Whether you realize it or not, the question you’ve posed begs a host of others, none of which are as easy to resolve as you might suppose. For example, what exactly do you have in mind when you refer to terminal patients as “being kept alive against their will?” Technically speaking, no one can be kept alive against his will. Everyone has the right to refuse treatment and die a natural death if he so chooses. In fact, mentally competent adults can refuse or stop life-prolonging treatments at any time. The medical decision-maker for a non-competent adult can also make that decision. Before we go any further, then, it’s important that one fact is clearly understood: physician-assisted suicide (PAS) is something entirely different from the mere cessation of life-saving measures. It is an intentional act designed to facilitate and hasten death by means of lethal prescription drugs. As such, it represents an alarming and dangerous shift in the ethics of our medical community.
There’s also the question of the whys and wherefores that need to be considered. What compels the average patient to pursue doctor-prescribed death? Your words suggest a belief that pain is a major factor – that anyone “facing a painful and certain death” will naturally want to put an end to his or her life as soon as possible. But this isn’t necessarily true. As a matter of fact, statistics gathered in the state of Oregon indicate that pain is not the number one concern cited by patients who seek PAS in that state. Loss of autonomy, loss of dignity, and inability to engage in enjoyable activities all rate higher on the scale. These issues are important, of course, but the premature death of the patient by suicide is not the only way to address them.
Where pain is concerned, suicide is hardly the best medical alternative available. Pain- and symptom-management have improved significantly in recent years, thanks in part to the expansion of hospice and palliative care. For most patients, pain can be controlled along with other physical symptoms of disease and the dying process. Palliative care addresses the physical, psychological, emotional, and spiritual needs of the patient and the patient’s family. As palliative care specialist Dr. Dan Maison says, “One phrase that gets under my skin and breaks my heart is when someone says, ‘There is nothing more we can do.’ There is always more that we can do.’” In reference to the highly publicized case of Brittany Maynard, Dr. Maison adds, “Actually, we take care of folks like her all the time, and we’re able to keep almost all of them very comfortable.”
Something similar can be said in connection with depression. Suicide is never an acceptable solution for the depressed. Depression can and should be treated, but all too often it isn’t. A 2008 study published in the British Medical Journal stated that one in four Oregon patients who seek PAS are suffering solely or primarily from depression, yet in 2014 only two such patients in Oregon (out of 105) were referred for psychological evaluation under its doctor-prescribed suicide law. This is an unacceptable situation and one which should give pause to anyone who is thinking about supporting efforts to legalize physician-assisted suicide.
You should also be asking yourself some tough and sobering questions about PAS’s inherent potential for abuse. That potential is very real despite proponents’ assertions to the contrary. Elder abuse is a growing and documented problem. Seniors, especially those who suffer from serious terminal diseases, easily become vulnerable to the whims or agendas of family members, caregivers, or other third parties. This is particularly true in cases where someone stands to gain financially by the patient’s death. The danger is further enhanced by the fact that existing laws in states where PAS is legal do not require the patient’s consent at the time of death – only consent to obtain the lethal prescription. Very few people understand that there is no provision for medical oversight after the lethal drugs leave the pharmacy. Witnesses do not need to be present when they are administered, nor is family notification required in advance. It’s not hard to imagine what this might mean. Once the drugs are released from the pharmacy, there is no way to know if the patient takes them voluntarily or if they’re slipped into his food or drink by someone else. The situation is ripe for abuse, as indicated by the finding that, in 2013, the median age of Oregonian patients seeking PAS was seventy-one, half of whom cited “being a burden on others” as a reason for committing suicide. When it comes right down to it, there is no protected “choice” to die as PAS proponents claim.
Then there’s the problem of how physician-assisted suicide is likely to function within the context of our broken, profit-driven health care system. Suicide drugs are far less expensive than effective treatment or palliative care. This is a matter of great concern. In light of today’s escalating health-care costs and the demands to “manage” medical expenses, a very real possibility exists that terminal patients will be “encouraged” to choose PAS as the cheapest option – a suggestion that will carry extra-special weight with those who are already worried about “burdening” their loved ones. Coverage providers will also have something to say in the matter: at least two patients receiving medical care under the state-funded Oregon Health Plan have reported being denied treatment and offered PAS instead. Eventually the “right to die” could become a “duty to die.” Under the circumstances, it’s not hard to see how this might come about.
It’s also important to remember that the finality of suicide rules out the “what ifs” that are such a common element of human life. What if a doctor’s diagnosis or prognosis turns out to be incorrect? What if a new treatment is in the pipeline? What if there’s a chance that a patient will be suddenly and inexplicably cured of his disease? We’ve all heard of such cases. Some of us have even known people who were miraculously healed of a terminal disease. PAS eliminates these possibilities.
Doctor-prescribed suicide also places government in the role of approving some suicides while discouraging others. This sends a confusing and inconsistent message to the public. It strongly implies that some lives simply aren’t worth living. That’s not to mention the formidable psychological impact that this kind of endorsement, along with the example set by patients who choose PAS, is likely to have on the hearts and minds of individuals who are struggling with disappointment, depression, or disease in any form. Once suicide is legitimized, it is almost certain to become more common. And at that point it will no longer be a private, personal affair. When my “choice” to die causes someone else to take his own life, we have moved beyond the realm of “individual rights.”
This leads to the last and most important question of all: what are the moral and ethical implications of physician-assisted suicide? Do we really have the moral authority to end our own lives? Does anyone else – doctors included – have the authority to end them for us – even at our request? Up until very recent times the unanimous answer would have been “No!” Western civilization has long considered suicide morally wrong, basing its judgment on the belief that human life is a gift from God – regardless of its circumstances. Life itself is a thing of inestimable value.
Ironic as it may seem, laws that implement physician-assisted suicide actually have the effect of denying “death with dignity” to terminally ill patients. That’s because human dignity comes from God alone and is affirmed by other people, especially those who care for us during our final days. If those same people dismiss the value of our continued existence, what’s left to us? If physicians trample on the Hippocratic Oath’s proviso to “Do No Harm” by prescribing lethal drugs, what will become of the delicate trust relationship between doctor and patient? It’s not without reason that the Disability Rights community – people who often depend upon the caring support of others for their daily needs – has risen up en masse in opposition to PAS. Legalizing doctor-prescribed death is like putting fire into a paper bag: it cannot be contained.