The Medical White Wall of Silence Wraps Around the Clerical Collar

Today at a local Compassion & Choices chapter meeting we, refreshingly, heard from a Catholic Father who’s worked as a medical chaplain for many years, including at my local county hospital system. He supports Oregon-style physician aided death, as he prefers to call it—the kind of system intended to offer an option for the brutally terminally ill, with safeguards that usually bar people with long-term degenerative diseases (ALS, dementia) from participating because by the time they become diagnosed as terminal they usually are passed the point of self-deliverence (which by default would force loved ones and/or a doctor into a euthanasia role to end the patient’s life).

The Father (I’m intentionally shielding his identity) was particularly lucid in describing the systems of thought informing those who support and oppose PAD (utilitarian for those who support aided dying; duty-bound for those who oppose). Although I didn’t learn much new, his experiences, perspective, and lucidity were well worth the time spent listening.

When it came time to describe what I call “wink-nod euthanasia,” the Father referred to it in terms of titrated deaths. To titrate means to measure and adjust drug dosages—the context being when heavy duty pain relievers delivered by IV are increased knowing that one, if not the, likely effect will be the death of the recipient. His point was, as aided dying proponents remind us, that the medical practice of aiding dying is well-known and ongoing. In my lingo I’d say titrated dying is normative—a part of everyday medicine. We (the public) just don’t know how often it occurs. It’s hidden in plain sight because people either hide behind the principle of double effect—claiming that their only goal in titrating is to reduce suffering, which is acceptable even if a secondary goal is that the patient dies—or they hide by not saying anything at all while doing the titrating.

During Q&A I asked the Father if he would, based on his years of experience in the county, ballpark the number of tritrated deaths as a percentage of all county deaths. He said no, he would not, because any number can and might be used to inflame, showing up in a newspaper article under a headline like “Local Doctors Kill Patients”.

Although an understandable concern, thus does the medical white wall of silence, which I have personally experienced over the years as a lay end of life researcher, extend to the white clerical collar. While my blood pressure is quite low about this by now, intellectually I find this white wall maddening. Our society cannot have an honest conversation about legal, openly available aided dying if an important comparative aspect—ongoing hidden aided dying—cannot be quantified. What the Father did reiterate is that titrated dying is a known and broadly-accepted medical form of dying. I didn’t expect the wink-nod aspect of it to go so public.

Wouldn’t it be interesting to know the data? … what percentage of institutional deaths occur by titration? When aided dying opponents lament the lack of real, or effective, reporting on PAD use, I wonder if they lament the complete lack of honesty and reporting about titrated deaths. As Toni Broaddus, California Compassion & Choices Campaign Manager said at a recent end-of-life conference at which I presented, PAD is the only dying pathway typically subject to reporting requirements, whether one assesses them as effective or ineffective in terms of presenting meaningful data.

Apparently what’s good for the reporting goose (legalized aided dying) is not good for the reporting gander (medically titrated wink-nod euthanasia). We can’t “take a gander” at titrated dying rates in what I’ll call the White Swirl of Silence that bridges medicine, business, and the clergy and, by the way, skews government reporting.

It’s not pleasant criticizing a priest who is very much in favor of aided dying (as you may infer that I am). What the hell; I’m just an echo chamber.