For the past 36 years, I have lived and practiced in the state of Oregon. For half that time, there was never any doubt about my role as a physician: It was to strive to cure. Failing cure, I would strive to always comfort and care—never kill.
At my medical school graduation, I recited the Hippocratic Oath, which includes the clear statement to avoid doing harm—"I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect."
Since Oregon voters rejected this foundational principle with the passage of assisted suicide 20 years ago, there has been a profound shift in the public's attitude toward medical care—a corruption of the Hippocratic tradition, new fear and secrecy and a fixation on death as the solution to suffering. By the end of this calendar year, almost a thousand Oregonians will have taken their own lives by ingesting massive overdoses of prescription drugs. While only some doctors participate directly, all Oregon physicians are now licensed to help patients kill themselves.
False Claims and Secrecy
Promoters of assisted suicide prefer euphemisms—"death with dignity" or "choice in dying"—and point to Oregon as a model for spreading assisted suicide to other states. They claim Oregon's safeguards work and there have been no problems. This is not true. Their use of euphemisms and repetition of false claims cannot hide the reality.
In truth, there is a shroud of secrecy enveloping the practice. Doctors do not accurately report the actual manner of death on the death certificate. Instead, they are required by state law to fabricate the cause of death stating that the cause is "natural" rather than suicide.
In fact, in late 1997, just before assisted suicide was about to be implemented, the legislature introduced a system using two different death certificates (one that is public with no medical information and a separate one that is never made public). Thus, it's impossible for anyone outside of the Oregon Health Division (OHD) to track the statistics.
What little tracking is done is only by second- (or even third-) hand reporting by doctors who are rarely actually present when the overdose is taken. There is never any review or verification of the details provided. Even this questionable identifying data is deliberately destroyed by the OHD after a tally is made. Where else in the medical profession are records deliberately destroyed?
Also concerning are the regular notices I receive from the state Medicaid program saying it won't cover many important services and drugs for my patients—even some pain medications—but it will pay for physician-assisted suicide. Supporters claim this gives patients choice. What sort of a choice is it when life is expensive but death is free?
I have seen firsthand how the law has changed the relationship between doctors and patients, some of whom now fear that they are being steered toward assisted suicide.
In one such case, a patient with bladder cancer contacted me. She was concerned that her oncologist might be one of the "death doctors," and questioned his motives. Her concern grew after she obtained a second opinion from another oncologist who was more positive about her prognosis and treatment options. Whichever of the two was correct, such fears were never an issue before assisted suicide passed.
In another case, a colleague who enthusiastically adopted the practice gave advice to a cancer patient over the telephone. Without ever examining her or referring her to a pain management specialist, he concluded she was a good candidate for ending her own life. He then "helped" her contact an organization promoting assisted suicide. Within a few months, she was dead of an overdose.
The Message Behind the Words
Since doctor-assisted suicide has become an option, I have had scores of patients discuss it with me in my practice. Most of them didn't have a terminal diagnosis.
One of the first people to ask me about it was a patient with a progressive form of multiple sclerosis (MS). He was in a wheelchair yet lived a very active life. In fact, he was a general contractor and quite productive. I asked how MS had impacted his life. He acknowledged that it was a major challenge, and then said if it got much worse, he might want to "just end it."
"It sounds like you are telling me this because you might ultimately want assistance with your own suicide if things got worse," I said. He nodded, and seemed relieved that I understood what he was saying.
I told him that I could readily understand his fear and his frustration—even his belief that physician-assisted suicide might be a good option. At the same time, I told him that should he become sicker or weaker, I would work to give him the best care and support available. I told him no matter how debilitated he might become, that—at least to me—his life was, and would always be, inherently valuable. As such, I would not recommend, nor could I participate, in his suicide. He simply said, "Thank you."
The truth is that we are not islands. How a physician responds to a patient's request has a profound effect not only on that patient's choices, but also on his view of himself and his inherent worth.
When a patient says, "I want to die," it may simply mean, "I feel useless." When a patient says, "I don't want to be a burden," it may really be a question: "Am I a burden?" When a patient says, "I've lived a long life already," he may really be saying, "I'm tired. I'm afraid I can't keep going."
And when a patient says, "I might as well be dead," she may really be saying, "No one cares about me."
How one responds is critical. Such patients deserve our support and love, not a doctor acting as a veritable vending machine.
Under Oregon's law, a patient can request lethal drugs only if he has a terminal illness and less than six months to live. However, doctors are unable to predict the course of an illness six months out, and many patients given such prognoses live full, rewarding lives long past six months.
The law requires that patients be referred for psychological examination if the doctor suspects they have depression or mental illness. Yet last year, only three of the 105 patients who took their lives with a doctor's help were referred for psychological exams.
A study published in the British Medical Journal in 2008 examined 58 Oregonians who sought information on assisted suicide. Of them, 26 percent met the criteria for depressive disorder, and 22 percent for anxiety disorder. Three of the depressed individuals received and ingested the lethal drugs, dying within two months of being interviewed. The study's authors concluded that Oregon's law "may not adequately protect all mentally ill patients."
Indeed. How could doctors not recognize such individuals as depressed? After all, the prevalence of depression in the general population is at least double this rate, according to the National Institute for Mental Health. Given the reality that a life is literally on the line, shouldn't doctors be even more vigilant to avoid assisted suicide in patients with a highly treatable condition?
In reality, some doctors have little formal training or practice in recognizing psychiatric needs. Sadly, some doctors (even some psychiatrists) see suicidal depression as "rational."
They believe actively ending a patient's life live is not only acceptable under some circumstances, but good. They have come to believe the solution to some suffering is ending the life of the sufferer.
In fact, former Tufts University Dean Dr. Louis Lasagna has created a "Modern Version" of the Hippocratic Oath, which states: "If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty."
Astonishingly, the next line of this modern version is "Above all, I must not play at God."
Can you believe it? A doctor embraces the power and "awesome responsibility" to decide to "take a life" and yet also maintains the position that he or she won't "play at God."
Sadly, all doctors in Oregon have been empowered by the state to end the lives of their patients. After receiving the label of "terminal," all a patient needs to do is ask. Then the doctor can decide if his life is worth living.
For me, all of these issues surrounding end-of-life care have become very personal. Last year my wife, Marlene, died of cancer. We had been married for 40 years. The final five years, we both knew she would inevitably die. At one point, doctors told her she would only live for three to nine months—yet she lived almost four times that long.
While I treasure all our years together, the last five were among the best. There was great suffering, but also great joy in the many special moments that we and our seven children shared together—moments that became all the more treasured the closer we came to the end of her life. I wouldn't trade a nanosecond of them. She died peacefully and naturally at home, surrounded by family and friends. She didn't take an overdose, yet her death and life had great dignity.
While assisted suicide was legalized in 1994, it will always be unethical—because any doctor who assists in a suicide has an inherent conflict of interest. Knowing this, I carefully chose a palliative care specialist for Marlene—he or she had to be a doctor who respected the value of my wife's life in all of it stages, regardless of prognosis and her progressive weakness and debility.
While most states have appropriately rejected assisted suicide thus far, special-interest groups will try to expand it soon. Today four states—California, Oregon, Vermont and Washington—have passed assisted-suicide legislation either by ballot or legislative action. Since a single judge in Montana ruled that the state constitution doesn't prohibit assisted suicide, some doctors have begun to prescribe lethal doses to some patients there, too. In 2015, promoters of assisted suicide have begun efforts to enact legislation in more than two dozen states.
While there is growing resistance movement that includes disability-rights activists, palliative care specialists, oncologists and many major medical organizations, more is needed if we are to avoid becoming a culture of death. Everyone who recognizes the inherent value of all human life must continue to actively pray and actively oppose any and all efforts to legalize the situational killing of patients by doctors.
Doctors should care—not kill.