2008 Civil Disobedience for Autonomy
posted by October 30 at 11:46 AM
onOne of the toughest things to imagine, if I get married, is making a difficult medical decision for my partner when she cannot do so herself. Intubation or death by asphyxiation? Call in the organ donation team, or the morgue?
It's one of those promises we make to one another, when committing ourselves to a partner. In sickness and health. We agree to take on the horrible responsibility of being the one charged with making those difficult decisions for the person we love, thinking of and for them when they cannot.
Shortly, I'll be returning to the wards, treating patients as a medical student. I'll soon be the person asking husbands and wives for these difficult decisions. Stronger than most who find themselves in medical school, I believe in the autonomy of patients. I believe that everyone competent deserves to choose what happens to themselves in a hospital--when they choose to end their suffering, and to whom they wish to delegate this supreme authority. In these difficult and wrenching decisions, I believe the state, the community and even the doctor should be quiet. As a physician, it is my role to honestly present the choices and implement whatever course the patient or the person he or she loves decides. The churches, the ignorant and intolerant, the meddling sanctimonious crowd should stay silent.
The opponents of Washington's I-1000 and proponents California's Proposition 8 both wish to interject, to restrict choices for others with their notions of what is right and wrong, comfortable and uncomfortable. They wish to impose their narrow moral sense on everyone, using my hands as a doctor to do so. What if I refuse to follow their intolerant and meddling desires?
What if I refuse to ignore the pleas of a patient facing unbearable suffering?
If California's Proposition 8 passes, David could very well get a letter informing him that his marriage is annulled. What if I refuse to listen to this letter, if it should come? David's marriage is as real and as valid as any in my experience. Why should I allow the intolerant, even if it is a intolerant majority of the electorate, to dictate their false moral posturing through my actions.
Why should American physicians be expected to tell a sobbing husband he cannot see his husband in the hospital? To tell a mother in agony she must suffer for a few hours more, in service of those who cling to a medieval notion of the morality of human mortality? It's all too easy to ask for bigotry and coercive enforcement of your faith in a voting booth. It's quite another to the be individual who actually must execute this cruel acts. As a doctor, one of my central duties is to protect the right of my patients to make decisions for themselves, to stand up for their autonomy when they are too weak to do so.
I deeply and sincerely hope that the voters will recognize the right of each of us to steer the course of our own lives, and make our own decisions. If not, I should refuse to acknowledge unethical laws, laws that interject community power into a decision that should be left to our own conscience.
My fellow medical students and doctors should do so as well.