Lessons Learned: Facing Physician-Assisted Suicide
Dr. Rachel B. DiSanto shares how she learned how to stand up for Christian principles in the fight against physician-assisted suicide in this article published in the spring 2018 edition of Today's Christian Doctor.
by Rachel B. DiSanto, MD
The beginning of my medical education was also the beginning of my experience with physician-assisted suicide. I was a first year medical student at the University of Vermont College of Medicine (now the Larner College of Medicine) in Burlington, Vermont in 2000, and I had recently joined the student chapter of CMDA. I was invited by our graduate mentors to attend an informational meeting about Vermont’s newly proposed physician-assisted suicide legislation. CMDA CEO Dr. David Stevens had traveled to Burlington to lead the discussion. It was the first of countless such meetings he has conducted in the last two decades. I remember being simultaneously inspired by the wisdom and courage of my mentors and the CMDA leadership, as well as terrified that I would ever have to step into such a contentious legal battle to defend what I knew was right. I had gone into healthcare to help people, and possibly share my faith, but it had not yet occurred to me that I might be called to participate in controversial, public battles over vital moral and conscience issues in healthcare. As a young woman who grew up in New Hampshire, I was already in culture shock having moved to the progressive hub of one of the most liberal states in the country only a few short months prior. I was seeing the active and open ridicule and intimidation of conservatives, and especially Christians, in every facet of my medical education, and I was scared.
Fast forward 15 years to 2015. Culturally, things went from bad to worse in Vermont during this passage of time. My closest mentor and dear friend, Dr. Bob Orr, had been challenged and belittled for his faith on a television news program. After a heated and prolonged battle lasting over a decade, physician-assisted suicide was finally passed into law with Act 39, and I was eight years into family medicine practice in rural, impoverished Northeast Vermont. I had continued to be peripherally involved in the fight against physician-assisted suicide legislation, but I had not been one of the physicians taking the lead in the media or in testifying at the state level. Shortly after, some of us in leadership positions in CMDA were asked what advice we would give to other members battling this issue across the country. It forced me to consider what I personally could have done differently. Though the outcome seemed foregone, as everyone knew the legislature had enough votes to pass it, I felt sad, ashamed and angry that I had not tried harder, had not personally put more on the line.
As God so often does, He quickly brought an opportunity to me to enter the battle in ways I had previously avoided. Maryland was considering legalizing physician-assisted suicide, and the state legislature formed a committee to investigate other states’ experiences. I was asked to testify (via Skype) before this committee, and I decided I had to try. I had no experience and very little faith in myself, but God wasn’t looking for either of those things from me; instead, He was simply looking for faith in Him. The testimony went well, although I was sharply questioned and criticized by the committee chair. CMDA’s partners in Maryland who spearheaded the effort for us were tremendously supportive. I learned so much through that brief experience. Despite my perceived inadequacies, I found that God is really just looking for us to show up. I might have been tempted to check that off my list and think I had done my good deed in the fight against physician-assisted suicide, but somehow I knew that was only the beginning.
In spring 2016, Dr. Stevens approached me to get involved with a somewhat new approach in CMDA’s legal efforts to support healthcare right of conscience. With the help of Alliance Defending Freedom (ADF), CMDA was filing suit as a plaintiff in a case in a federal court in Vermont to protect its members’ right not to participate in physician-assisted suicide. The Vermont law legalizing physician-assisted suicide included an extremely loose clause that stated no one had to participate against his or her conscience, but it did not specify whether a physician was required to refer a patient seeking a lethal prescription. When Dave asked me to join this lawsuit, I remember thinking, “Is this really necessary? I mean, shouldn’t we wait until it becomes a problem and then try to defend ourselves legally? Aren’t we picking a fight where no fight may ever exist?” Having said that (to myself), I remembered how I had felt a year before when testifying before the committee in Massachusetts. Perhaps this was the time to really put myself out there. I knew God was calling me to step out in faith, but what would my colleagues think? What would my boss think? What might get printed in the paper? Would I be subject to an exposé the way my mentor had been 10 years ago? I was asking these questions out of fear, even though I knew none of those things should matter. Despite my fear, I placed my faith in the One I could trust with my career and my reputation. And during the course of the next 18 months, I became intimately involved in a federal lawsuit that ultimately won a significant victory when the judge ruled healthcare professionals are not required to refer patients for physician-assisted suicide. It was a victory for Vermont physicians who morally oppose participating in physician-assisted suicide. But more importantly, it was a victory for all CMDA members, as it demonstrated we could successfully seek preventative legal action in advance of conscience issues arising. It is a promising new step in protecting the freedom of all healthcare professionals.
As God always does, it wasn’t long before He led me to an encounter that only confirmed why it had been so important to seek this legal action at just the time we did and why it was so important I faced my fears and got involved. The email I sent to Dr. Stevens in fall 2017 best explains this encounter:
I want to thank you and everyone who has contributed to my education and ability to engage with the issue of physician-assisted suicide over the years. I have had a very real encounter with this issue in the last month. I had an 86-year-old patient with metastatic lung cancer diagnosed last spring who has been declining this year. He came to me this fall seeking physician-assisted suicide via Act 39. While I always knew roughly how I would frame my objections and any conversation with a patient about this, this was my first test, and I found I was so extremely grateful for the experience of having participated in the ADF case. Specifically, I was grateful when it came to the idea of mandated referral. My patient and his family were very understanding and gracious about my respectful refusal to participate, but it would have very quickly become muddy with regard to whether I was obligated to refer him to someone who does participate. This was further complicated by one hospice nurse who advocated/informed the family as much. It was a great opportunity to educate my colleagues at the office and at hospice, and I was not only grateful for the result of the ADF case but for the talking points I picked up throughout that process. It gave me such confidence in communicating the issues and also helped me relieve a lot of anxiety in my partners about this issue (including one Muslim colleague). It was a unique time to be a light in a sort of different way, and God was faithful. In the end, the patient was unable to find ANY local physician willing to help him with physician-assisted suicide (and when his wife called Compassion & Choices, they had nothing to offer her, praise the Lord!!), and so he gradually became more receptive to my advice regarding other methods of palliation and care at the end of his life. I am pleased to say he passed peacefully just this evening at the hospital, having gotten everything he ‘wanted’ out of his dying experience, minus his ability to choose the exact date and moment of his death. But he did not suffer, did not ‘burden’ his family with a long, drawn-out death and was able to retain his dignity to the end. He, his wife and his son were grateful for my care, and I was able to care for him myself this afternoon before he passed.”
As I wrote those words to Dr. Stevens, I was overcome with gratitude to God for His faithfulness throughout the legal process, as well as for the lessons I learned from it. His timing is perfect, and as I reflected on what I had learned, I realized this particular patient’s case perfectly answered my original question about why we should bother proceeding with the lawsuit. If it had not been for the clear lines drawn by the settlement—the specific protection to not have to refer patients to a physician willing to provide a lethal prescription—I would have likely had a difficult and heated situation with this patient and his family at the end of his life, a situation we all were eager to avoid. My relationship with the patient and his family allowed me to have these repeated difficult conversations, and our mutual respect and his confidence that I wanted to do everything in my power and within my moral beliefs to help him allowed him to trust me to care for him to the end. That, to me, is good palliative care. It is not popular in our culture to consider suffering as anything but bad and unnecessary, but when we take the time to help our patients see how even pain and suffering can have purpose, and that they will not be alone in their suffering, we discover hidden treasure amidst the pain that might not otherwise have been uncovered.
God loves to bring us full circle. He did that for me in this area of my life. He has also done that for my beloved mentor, Dr. Bob Orr. In fall 2017, Bob was honored by having an ethics lectureship named after him at the UVM College of Medicine—the very community where he had previously been attacked now has honored him. To give the inaugural lecture, Dr. Farr Curlin was invited to speak on one of Bob’s favorite topics: palliative care at the end of life. Dr. Curlin spoke about the ars moriendi (art of dying) or, as he put it, “Living well in the face of dying.” He advocated for our role in medicine at the end of life to shrink, not encompass the entire dying process. He argued that the medicalization of dying for the purpose of totally relieving physical suffering has often done a disservice to our patients by isolating them from their physical, spiritual and emotional supports.
Physician-assisted suicide certainly aims to completely eliminate suffering by eliminating the sufferer. That is why it is so important to not only oppose the legalization of physician-assisted suicide, but also to uphold the Christian principles of the ars moriendi, to help our patients live well in the face of dying and to see that suffering can contain purpose. Looking back to that scared first year medical student I was back in 2000, I am so grateful that my journey has included these lessons, that I have the privilege of caring for my patients at the end of life and that I have the opportunity to serve my brothers and sisters in Christ through CMDA.
CMDA is a leading voice in the battle against the legalization of physician-assisted suicide. For resources and the latest information about the dangers of physician-assisted suicide to healthcare and your right of conscience, visit www.cmda.org/pas. If you want to get involved in your local state’s grassroots efforts, contact email@example.com.
ABOUT THE AUTHOR
Rachel B. DiSanto, MD, is a wife, mother and family doctor in a rural community in Northeast Vermont. She practices both inpatient and outpatient medicine, and she enjoys teaching medical students and residents in her practice and at the University of Vermont. One of her passions is healthcare missions to the developing world. She has participated on numerous Global Health Outreach teams and has focused in recent years on teams that help victims of human trafficking. This has led to work in her state on a task force to develop a curriculum for educating healthcare professionals and students about the issue of human trafficking and how to recognize victims in the healthcare setting. She speaks throughout the state to medical audiences on the topic and chairs CMDA’s Commission on Human Trafficking. She also loves serving on CMDA’s Board of Trustees.