As a practicing physician and medical school professor with more than 30 years of experience, I know firsthand that hospice and palliative care are wonderful and underutilized resources for the terminally and chronically ill. One should also note that refusing medical interventions and medications at the end of life is both a reasonable and ethical option at times.
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On the other hand, physician-assisted suicide — which could be on the agenda during Nevada’s current legislative session and is now being referred to by the candy-coated label “medical-aid-in-dying” — is an ethically absurd and morally corrupt intervention. It is overt killing at its very core.
First and foremost, physician-assisted suicide (PAS) creates perverse incentives to prematurely kill, not to just “aid in dying.” It also turns the physician into a complicit partner in this outright killing.
For the patient, the “right to die” often becomes a “duty to die” because of real or perceived fears, family burdens and financial concerns.
The overarching premise pushed by proponents of this concept seems to surround “control” — providing patients with total control of every aspect of their life and death. Unfortunately, PAS does the opposite. It limits choice and control by limiting access to health care and treatment.
When insurers and our government are faced with skyrocketing health care costs, PAS gives them the real and inexpensive alternative to deny you care and provide you with a deadly prescription instead. It’s a lot cheaper to give you a bunch of pills to kill you rather than pay to treat you. Sadly, such real abuses are already being witnessed in states where PAS is legal. Since PAS became legal in California and Oregon, I have experienced firsthand the abuses that PAS incentivizes.
I cared for two patients in my hospital in Northern Nevada who were seeking transfers to their home states of California and Oregon for lifesaving treatments. With these particular treatment options, both patients had an excellent chance of cure. Without the treatments, both would likely die from their diseases.
When I spoke with the medical directors of the patients’ insurance companies, both of them told me they would cover assisted suicide but would not approve coverage for lifesaving treatment. Neither the patients nor I had requested assisted suicide, yet it was readily offered. Instead of the best treatment options, my patients were offered the cheapest option — a quick death through lethal medications. This was perfectly legal to do in those states but certainly unethical.
Another underlying premise proponents use to push physician-assisted suicide is that you should fear horrible, unending pain at the end of life. This is simply not true. In fact, “pain” is not even in the top five reasons for requesting assisted suicide, according to 20 years of data from Oregon. The top three reasons listed are loss of enjoyment in usual activities, burden to family and loss of autonomy.
I agree that these are serious and important social issues that need careful multidisciplinary attention, psychological care and skilled physician interventions.
Appropriately utilized palliative and hospice care can address these issues directly and can help immensely. But assisting with the overt killing of our terminal patients is not the answer to these important issues.
It is true that we can and should do more to properly control physical symptoms and psychosocial issues at the end-of-life. Increasing education and training in palliative and hospice care will accomplish that goal.
Caring for patients physically, emotionally, and spiritually at the end-of-life, not assisting in a suicide, is where our precious medical education resources should be allocated.
I believe that the real story here is exposing the risks and perverse incentives that the legalization of physician-assisted suicide creates. The problems are not limited to the residents of the states where it is legal; it is crossing state borders and permeating the attitude of the decision-makers who determine your care.
The American College of Physicians recently reiterated its opposition to physician-assisted suicide. I couldn’t agree more.
I applaud them for their honesty in pointing out the ethical problems with physician-assisted suicide. Lawmakers and health care policy advocates considering this issue should take notice — as should we all — of the very real and negative impacts this “option” has on patients, their families and on society as a whole.
Dr. T. Brian Callister, M.D., is a board-certified internal medicine specialist and the governor-elect of Nevada for the American College of Physicians. He is professor of medicine and academic hospitalist at UNR’s School of Medicine.