A Chosen Death: The Dying Confront Assisted Suicide.

At a recent party, I met a doctor who proclaimed himself a liberal. "I'd rather die than be blind," he told me, thinking he was being sympathetic. "I don't see why you people don't commit suicide."

"God day to you, too," I thought, while hastily pursuing more cheerful conversation.

Disconcerting as it was, this encounter didn't surprise me. When I was born, the doctors, on finding that I was blind, apologized to my parents for keeping me alive.

My story isn't unique; it's representative of the way our society tells us that "disability is a fate worse than death."

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Today, you can't pick up a newspaper or turn on the TV without reading or hearing about assisted suicide and "the right to die." So I've been thinking about those who believe we who are disabled would be better off dead.

In A Chosen Death, Shavelson has two agendas: to profile five people (three with terminal illnesses and two with disabilities) who wanted help in ending their lives; and to argue for the legalization of assisted suicide. Though Shavelson cares deeply about his subjects and their families, he uses their stories to buttress his argument for "the right to die."

Most books on social issues are filled with jargon and ponderous prose. Shavelson, an emergency-room physician and photojournalist, gives us a well-written, lively book. He uses his skills as a journalist to present his arguments for assisted suicide. We come to know Shavelson's subjects as fully human beings: sometimes likable, occasionally disagreeable; at times brave, more often frightened.

Renee, an emergency disaster planner for the government, and Marry, a mystery writer, were terminally ill from cancer.

Pierre, a circus trapeze artist who had AIDS, planned to kill himself, but died a few hours before.

George, an emotionally troubled but not terminally ill man, was partially paralyzed as a result of two strokes. Depressed, he sought someone to help him kill himself. A competent counselor wanted George to get professional help so that he wouldn't rush to end his life. But George didn't want this sort of help. Instead, he found Sarah, an untrained and emotionally unstable volunteer for a local Hemlock Society chapter, who assisted in his suicide. (George and Sarah are pseudonyms, Shavelson says.)

Shavelson argues that if assisted suicide were legalized, there wouldn't be any "Sarahs" out there rushing to help people commit suicide. Yet many people, including doctors, have a low opinion of the "quality of life" of people with disabilities. If assisted suicide were made legal, wouldn't there be physicians and mental-wealth professionals who would share George's dim view of his life?

Shavelson wants to turn the reader into an advocate for assisted suicide. Yet for me, A Chosen Death had the opposite effect: it confirmed my opposition to assisted suicide.

Shavelson holds the "liberal" view that assisted suicide is an issue centered on freedom of choice: that people who are terminally ill or disabled should have the right to choose to die if they are undergoing unendurable suffering.

The author believes that, with the proper safeguards, physician-assisted suicide should be legal. Terminally ill patients with only six months to live would be examined by two doctors. These physicians would confirm that the patient is terminally ill, has received adequate health care, and isn't depressed. Hospital review committees would assess these physicians' recommendations to determine if assisted suicide should occur.

Yet in an effort to show the complexity of this issue, Shavelson unwittingly articulates the problems with the "liberal" position on assisted suicide. Some thirty-seven million Americans have no health insurance, health-care rationing is fast becoming a reality, and health-care providers are being pressured to cut costs any way they can.

In this context, disabled people, the elderly, African Americans, gay people--all people whose lives are deemed too costly, too great a burden, or of too little value--could be pressured not only to forgo medical treatment but to opt for assisted suicide.

For those who are marginalized in our country, "the right to die" could all too easily become "the obligation to die."

Some months ago in The San Francisco Chronicle physician Bruce Bartlow said, "As director of intensive care in a community hospital, I squander millions of dollars on patients too elderly or too ill ever to return to meaningful function.... We must face the un-American fact that not all individuals' remaining lives have equal value. Value should be assessed ... on how their survival enriches or drains their family and community."

Such values are rapidly becoming the norm in America today. And disabled people are being refused medical treatment.

Take the case of Sandra Jensen, a thirty-five-year-old woman with Down syndrome who needed a heart-lung transplant. Jensen had lived on her own and held a job for years. She had been an ardent advocate for people with disabilities and had been present when George Bush signed the Americans with Disabilities Act. Yet for many months, Jensen was rejected as a transplant candidate solely on the basis of her disability.

After intense lobbying from disability advocates across the country, she received the transplant in January. But how many of us have Jensen's access to advocacy groups?

Shavelson is a humane physician and writer. Yet he exhibits a naive faith that, if it were made legal, doctors could fairly regulate assisted suicide. I've encountered many doctors and mental-health professionals who, though well-meaning, have had prejudicial attitudes toward the disabled. So I find Shavelson's trust in the wisdom of physicians a hard pill to swallow.

According to a Louis Harris poll, nearly half of the general public says it is afraid of disabled people. Doctors are members of the general public; most have the same attitude toward disabled people as everyone else. Medical school trains them to overcome disease, not to overcome prejudice.

Is there any reason that doctors sitting on hospital review committees would put such prejudice aside in reviewing cases involving assisted suicide or allocation of medical treatment?

Shavelson also would have us believe physicians would ensure that people would choose assisted suicide without coercion. I find this hard to accept. Coercion takes many forms.

For example, in December, George Delury was indicted on manslaughter charges for allegedly helping his fifty-two-year-old wife, Myrna Lebov, kill herself. Lebov had multiple sclerosis. During the last three months of his wife's life, Delury kept a diary. He wrote of the "tyranny" that caring for her cast over his life and of his uncertainty over whether she had actually chosen suicide.

In one entry, Delury wrote that he wished he could say to his wife, "I have fallen prey to the tyranny of a victim. You are sucking my life out of me like a vampire." In another entry, he asked himself, "If she asks for the poison now but seems very depressed, should I comply? Is she still autonomous? If I comply, I may be serving my own interests more than hers."

I wasn't convinced by Shavelson that assisted suicide would be carried out responsibly if it were made legal. Yet I found A Chosen Death to be well worth reading. In contrast to many works on social policy issues written by physicians, his work includes the views of those who are often discounted or disrespected by the medical profession.

A Chosen Death informs public debate on one of the most emotionally charged, complex issues of our time. But despite its intentions, this work shows the need for all of us to care for and value everyone's life, rather than work for "the right to die."