CMDA's The Point

Physician-Assisted Suicide and Euthanasia

February 13, 2020
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by Robert E. Cranston, MD, MA (Ethics)

For every complex problem, there is a simple straightforward solution…that is dead wrong. This is the case with physician-assisted suicide in America today.

 

When outrageous, dangerous ideas hit public awareness, they initially arouse furor and alarm. Over time, normalization occurs, and these dangerous ideas are accepted. Eventually they become the new accepted truth. Finally, those who decline to accept these hazardous ideas are labeled as narrow-minded, Luddite, truth-deniers. This is what has happened across the Western world, and more recently in the United States and Canada with physician-assisted suicide.

 

On October 27, 1997, Oregon became the first state to legalize physician-assisted suicide. Many Americans were shocked and dismayed at this development. Over time, more and more people have accepted physician-assisted suicide, and it continues to gain momentum. In Canada today, if a patient requests a physician or advance practice provider to assist with suicide, the doctor or advance practice provider must provide such care or provide a referral to someone who will participate.

 

In a recent town council meeting in Evanston, Illinois, Alderman Eleanor Revelle of the 7th Ward expressed an opinion that seems to be gaining traction. She said that in 20 years since the adoption of the first “Death with Dignity” statute in Oregon, there had been no evidence of coercion or abuse in that state. She also stated that nine other states have since adopted such legislation. In truth, scant evidence exists because Oregon, like many other states, has a voluntary, poorly referreed reporting system with no reasonable means of enforcing the rules it has in place for monitoring activity.

 

Physician-assisted suicide is wrong for patients, physicians and society for a number of reasons. CMDA offers multiple articles and resources outlining these dangers at www.cmda.org/pas. Another great resource is the Patients’ Rights Action Fund (PRAF). PRAF is a coordinated network connecting many grassroots organizations around the country to help states and local organizations oppose the legalization of physician-assisted suicide. PRAF’s website contains several well-reasoned articles and videos on this topic and warrants your review. A Primer on Assisted Suicide Laws is a 38-page document that contains five primary articles and appendices with 10 more, including personal testimonies and specific cases in which physicians and families ignored or subverted physician-assisted suicide laws in order to hasten death.

 

The first and most important reason to oppose physician-assisted suicide is that, with few exceptions, it is immoral and unethical deliberately to cause someone’s death. Physicians in the Hippocratic tradition have known and practiced this rule for more than 2,000 years. While the often-quoted phrase “First do no harm” is included only in the Hippocratic writings, the phrase “I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan” is an integral part of the original Hippocratic Oath itself.

The PRAF primer, in a section titled “Key Objections to the Legalization of Assisted Suicide,” lists several objections, a few of which I will highlight:

  • Advocates of physician-assisted suicide often cite pain as a primary reason for allowing it, but in multiple polls of patients requesting physician-assisted suicide, it is not even one of the top five reasons for requesting it. With high quality palliative and hospice care, today almost all pain is manageable. The catchy idea that, “I wouldn’t let my dog suffer like that,” is a straw man argument
  • Safeguards do not work. Oregon and many other states have proven this. Patients do not receive the psychological evaluations they need, with many having treatable depression. When a primary doctor refuses to sign off on paperwork for physician-assisted suicide, patients shop around until they find someone who will. Physicians signing off on physician-assisted suicide often do not really know the patients. Waiting periods are not enforced.
  • There is poor oversight for monitoring the complex process, along with poor documentation. It is almost impossible to get reliable statistics. Patients who receive lethal medications may or may not take them. The actual time from ingestion to death is highly variable, and a doctor need not be involved after the point of prescribing the medications. There is no penalty for not completing records.
  • Physicians are legally required to falsify medical documentation. When a patient dies from ingestion of lethal medications, physicians must name the underlying disease, not physician-assisted suicide, as the cause of death on the death certificate. When a patient with glioblastoma, who might have lived for months to years before succumbing to the tumor, takes a lethal cocktail, the cause of death listed is glioblastoma, not physician-assisted suicide.
  • A total of 30 states have already specifically outlawed physician-assisted suicide. This cuts across political lines. While physician-assisted suicide advocates attempt to characterize their opponents as religious conservatives, many persons who actively oppose physician-assisted suicide are neither. This is a human rights issue, not a religious issue.
  • According to PRAF, many organizations oppose physician-assisted suicide, including, but not limited to, the American Medical Association; the National Hospice and Palliative Care Organization; many disability rights organizations and more. Public opinion does not establish ethical principles, but the fact that these organizations, which understand death and dying well, all condemn physician-assisted suicide, tells us something.
  • Physician-assisted suicide is dangerous to persons with disabilities. One of the consistently loudest voices against physician-assisted suicide is Not Dead Yet (NDY). NDY represents many citizens with disabilities, including those with multiple handicaps such as blindness, deafness, paralysis, speech disorders and cognitive disorders. Ongoing care for these persons is expensive, whereas a single dose of secobarbital is much less costly. Interestingly in 2009, a lethal secobarbital dose cost only $200, but when Valeant bought Seconal in 2016, the price increased to now being from $3,000 to $7,000. Phenobarbital is much cheaper, and other cocktails including morphine, beta-blockers and benzodiazepines are more widely used now. Even at $7,000, however, this is much less expensive than the cost of caring for a multiply handicapped citizen for even a few weeks.
  • Physician-assisted suicide is dangerous to vulnerable persons. According to PRAF, estate beneficiaries have already been subtly, or not so subtly, pushing family members to accept physician-assisted suicide. Why should younger relatives lose their “rightful inheritance” to pay for ongoing medical care when a simple cocktail can not only end the patients’ “suffering” but also preserve the heirs’ birthrights? The temptation to nudge patients into physician-assisted suicide is too great.

 

Physician-assisted suicide is dangerous for patients, physicians, advance providers and society. There are sound ethical counter-arguments for every autonomy-based argument for physician-assisted suicide. As Christian caregivers, we should do all we can in our power to halt this deadly movement.

 

As Dr. Martin Luther King, Jr. preached in a sermon in Selma, Alabama, on March 8, 1965, “A man dies when he refuses to stand up for that which is right. A man dies when he refuses to stand up for justice. A man dies when he refuses to take a stand for that which is true.”

 

More succinctly, as a pithy paraphrase of that sermon, often attributed to Dr. King, “Our lives begin to end the day we become silent about things that matter.”

Robert E. Cranston, MD, MA (Ethics)

About Robert E. Cranston, MD, MA (Ethics)

Robert E. Cranston, MD, MA (Ethics), MSHA, FAAN, CPE, is a board certified neurologist, with additional training and experience in palliative medicine, executive coaching and medical leadership. He currently serves at Carle Foundation Hospital, in Urbana, Illinois, as an attending neurologist, Medical Director for Talent Development and Learning and (Past Chair—14 years) of the Carle Ethics Committee. He is a clinical associate professor of medicine (neurology) at University of Illinois College of Medicine, Urbana-Champaign and Carle Illinois College of Medicine, and he is a member of the CMDA Ethics Committee.

1 Comment

  1. Avatar Jennifer Allen on March 9, 2020 at 2:32 pm

    The Illinois state medical association is in the process of taking a neutral (and dangerous) stand. Those in IL, please notify them of your stance so we fight this! I have been told that once a “neutral” or positive stance is taken, the state adopts the PAS. We have trouble already killing our future tax base (Govenor Pritzger wants us to be the abortion capital of the nation), we don’t need to kill our current one too (since money seems to be our core state value).

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