By Jonathon Van Maren
While assisted suicide has been legal in Canada for over two years, the debate is still raging south of the border in America. Six states have legalized euthanasia so far, with approximately 20% of the population now living in a jurisdiction where they can access what is insidiously being referred to as “end of life care.” A lethal injection is “care,” of course, in precisely the same way getting shot in the head is a cure for a migraine.
Many doctors are pushing back hard, and the ethics council of the American Medical Association recently reaffirmed its opposition to assisted suicide after researching the practice for a full two years. Unfortunately, the governing body of the AMA “narrowly rejected” this report and sent it back to the ethics council for further study. It is not yet clear what that will mean, and whether the AMA will stick to their current position, which describes assisted suicide as “fundamentally incompatible with the physician’s role as healer…difficult or impossible to control, and would pose serious societal risks.”
In response, Dr. Joseph Marine has penned a brilliant article for RealClearHealth articulating five key reasons that he cannot support assisted suicide, and why other physicians should emphatically reject the practice as well:
- PAS is unethical for doctors and nurses and is not medical care.The Oath of Hippocrates, from over 2400 years ago, states that “neither will I administer a deadly drug to anybody when asked to do so, nor will I suggest such a course.” In modern times, most major medical organizations, including the AMA, the American College of Physicians, the American Nurses Association, the National Hospice and Palliative Care Organization, and the World Medical Association, have agreed and issued statements opposing PAS. PAS has no basis in medical science or tradition, no peer-reviewed guidelines or standards of care. No one would consider giving patients cyanide tablets or carbon monoxide to be medical care. Neither is misusing dangerous controlled drugs as poisons.
- The supposed “safeguards” in PAS laws are an illusion.They include no requirement for psychiatric evaluation or for witnesses to the consumption of the lethal overdose, no medical examiner inquests, no independent safety monitoring board, and no mandatory routine audits of records and documentation. There is no requirement that the prescribing physician has a meaningful long-term patient-physician relationship with the patient seeking assisted suicide and physicians are immunized from ordinary negligence. Additionally, all medical records and documents connected to the provision of assisted suicide are protected from legal discovery or subpoena, ensuring that no investigation is ever likely to take place.
- Abuses of PAS laws are already occurring in the U.S. Despite the extraordinary legal protections given to PAS practitioners and the lack of meaningful oversight, cases in the U.S. have been documented where PAS drugs have been given to patients with severe depressionand dementia, and at the urging of relatives rather than a patient’s independent request. We know that patients in Oregonhave been given PAS drugs and lived for years afterwards, when the law requires a six month prognosis. In addition, there are reports that health insurance companies have denied patients investigational therapies while offering to pay for PAS drugs. Documents from the Oregon PAS program also show that patients may take as long as four days to die after ingesting PAS drugs. For 80 percent of patients, it is unknown if complications occurred (because of lack of medical witnesses). Doctors experimenting with novel PAS drug cocktails in Washington State caused some patients to “scream in pain” before dying.
- PAS is unnecessary.Patients may already decline any and all medical care that they do not want, and can encode their wishes in advance directives, to be overseen by designated and empowered health-care proxies. Palliative care, hospice care, and pain management programs have made enormous stride in the past decades, and almost all pain and distress at the very end of life can be treated with medications. Moreover, the great majority of patients do not seek PAS because of pain (less than 25 percent in Oregon). Rather, loss of autonomy and fear of being a burden on others are the dominant reasons.
- The vast majority of doctors in the U.S. will not practice PAS. In Oregon, all suicide prescriptions are written by only 2–3 percent of the state’s doctors, and the average duration of the doctor-patient relationship is only three months, indicating that patients’ personal physicians are rarely providing these prescriptions. In Washington DC, nearly one year after legalization of PAS, only twoout of 11,000 licensed physicians (0.02 percent) have registered to participate. These facts indicate that the vast majority of U.S. physicians recognize that PAS is wrong and that physicians who practice PAS may not be trusted by patients with their lives and their health.
For those of you who are interested in putting these arguments to use in a practical way, I recommend the book my colleague Blaise Alleyne and I wrote last year, A Guide to Discussing Assisted Suicide.