assessment such as “intolerable” etc. is important. What is intolerable for one, is tolerable for another, and the language needs to leave room for people to determine what that scale looks like for themselves – and it can’t just be a physical scale of pain, it has to be a question of quality of life in general, and that too must be determined on a case by case basis. Some people can’t be mentally healthy slowly dying alone in a hospital.

    I didn’t read it so much as about being able to have complete control over our bodies, though our culture does perpetuate this idea. More I thought it is about who has the control to say when life with illness becomes unbearable. Yes, this does leave room for some to seek out death instead of other medical options, but it makes it clear that it’s not a decision for doctors or an advisory board to be making broad standards for. Anyone other than the patient deciding they are ready to die is all personal opinion, and unmeasurable. It is impossible to develop a standard that applies to all. It’s like the statement: “Abortion is only okay when the fetus is a product of rape” – it’s totally arbitrary, does not take into account other circumstances that lead women to consider abortion, does not take into consideration of how rape is defined differently by different groups.

    It might be naive of me to think that assisted suicide is a treatment, and that other treatments would always be offered alongside side (worst case), or after others had been exhausted and patient had requested information (best case). I think of it as an expansion of service, rather than a denigration of it. I do not have much experience with chronic pain or terminal illness, or the medical care system in general, so maybe it’s hopeful that I believe most doctors will want their patients to live, and will strive to improve their lives before offering to end them.

    Great questions about repercussions for medical staff who object to the practice, though the abortion laws, if we use them as a model, does leave room for doctors to refuse to perform them, and so I expect language would work the same. While I can’t seem to find anything legal that says this also applies to nurses or assisting staff, most public hospitals have unions which would have language in their contracts protecting members from discrimination based on religious beliefs and ensure their rights to refuse work that is in contrast with any of them without prejudice or backlash to their employment.

    Always interesting to read your thoughts on health care!

    Liked by 1 person

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s