Right to die, or inevitable obligation?

The arguments in favor of Physician-Assisted Suicide are compelling, and usually wrenching.  The heartache of families struggling with lengthy palliative care makes it difficult to be on the other side of this controversial, painful issue. But as policymakers in Albany soon debate whether to legalize this end-of-life process, we must have a vision beyond the sadness of individual families, and even the medical and scientific data of the issue, and instead focus on larger issues of appropriateness and consequences. With respect and sincere compassion for the families advocating for Physician-Assisted Suicide, their pleas should not drive decision making here.

Governments and markets create spaces for things to happen, often involving a profit. If there is a way for money to be made, smart people with clever systems will rush in. Sometimes a space is created for newly-allowed, some would say overdue, conduct- such as , marriage equality as a civil right. Technology companies are disrupting traditional ways of getting things done in spaces that government either leaves alone, or seeks to contract, in businesses as varied as transportation, housing, supply chains, information delivery, healthcare and entertainment.

By allowing Physician-Assisted Suicide, government wouldn’t just be carving out a space where suffering terminal patients and their families could make a decision; it would be creating an option, one that some would feel pressured or obligated to choose. The cost of care measured against inheritance or upcoming college tuition bills for grandchildren become allowable considerations. Quality of life for the living left behind would weigh heavily on patients’ minds. Mood becomes a factor, worse days compelling decisions that could never be undone.

And what of those who decide not to avail themselves of this new option? Would their families ostracize them? No matter what protections accompany Physician-Assisted Suicide, there is no bulwark against feeling like a burden. When does a right to die become an obligation to die?

What sort of businesses or industries would spring up in this space? Specialty law practices and courts? Doctors who would certify anything, similar to those who run “pill mills?” Coaching services for families and patients? Therapists? Social Workers? Who pays?

The class implications of this policy are both stark and staggering. Affluence has always impacted health outcomes, but under Physician Assisted Suicide will we see those without means or a financial cushion opting to die sooner, and more often? States once sued tobacco companies for the impact that smoking-related illnesses had on their budgets, is there a parallel to be drawn to those insisting on costly, lingering care? As boomers age and become more infirm, and as caring for those with dementia and physical frailty take up more of sandwich generation resources, what happens then?

Our Judeo-Christian / Abrahamic heritage is opposed to suicide, and our growing embrace of religious and ethnic diversity includes faiths with similar prohibitions. Is New York, with its vast population, ready to navigate this spiritual minefield?

But most of all, this feels like a dangerous cop-out. Government should focus on improving the lives and quality of life of the living, no matter how sick, not hastening their death. Physician-Assisted Suicide is not an expanded civil right, like marriage equality. It is not an economic justice issue, like banning the box in employment applications. It is not about protecting information, like net neutrality. It is not a movement whose time has come. The consequences are simply too severe.

Michael Tobman is a Brooklyn-based political consultant.