Physician–Assisted–Suicide; the collaboration of two through a professional relationship, to cause the death of one.
Ever since Socrates took hemlock, suicide has been part of society, sometimes supported, often condemned. Today, many argue that we have a right-to-die, sort of an infinite extension of free speech or thought. Regardless, to actively involve doctors is a unique distortion of the medical arts, as if stopping a beating heart can somehow mend disease. For a healer to take life is bizarre and threatens the physician-patient relationship. If individuals really want and require assistance to die perhaps there is another solution.
A long trail of vital documents marks our lives. These include birth certificate, diplomas, driver’s and marriage license, advanced directives, wills and most recently the POLST. Perhaps we should create a new personal document. Its purpose would be to give each person not only permission to kill themselves, but access to the means. A permit controlled by the patient and only their responsibility. A passport for dying. A Suicide Certificate.
The Suicide Certificate would be a kind of application. A legal checklist, which once complete would allow the individual to die by their own hand, but in a controlled and definite manner.
What would go on this form? First, basic demographics; name, birth-date, address, social security number, etc. It is important to confirm that the right person is filling out the form. A photograph might be a good idea.
Next, statements regarding right-to-die laws. This could include a review of the sanctioned methods available, as well as the legal indications and limits for committing suicide. It might remind the applicant that a terminal disease is required, what is and is not a qualifying medical condition, and that suicide pacts are discouraged and therefore forbids sharing the lethal prescription. The whole form might start on-line and as part of the process an instructional video must be viewed and review answers given correctly, before it can be printed. Alternatively, an app could be developed.
This November, voters weighed in on an array of state ballot initiatives on health issues from medical marijuana to health care reform. Ballot outcomes by state are listed below (more after the jump).
Voters in Alabama, Montana, and Wyoming passed initiatives expressing disapproval of the Affordable Care Act, while a similar initiative in Florida garnered a majority of the vote but failed to pass under the state’s supermajority voting requirement. Missouri voters passed a ballot initiative prohibiting the state executive branch from establishing a health insurance exchange, leaving this task to the federal government or state legislature.
Florida voters defeated a measure that would have prohibited the use of state funds for abortions, while Montana voters passed a parental notification requirement for minors seeking abortions (with a judicial waiver provision).
Perhaps surprisingly, California voters failed to pass a law requiring mandatory labeling of genetically engineered food. Several states legalized medical marijuana, while Arkansas voters struck down a medical marijuana initiative and Montana voters made existing medical marijuana laws more restrictive.
Physician-assisted suicide was barely defeated in Massachusetts (51% to 49%), while North Dakotans banned smoking in indoor workplaces. Michigan voters failed to pass an initiative increasing the regulation of home health workers, while Louisiana voters prohibited the appropriation of state Medicaid trust funds for other purposes.
Next Tuesday, those of us registered in Massachusetts will have the opportunity to vote on “Question 2″ – prescribing medication to end life, otherwise known as physician-assisted suicide.
As described by the state secretary, “This proposed law would allow a physician licensed in Massachusetts to prescribe medication, at a terminally ill patient’s request, to end that patient’s life. To qualify, a patient would have to be an adult resident who (1) is medically determined to be mentally capable of making and communicating health care decisions; (2) has been diagnosed by attending and consulting physicians as having an incurable, irreversible disease that will, within reasonable medical judgment, cause death within six months; and (3) voluntarily expresses a wish to die and has made an informed decision.”
There are, of course, a number of other safeguards built in, such as the need to make the request twice, separated by 15 days, in the presence of witnesses. However, there could probably be stronger safeguards to protect individuals who are experiencing depression and anxiety, and might have preferable alternatives to physician-assisted death.
“I will give no deadly medicine to any one if asked, nor suggest any such counsel.” This is an excerpt from The Hippocratic Oath – the oath that guides my practice as a physician. On the November ballot, the Massachusetts Question 2 about physician assisted suicide, runs contrary to the foundation of medical practice. Since the 5th century BC when Hippocrates crafted the oath, the notion of Physician Assisted Suicide (PAS) has been debated in Western Society and repeatedly rejected as a violation of civilized behavior.
If adopted, MA Question 2 would legalize PAS for terminally ill patients who have fewer than six months to live. The assumptions underlying this question are erroneous. In 27 years as a primary care physician, I have never told a patient how long he or she has to live. An individual lifespan is scientifically impossible to predict with exactness. Time and time again, standards in medical literature that project survival for particular diagnoses are wrong. Today in my practice, I have numerous vibrant patients who have long outlived calculated life spans. This is not only for people with cancer, but diseases like multiple sclerosis, chronic obstructive pulmonary disease, kidney failure and heart failure. I never tell my patients how long they have to live. Why? Because the best prediction is based on old literature and past practice. New therapies combined with preventive and behavioral medicine change the true experience of each disease.
What motivates some people to elect PAS? Those who support Question 2 typically cite the patient’s right to self-determination and desire to avoid pain. But, the little we know from pre-death interviews in states such as Oregon, Montana and Washington shows otherwise. Some patients claim that it is their inability to do what they want to do that motivates their desire for death. Not wanting to burden loved ones can also motivate the choice to elect suicide. For my work as a physician, part of the job is helping patients and families to adjust to new circumstances. People who fear losing control of basic bodily functions can grow to realize that their humanity is about so much more than those acts. Despite new limitations, they can still fulfill significant roles in their communities and families. Furthermore, clinical depression is present in at least 25 percent of people with chronic illness. Depressed people think about suicide. Depression, however, is treatable. Question 2 does not mandate that the patient submit to evaluation and therapy for depression. Furthermore alleviating pain and suffering is the objective of all doctors. Some even specialize in hospice and palliative care.