Women's sacrifices, taken to the extreme

The Middle Ages

December 16, 2007|By SUSAN REIMER

Christopher Buckley's dark satire Boomsday imagines a Social Security crisis that pits the generations against each other, and a public relations campaign to persuade older Americans to do the "right" thing and check out early. There are even financial incentives and free Botox if you schedule your suicide.

But what if, in such a world, it were the women - the always dutiful women - who felt the pull of responsibility most strongly and signed up first?

That is exactly what Susan Wolf, a bioethicist at the University of Minnesota and an opponent of physician-assisted suicide, fears.

Wolf made her case in a recent The New York Times Magazine article written by Daniel Bergner about the efforts of former Washington Gov. Booth Gardner to pass a physician-assisted suicide law like the one on the books in Oregon.

Women are caretakers of children, parents and husbands, she argued. Aren't they more likely to want to avoid being a burden themselves when they become old or very sick?

Wolf also said women are more likely to acquiesce to the authority of a doctor, who is most often a man.

If assisted suicide were one of the options the doctor presented, as he would be obliged to do if it were legal, wouldn't a woman be unduly influenced toward that choice?

In Bergner's article, Wolf also talked about the literary and cultural traditions of suicides by women, going back to Sophocles' Antigone and Shakespeare's Ophelia.

Wolf was unavailable to elaborate on her theory of the particular vulnerability of women in a society that permits physician-assisted suicide. Her office at Minnesota said she was dealing with a health crisis involving her mother.

But something about this point of view didn't sit right with me, particularly because statistics from the first decade of the Oregon law show that assisted suicides have been split pretty evenly between men and women.

So I pursued it with Dr. Peter Terry, a professor of medicine

in pulmonary and critical care at the Johns Hopkins Bloomberg School of Public Health and a member of Hopkins' Berman Bioethics Institute.

"The Oregon statistics don't on the surface suggest that there will be a propensity of overinvolvement by women," he said.

And, he said, "There are relatively good sociologic studies that suggest that women tend to have larger support groups as they age than men.

"The effect of the support group might counter any propensity."

Exactly, I thought. My girlfriends would never let me check out, and they'd make sure I was cared for.

It also occurred to me that, while my mother's generation might have been vulnerable to a suggestion that once her care-giving days were over, she was expendable, I doubt that this generation of women would think that way.

We are the boomers, after all. We think we are the center of the universe.

"I think that is a good point," said Terry, laughing slightly.

Wolf did not limit her fears of vulnerability to women. She expressed concerns for minorities, too. On that point, Terry agrees, and it is fundamental to his opposition to physician-assisted suicide.

"The health care system that we have does not provide equal opportunity to all. The poor and those who aren't able to afford comfortable end-of-life care, because they are suffering, might choose this."

However, Dr. Thomas Finucane, who specializes in geriatrics at Hopkins Bayview Medical Center, agrees with Wolf.

"I think women are more vulnerable," said Finucane, who also is a member of the Berman institute. "Elderly women are more likely to acquiesce to the suggestions of men wearing the cloak of respectability."

And the mere availability of assisted suicide as a medical option, Finucane said, would "poison every single conversation a doc has."

Besides, he said, suicidal thoughts are a function of depression. That means you treat the depression. You don't write a script for a deadly cocktail.

"In both genders, there is strong evidence to suggest that if you are considering suicide, you have major depression, and that's true even if you have advanced cancer."

In his 25 years as a geriatric physician, Finucane said, only one patient has asked that death be expedited.

"And that was a man."


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