Scripting “The Conversation”

They’re at it again. NPR hosted another sham debate. On the left we have Ira Byock, hospice and palliative care advocate; and on the far left we have Compassion & Choices, the radical pro-assisted suicide/euthanasia group.

They are debating a subject that no one would have noticed if it weren’t for well-coordinated media hype from MSNBC, People Magazine and the like.

This is a staged “dialogue” on assisted suicide. Compassion & Choices presents the thesis (assisted suicide should be legal), then Ira Byock comes in with a straw man antithesis (traditional medicine will let you suffer) and then the synthesis: palliative care.

Here’s the dirty little secret: Ira Byock is, himself, a euthanasia advocate.

“That can’t be true!” you say. “Byock directs an institute at a Catholic hospice, and surely a Catholic hospice would not appoint a director who advocates such a thing.” Indeed, it is a mystery why a Catholic institution would put a fox in charge of the hen-house, but that is the case.

Byock and euthanasia proponent Timothy Quill (who infamously wrote about helping a patient kill herself), advocate for “terminal sedation,” that is, sedating the patient and withholding or withdrawing nutrition and hydration. In other words, kill the patient by “allowing” the patient to die of starvation and dehydration. Byock and Quill argued that this would provide a morally acceptable alternative to lethal injections and overdoses.[1] Moreover, Byock would have you think that this terminal sedation is a good death (euthanasia, strictly translated, is “good death”). But euthanasia (much like Utopia) looks better on paper than it does in reality. Death by starvation and dehydration is not a pleasant way to die, and is too easily imposed on a patient.

Byock did this same sort of thing in 2005: amplifying arguments for assisted suicide that arose from legislative battles in Vermont and California, misrepresenting pro-life as not offering a legal alternative to assisted suicide, then positioning his palliative care as a happy solution to the suffering of the “chronically ill man who feels he’s a burden to his family and society.” [2]  And as he and so many other palliative care advocates do, he framed the issue as a public health problem requiring national health solutions.

In an article in the Burlington Free Press, while bemoaning the “fracas” of “an increasingly polarized debate,” Byock ratcheted up the rhetoric by declaring that “a public health crisis surrounds the way we care for people and the way we die.”  In a particularly ironic twist, Byock — the man who promoted a “good death” by starvation – lashed out against the American healthcare system, charging that “thousands of elderly Americans in nursing homes are literally starving” because of a labor shortage. Solving the “social crisis,” he said, “would require a willingness to jettison conservative-liberal divisions and old baggage from the abortion debate. . . We could insist and ensure that nursing homes [employ] qualified people.” Then came a familiar refrain: “Training and paying [nursing home employees well] wouldn’t require more money than our health care system currently squanders on unwanted hospitalizations or futile treatments.” [my emphasis]

Unfortunately, a number of pro-life groups assist in this little charade. Either acting out of fear – of a perceived threat of rampant assisted suicide, or fear of being perceived as “obstructionist” – or out of a desire to legislate more money and influence for themselves, they embrace and recommend palliative care, in spite of its nebulous and ever-evolving definition.

A case in point is the Euthanasia Prevention Coalition in Canada, a group that has been setting off alarms about assisted suicide, and answering them with calls for more money for palliative care. On October 23 both Compassion & Choices and Ira Byock issued press releases on the NPR debate that had occurred ten days earlier. Almost simultaneously, the EPC rushed to its website with extensive quotations from Byock on the evils of assisted suicide, accompanied by a flattering publicity shot of Byock.

This business of facilitating the shift from standard medicine to palliative care’s rationalizing the withdrawal of food and water from severely ill patients brings to mind a relevant passage from Jonah Goldberg’s Liberal Fascism. Goldberg wrote:

“I reject the clever argumentation of liberals who claim that their effort is merely ‘pragmatic’ or piecemeal.  ‘Oh just this one brick. What’s wrong with this brick?’ is how liberals argue about every stage of their project. But it’s not just one brick. Nor should conservatives believe it is merely a slippery slope. That image suggests forces outside of our control pulling us in a direction not of our choosing. If society is moving in a direction not of its choosing, it is often because it is being pushed by the self-appointed forces of progress.”

What will it take for pro-life to admit that their infatuation with palliative care is misguided? Sure, palliative care programs are much more than terminal sedation. The majority are fraught with advance care planning and end-of-life conversations (and POLST); consensus ethics, demoting physicians, and restructuring healthcare into teams; and framing the conversation in terms of “not prolonging life.”

People who recommend palliative care must certainly be familiar with the five stages of loss: denial, anger, bargaining, depression and acceptance. It’s about time that pro-life devotees of palliative care admit they are stuck in the denial stage, or at least in the bargaining stage. It is time to accept the fact that “palliative care” today is not what they imagine it to be, and it is time to stop recommending consultations and policies that are, in all probability, lethal.


[1] TE Quill and IR Byock, Responding to Intractable Terminal Suffering. Ann Intern Med, Oct 2000; 133(7): 561-562.

[2] I. Byock (2005) Both Sides are Wrong in Suicide Debate. Burlington Free Press.