That column is disingenuous, since to conform with the statute, one would have to acknowledge prescribing to assist, and otherwise, one could simply have a board affirm one met standard of treatment. Here is something on the other side:
Pitfalls of physician-assisted suicide
By Hilary Evans, M.D.
Hilary Evans, M.D., is an associate pathologist on the staff at Lee Hospital in Johnstown.
Published September 1997
The Supreme Court’s unanimous decision that physician-assisted suicide is not a constitutional right was literally cheered by delegates to the AMA meeting in Chicago this summer. Fifty-one other medical organizations and President Clinton also oppose the legalization of physician-assisted suicide. Earlier this year, the President signed into law a bill banning the use of federal funds to pay for suicide assistance.
Rightly understood, the decision does not in and of itself ban physician-assisted suicide; it upholds the power of states to do so. Nothing is said about the right of states to allow assisted suicide or about the status of this practice in states which have no law concerning it. Chief Justice Rehnquist said, "Our holding permits this debate to continue, as it should in a democratic society."
The debate will doubtless continue; therefore we physicians must examine the issue.
The Supreme Court case was an appeal by the states of New York and Washington, whose laws against physician-assisted suicide had been overturned by the Second and Ninth Circuit Courts of Appeals. The lines of reasoning which guided these two Appeals Courts disturb me. Both found a constitutional right to physician-assisted suicide in (different sections of) the Fourteenth Ammendment, but stated that only terminally-ill people have this right.
Both courts held that there is no difference between giving a lethal prescription to allow a terminally ill person to commit suicide and withdrawing life-support such as a respirator. But the difference is between the right to not be invaded by medical technology and the right to commit suicide. And from the doctor’s perspective, it is the difference between the intent to comfort and the intent to kill.
Judge Miner, of the Second Circuit Court of Appeals, added that the state "has no interest in prolonging a life that is ending." Perhaps unintentionally, he has laid the legal groundwork for fiscal euthanasia.
In a country where suicide is the eighth leading cause of death, we should not be surprised at the many requests for physician-assisted suicide. Various surveys provide insight into the reasons for these requests. One-third are due to physical symptoms. Of these, half are pain and half are such symptons as difficulty breathing, weakness and nausea. In the other two-thirds, the patient concerns are loss of control, loss of dignity, being a burden and being dependent. Such attitudes should alert us to depression.
Indeed, a major factor in requests for suicide is depression, even when it is secondary to physical symptoms or to a general state of helplessness. Studies have shown that depressed patients who request suicide freqently change their minds after their depression is treated, even though their physical condition is not improved. Yet physicians fail to recognize treatable depression in about 50 percent of cases.
When physician-assisted suicide is practiced, someone must decide who may commit suicide and who may not. In practice, the physician "plays God" by determining whose request for suicide is valid. Such is the case in the Netherlands, where physician-assisted suicide and "voluntary active euthanasia" are allowed (although not legal). A commission appointed by the Dutch government in 1990 carried out a comprehensive survey, in which they found that physicians performed this service for less than one-third of the patients who requested it. For most of the other two-thirds they found alternatives which made life "bearable again." (The Dutch criterion for suicide/euthanasia is "unbearable suffering"—not necessarily physical suffering). The doctor, thus, must decide whether the patient has suffered enough.
Some proponents object that the only reasons to oppose physian-assisted suicide are moral/religious. Yet, the state of New York appointed a 24-member Task Force on Life and the Law, with a broad base of representation, and they voted unanimously against the legalization of physician-assisted suicide.
Now that physician-assisted suicide is legal in Oregon, the practical issues of performing it have come to the fore.
The Oregon statute is very specific and detailed. A physician is allowed to prescribe a lethal dose of medication requested by a terminally-ill patient for self-administration. Only competent adult residents of Oregon who are expected to live less than six months are eligible. The patient must make two oral requests and one written request within a 15-day period. A second physician must confirm the diagnosis, the patient’s decision-making capacity and the voluntary nature of the request. If the patient’s judgment appears to be influenced by depression or some other mental disorder, referral to a mental health professional is required. The physician must ask the patient to disclose the decision to family members, but the patient may refuse to do so. Physicians must report their participation in assisted suicide to the state. They are protected from professional and legal liability.
A survey of Oregon physicians revealed the following concerns among those not opposed to physician-assisted suicide on moral/ethical grounds:
• Half feared the attempt might fail and result in harm.
• Half were not confident they could predict when a patient had less than six months to live.
• Half were not sure what drug they would prescribe.
• One-third feared someone other than the patient would take the medication.
• One-third were not confident they could recognize depression.
• Some did not want to become known as "suicide doctors."
The Oregon law does not require a physician to be present when the patient takes the medication, and it forbids the administration of a lethal injection if the injested medication does not result in death. So the practical application of physician-assisted suicide has some real pitfalls.
An unresolved issue is the conflict between the patient’s right of privacy and the right of other health care professionals, such as pharmacists, to refuse to participate. The Oregon pharmacists’ task force has recommended that the pharmacist be informed in advance that the patient is bringing in a lethal prescription. Some in this group recommend that the pharmacist notify the state of filled lethal prescriptions, and that the state keep records of lethal prescriptions: written, filled and taken. Physicians object that this will both violate patient confidentiality and mark them as "suicide doctors."
There are also social hazards. The disadvantaged minorities in our multicultural society will be further alienated from the medical care system out of fear that their deaths would be hastened. This has already happened to the Aborigines in Australia’s Northern Territory, where assisted suicide is legal.
Two American studies have indeed shown that, among the elderly, those most vulnerable to the abuse of physician-assisted suicide—women, blacks, low-income people and poorly-educated people—fear the legalization of physician-assisted suicide. One woman responded that she fears the younger generation and their attitudes.
I personally oppose physician-assisted suicide on the ethical principles embodied in the Hippocratic Oath— "Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course."
In our libertarian culture, people think it ludicrous that something can be wrong because it is forbidden. But the near-universal acceptance of the Oath by pagans, Christians, Jews and Moslems for over two millenia should make us ask whether any of its principles are morally unsound.
The essence of the oath is patient welfare— "I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing...into whatsoever house I enter, I will enter to help the sick and will abstain from all wrongdoing and harm..." Five practices are prohibited: poisoning, abortion, "cutting for the stone," sexual abuse of patients and breach of confidentiality. If "cutting for the stone" is interpreted as restricting one’s practice to one’s area of expertise, the Oath is entirely relevant.
Medicine is now making great progress in pain management, antidepressant therapy and end of life care. In the Hippocratic Spirit, let us "use treatment to help the sick according to our ability and judgment, but never with a view to injury and wrong-doing."
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