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Helping the vulnerable at risk for assisted suicide

(RNS) — Worrying about loneliness this time of year has, over the decades, become part of the holiday ritual itself. And with good reason: Very often the holidays are when the pain and other effects of social isolation, especially for seniors without children supporting them, are felt most profoundly.

In our current moment, however, we discuss loneliness the whole year around. Also with good reason: The number of people who say they are lonely is epidemic. An alarming number of the elderly can go an entire week without talking to anyone, and younger people who are "connected" via social media are also far more lonely than they were in previous generations.

This kind of loneliness has produced a public health crisis. Death rates rise with it. Performance of daily tasks (like grooming and bathing) fall with it. Associations with abnormal immune responses and increased cognitive decline have caused prominent members of the medical community to sound the alarm.

Social isolation increasingly combines with substance abuse in a downward spiral leading to “deaths of despair” — a phrase that has, with wicked speed, embedded itself into common cultural use. Death by drugs. Death by alcohol. And yes, death by suicide.

Especially after high-profile suicides like that of Anthony Bourdain and Kate Spade, it is difficult to see how our culture could not be more aware of the deadly intersection of these factors. Except, it seems, when it comes to the relationship between loneliness and suicide assisted by a physician.

A study published in the Journal of the American Medical Association found that in the Netherlands, a world leader in the promotion of physician-assisted suicide, 56% of such deaths were associated with loneliness. One study participant said she “had a life without love and therefore had no right to exist.” Studies have found similar associations in other places with a substantial history with physician-assisted suicide, such as Switzerland.

Ruth Gallaid from Eugene, Oregon, who supports physician assisted suicide, protests in front of the Supreme Court Wednesday, Oct. 5, 2005, in Washington. (AP Photo/Charles Dharapak)

And all of this makes a certain kind of morbid sense, especially in the United States, where the states that offer physician-assisted suicide require (for now) one to be actively dying. What does a terminal illness on top of profound social isolation do to a person? What effect does the fear of dying alone do to a person?

It is nothing short of diabolical that we would respond to such vulnerable people by making it easier for them to kill themselves. Pope Francis sees this as part of our “throwaway culture” — a slouch toward discarding those whose inherent dignity is inconvenient to acknowledge and accommodate, much less embrace.

Instead of selling out to the lazy myths of U.S.-style libertarianism, we must focus on resisting social structures that produce social isolation in vulnerable populations and build up structures that can create a counter-culture of encounter — one in which the isolated and marginalized are welcomed into genuine, persistent relationships with the broader community.

If this sounds like a progressive argument, that’s because it is. Debates over physician-assisted suicide cannot be made to fit into our simplistic left/right political binary. Those of us who insist we must put the vulnerable first cannot support arguments that say marginal persons like the elderly are worthy of being killed.

But forget politics: Isn't the heart of the debate about those facing a painful death? Who could be unmoved by this situation? 

But it may be surprising to learn that in Oregon, one of 10 places in the U.S. where physician-assisted suicide is allowed, physical pain doesn’t even make the top five reasons people request it. Being a burden on others — and fear over loss of autonomy — are among the most important reasons.

I’ve learned a lot from the amazing people at Calvary Hospital, a hospice center in the Bronx, about requests for physician-assisted suicide. Dr. Michael J. Brescia, executive medical director and co-founder of Calvary, emphasizes this revealing fact: “At Calvary, we treat 6,000 patients a year, and no one, after they have been here for 24 hours, asks for assisted suicide. No one: no matter what’s wrong, and we’ve seen some terrible cases. Not when you reach out with arms of love.” 

Brescia finds himself in good company in resisting physician-assisted suicide. Despite well-funded challenges from the outside, the American Medical Association still rejects the practice, arguing that it is “fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.”

Physician-assisted suicide is one of the few issues that doesn't fall into the well-worn grooves of the culture wars. For that reason, we have a chance to resist this instance of throwaway culture. A diverse range of activists — disability, pro-life, health care, racial justice, anti-suicide and more — can unite around building a culture focused on what Dr. Brescia calls “assisted life.”

Deaths by suicide spike around January 1. Now is the time to begin building relationships and institutions that promote a culture of encounter that refuses to discard the lonely and marginalized.

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