The Moral Murkiness of Medical Aid in Dying with Katie Engelhart
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What ethical questions does medical aid in dying raise for doctors and patients?
Today's episode of The Nocturnist contains descriptions of mental health crises and suicidal actions. Listener discretion is advised.
At The Nocturnist, we are careful to ensure that all stories comply with healthcare privacy laws. Details may have been changed to ensure patient confidentiality. All views expressed are those of the person speaking and not their employer.
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Do no harm. Thou shalt not kill. Life is sacred and should be protected at all costs. Right? You're listening to the Nocturnist Conversations. I'm Emily Silverman. In this episode, I speak to journalist Katie Englehart about her new book, The Inevitable, Dispatches on the Right to Die. In it, she speaks to patients, doctors, ethicists, and others about the murky ethical practice of medical aid in dying. When is life no longer worth living? Who decides? And what do we do about it? This is one of the most provocative pieces of journalism I've read in recent memory, and I'm so excited to talk to Katie about it. Katie is a reporter and documentary film producer from Toronto who's based in New York City. She's also a national fellow at New America.
Englehart has worked as a correspondent for Vice News, based in London, and NBC News in New York. Her writing has appeared far and wide. Formerly, she was a graduate student of history and philosophy at Oxford University. Before we spoke, I asked Katie to read an excerpt from her new book, The Inevitable, Dispatches on the Right to Die. Here's Katie.
Betty said that she would go to Mexico herself. I'm going to do it, she told the others. Lots of people went to Tijuana, but Betty chose Tecate, a small city off Federal Highway 2, surrounded by mountains. She had read in her online suicide manual about Mexican pet stores where in-the-know foreigners could buy lethal poison. All you had to do was tell the employee at the register that your dog was very sick and needed to be put to sleep and that you were there to buy the sleeping agent. I'm on the case, Betty texted her friends from outside a local shop. She was a little bit scared, but not too scared. She didn't think the police would seriously target a woman in her 70s. They're not going to go after a little old lady, she said, and I could pull the little old lady cover if I had to.
I could sit and cry if I had to, no problem. Back in Manhattan, before she left for Mexico, Betty had bought a handful of expensive-looking cosmetics bottles and printed labels to stick on the front of them, for sensitive skin only. The idea was that she would transfer the pet store poison into the decoy containers before driving back over the border into California and flying home. The drugs would belong jointly to her and her two best friends. They would hold on to them, quietly, in their respective Upper West Side apartments until someone got sick. We have a pact, Betty said. The first one who gets Alzheimer's gets the Nembutal. The fast-acting barbiturate would put the drinker to sleep quickly, but not suddenly.
Once she was asleep, her breathing would likely slow over the course of 15 or 20 minutes before it stopped.
Thank you for that reading. I just wanted to open by telling you how much I loved this book. I can't stop thinking about it. How did you get interested in this topic?
This book started out with an assignment. I was living in London. It was 2015. I was asked to cover a debate going on in the British government about whether to pass right-to-die legislation, so legislation that would legalize physician-assisted death. And I found the debate to be interesting, but also very predictable. And it was in the course of that reporting that I learned about this whole sort of universe of people who were not waiting for laws to pass, people who were making their own arrangements to end their lives. In some situations, these were intimate arrangements within families, for instance. In other cases, I found quite organized networks of volunteers operating to help strangers end their lives when they wanted to.
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Chapters
8 chapters
1
What ethical questions does medical aid in dying raise for doctors and patients?
0:00–5:07
2
How did Katie Engelhart become interested in the right‑to‑die movement?
5:07–10:06
3
What does the excerpt about Betty’s plan to obtain lethal poison illustrate about DIY euthanasia?
10:06–16:11
4
Why do most U.S. physician‑assisted death laws require self‑administration of medication?
16:11–22:37
5
How do European countries differ in their approach to assisted dying and euthanasia?
22:37–28:01
6
What is “rational suicide” and how do clinicians view this concept?
28:01–33:57
7
How do patients define dignity and what role does autonomy play at the end of life?
33:57–39:52
8
What key insights did Katie take away from researching the right‑to‑die worldwide?
39:52–48:35