Assisted suicide is now legal in five states: California, Oregon, Washington, Montana and Vermont. In the coming year, Connecticut, Maryland and New York will likely face the issue in their state legislatures. All but one of those states, Montana, is a blue state, and in the three states set to consider the issue, Democrats control both houses of the legislature in Maryland and Connecticut, and the governorships in Connecticut and New York. So, this political battle will largely be fought within the ranks of the Democratic Party.
Liberals certainly value personal autonomy. They also have been the core of the party which has evidenced a sense of social solidarity: Democrats created the New Deal and continue to defend it, they support union rights, they care about immigrants and how they are treated. On the issue of assisted suicide, these values, personal autonomy and social solidarity seem to conflict and, indeed, there are prominent Democrats who support it and prominent Democrats who oppose it. All Democrats and liberals should oppose it and here is why.
Whatever your thoughts on the issue per se, how Democrats conduct the debate on assisted suicide will have a clear impact on how our nation confronts one of the most consequential political struggles in the coming years: entitlement reform. Medicare and Social Security (and other entitlements) account for a large and increasing share of federal spending. These benefits go disproportionately to the elderly, who some of us believe have earned the right to live out their lives in dignity and consequently believe that the rest of us have an obligation to provide for our seniors. This issue, along with immigration reform, more than any others, requires a renegotiation of the social contract, the sense of what we as citizens owe to one another. (Assisted suicide is not only an issue about the elderly, but it is primarily about them and they are the focus of my concern here.)
It is obvious to me that if liberals spend the next twelve months in the important media markets of Washington, D.C. and New York talking about the importance and value of social solidarity in opposing assisted suicide, they will be well positioned to defend against efforts to cut Social Security and Medicare funding. If, on the other hand, those of us who care about entitlements celebrate personal autonomy, we play into the hands of those who wonder why they should be expected to pay their money in taxes to support people they do not know or do not care about.
Make no mistake about it: When the ideological libertarianism of the right on economic issues combines with the moneyed interests of those who will have to pay more taxes to keep Social Security and Medicare afloat, powerful political pressure will be brought to bear. It is easy to scare people about the rising costs of entitlements because the numbers are scary. It is easy to find someone who defrauded Medicare and make that person the poster child of an otherwise very effective system for providing health care. (I have never understood why people buy into this kind of attack, using one person’s fraud to demean an entire system. After all, in Watergate, we drove Nixon out of office, we did not cease holding presidential elections.) In the 1980s, Republicans regularly denounced “welfare queens” to attack social welfare programs, and stoke a bit of racial animus as well. Some such campaigns will likely be used to convince Americans that “we can’t afford” Social Security and Medicare, we have to make cuts, the laws of economics demand it, that we are depriving our children of their future, etc. Just because this is bunk doesn’t mean it won’t work.
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This line of argument will have a harder time working if we on the left spend the next twelve months talking about the elderly in terms of solidarity and confronting assisted suicide because it is the opposite of solidarity. Solidarity with those who are suffering should speak to the liberal heart, shouldn’t it? And, it should speak to our brains too. Assisted suicide as public policy is a statement of failure, of social failure, not medical failure: Pain management has come a long, long way and those who are dying need not suffer pain and they can experience a death with dignity, surrounded by caring family and nurses. Vicki Kennedy, whose husband Sen. Ted Kennedy had died after a long illness, spoke to this in her important op-ed opposing assisted suicide in Massachusetts three years ago. She wrote:
When my husband was first diagnosed with cancer, he was told that he had only two to four months to live, that he'd never go back to the U.S. Senate, that he should get his affairs in order, kiss his wife, love his family and get ready to die.
But that prognosis was wrong. Teddy lived 15 more productive months. During that time, he cast a key vote in the Senate that protected payments to doctors under Medicare; made a speech at the Democratic Convention; saw the candidate he supported elected president of the United States and even attended his inauguration; received an honorary degree; chaired confirmation hearings in the Senate; worked on the reform of health care; threw out the first pitch on opening day for the Red Sox; introduced the president when he signed the bipartisan Edward M. Kennedy Serve America Act; sailed his boat; and finished his memoir "True Compass," while also getting his affairs in order, kissing his wife, loving his family and preparing for the end of life.
Because that first dire prediction of life expectancy was wrong, I have 15 months of cherished memories — memories of family dinners and songfests with our children and grandchildren; memories of laughter and, yes, tears; memories of life that neither I nor my husband would have traded for anything in the world.
When the end finally did come — natural death with dignity — my husband was home, attended by his doctor, surrounded by family and our priest.
That is what death with dignity looks like. That is what health care, which Sen. Kennedy considered the cause of his life, looks like. That is what solidarity looks like.
Assisted suicide is promoted as a means to alleviate suffering, but that is not how it is actually practiced. All of us fear being in great pain at the end of our lives, but once this right is established, people who are not facing great pain avail themselves of it. This is not a slippery slope argument. There is clear evidence that the slope is slippery. In Oregon, where assisted suicide has been legal since 1997, the principal reasons for availing oneself of the “right-to-die” are: loss of autonomy (91.4%), decreased ability to engage in enjoyable activities (86.7%), loss of dignity (71.4%), loss of control of bodily functions (49.5%) and becoming a burden on others (40%). Advocates of assisted suicide say they are in favor of “compassionate choices” but surely, there are more compassionate ways to help people cope with these anxieties than inviting them to kill themselves.
All of those items on the list are things people with disabilities confront and overcome, which is one reason the disability community is in the vanguard of opposition to assisted suicide laws. They understand that, yes, life is made more challenging because of their disabilities, but they are not expendable, they still have dignity. They understand, too, that a society that starts calculating what people can and can no longer contribute to society, that links human worth with other people’s determination of social utility, leads to inhumane judgments and expectations: If you are a burden, and you know it, why not dispose of yourself? On second thought, why shouldn’t society help you? Our country found its better angels when it passed the Americans with Disabilities Act that responded to the challenges people with disabilities face by trying to ameliorate the hurdles, not encouraging people to make themselves scarce.
Still undecided? When confronting a decision that involves competing values of personal autonomy and social solidarity, a pertinent question to ask is whether a given policy will impact the poor disproportionately. The rich can hire help so that they are not a burden, nurses to take of their physical needs, and the like, but the poor cannot. This should set off alarm bells in liberal minds. Among the reasons Gov. Jerry Brown should have vetoed the assisted suicide law in California is that the state’s Medicaid program does not cover palliative care, but it will cover assisted suicide. So much for choices! Advocates of assisted suicide argue that everyone is free to choose whether or not to seek the drugs that will take their life and this is true in a formal sense. But, formal freedom is not real freedom. The rich and poor alike are formally free to rummage in the dumpster for their dinner. Blacks were formally free to vote before the Voting Rights Act. Real freedom is something different.
I return to the issue of entitlement reform and pose a question to fellow liberals: Do you really trust President Obama and incoming Speaker Ryan not to find a compromise on entitlement reform that harms the poor and the elderly? I don’t. No one, absolutely no one, either man speaks with on a regular basis receives their actuarial statement from the Social Security Administration, looks at their estimated retirement benefit, and asks themselves if they will be able to live on that amount. They are wealthy and highly successful people. When they leave government service, they will likely make large fortunes in the private sector or go work at a think tank where the idolatry of the market convinced far too many that Simpson-Bowles was a good deal. I will support cuts in Medicare, Medicaid and Social Security only when the top marginal tax rate is back around 70% where it was in the Eisenhower years! Those were good years for the country, good years for the wealthy, good years for working people, but they were not years that produced the kind of Gilded Age economics we have today.
Social Security and Medicare exist so that the elderly will not be destitute. That is a low bar. We as a society, not our government, should do even more for our elderly. Our churches, our unions, our neighborhood watch groups, our schools, and most especially our families, should do more to keep our seniors involved in our lives. As Pope Francis never ceases reminding us, they hold the wisdom of years, which is a wisdom we could all use. Instead of seeing the elderly, and the entitlement programs that support them, as a burden, we should all find ways to celebrate their lives and keep them integrated into our own. We can start exercising this kind of social solidarity by opposing assisted suicide and reminding our seniors that they are not a burden, that they are needed and valued, that they have dignity and can never lose it. Here is an issue on which solidarity must trump personal autonomy or else we will all lose, and we might lose more than we first thought.