WHY PHYSICIAN-ASSISTED SUICIDE IS WRONG AND DANGEROUS
February 25, 2004
1. Origin and Principles of Physicians for Compassionate Care
When the voters of Oregon approved the legalization of physician-assisted
suicide in 1994, many physicians in Oregon organized themselves
into an organization called Physicians for Compassionate Care.
As members of this organization we affirm an ethic that all human
life is inherently valuable. We affirm that physicians' roles are
to heal illness, alleviate suffering, and provide comfort for the
sick and dying. We work to ensure appropriate care for our patients,
to speak out for the inherent value of human life, and to uphold
the time-honored values of our profession. We encourage physicians
to: heal the patient; enhance support for patients who cannot be
healed; avoid unnecessary therapies that will unduly prolong the
dying process; educate health professionals and the public about
the dangers of physician-assisted suicide and euthanasia, realizing
that they are fundamentally incompatible with our role as healer.
We encourage state of the art care for dying patients, including
optimal pain management and the recognition and treatment of depression.
We work to update health professionals on current pain management
technology and palliative care for clinical use to help confront
the challenges of serious, chronic and terminal illness with honesty,
caring and commitment. We collaborate with other organizations
to promote our mission.
2. Duty and Role of Physicians
Physicians have the duty to safeguard human life, especially life
of the most vulnerable: the sick, elderly, disabled, poor, ethnic
minorities, and those whom society may consider the most unproductive
and burdensome. Physicians are to use all knowledge, skills and
compassion in caring for and supporting the patient. Medicine and
physicians are not to intentionally cause death. The patient-physician
trusting relationship is the most important asset of physicians
and is for the protection of patients.
3. The Assisted Suicide Movement
In the United States, it is a very serious crime to assist another
person in their suicide; unless you are a physician in Oregon and
assisting a terminally ill patient to commit suicide. The proponents
of physician-assisted suicide want to change that criminal designation.
They desire that physician-assisted suicide be legal in the entire
United States. They are working to change state and national laws
for that purpose. The focus of this movement: is not on comfort
care, is not on pain management, in not on palliative care. Their
focus is to make physician-assisted suicide legal.
4. Who gets the Rights and Protection with Assisted Suicide?
The legalization of physician-assisted suicide does not give any
new rights to patients. Its purpose is to legally protect doctors
who write prescriptions for lethal drugs. Legalization of physician-assisted
suicide takes away from terminally ill patients, the protection
against doctors who order their death by a prescription for deadly
drugs. Those who ask for a "right to die" have to give someone
else the "power to kill".
5. Definitions of Physician-assisted Suicide and Euthanasia
Physician-assisted suicide: A patient self-administers the lethal
dose that has been prescribed by a physician. Euthanasia: Active
causation of death of a patient by a physician, by lethal injection
or other means.
6. Physician-assisted Suicide is Doctor Ordered Suicide
A prescription is a written order or directive to the patient. In
physician-assisted suicide, a doctor writes a prescription for
lethal drugs. In The Netherlands and in Oregon barbiturates (sleeping
pills) are being prescribed for this purpose. Morphine-like drugs
are not being used for this purpose. Physician-assisted suicide
is really doctor-ordered, doctor prescribed, or doctor-directed
suicide. When a doctor writes a prescription for physician-assisted
suicide, the message to the patient is: your life is not worth
living, you are better of dead, I don't value you or your life,
I want you dead, I order you to die, I direct you to die. Those
who desire a "right to die" are giving to doctors the "power to
kill". Assisted suicide is fundamentally incompatible with the
doctor's role as healer, comforter and consoler. Assisted suicide
is the ultimate abandonment of a patient by a doctor.
7. What About Concern about Not Wanting to be on Life-Support Technology?
Being on or off life-support life support has nothing to do with
physician-assisted suicide. There is a constitutional right to
consent to consent to and refuse medical treatment. You cannot
be forced to be on life-support machine. Stopping life-support
is very different than physician-assisted suicide.
8. What about Cancer and Pain?
There is an inverse relationship between cancer patients experience
with pain and their favoring assisted suicide. People with cancer
are less in favor or assisted suicide than is the general public.
Patients with pain want doctors to kill the pain, not kill the
patient. We should focus on improving the care of patients, not
on killing them. In Oregon, only a small minority of patients dying
of assisted suicide chose it because of fear of pain in the future.
This was not because they were having pain. The proponents of assisted
suicide acknowledge that pain is not an important reason for legalizing
assisted suicide. The message that the proponents of assisted suicide
are giving to the public and to patients, is that doctors can do
a better job of killing patients than they can of caring for their
medical needs. The doctors you don't trust to take care of you
are going to be given the legal power to kill you. My patients
have told me that they worry that the doctors will be the judge,
jury and executioner of their lives.
9. Relationship of Depression and Physician-assisted Suicide
Depression is the leading cause of suicide. There is a direct relationship
between depression and favoring physician-assisted suicide. Depression
is frequently overlooked in patients with serious physical illness.
Depression needs to be diagnosed and properly treated with counseling
10. Physician-assisted Suicide Destroys the Trust between Patient
The following is a personal story of Dr. Kenneth Stevens, M.D. "We
had been married for 18 years and had 6 children. For three years
my wife had been suffering from advancing malignant lymphoma. It
had spread from the lymph nodes to her brain, to her spinal cord
and to her bones. She had received extensive chemotherapy and radiation
treatments. She required considerable pain medication, antidepressants
and other supportive measures. In late May, 1982, we met again with
her physician to review what more could be done. It was obvious that
there was no further treatment that would halt the cancer's progressive
nature. As we were about to leave his office, her physician said, "Well,
I could write a prescription for an 'extra large' amount of pain
medication for you." He did not say it was for her to hasten her
death, but she and I both felt his intended message. We knew that
was the intent of his words. We declined the prescription. As I helped
her to our car, she said, "He wants me to kill myself." She and I
were devastated. How could her trusted physician subtly suggest to
her that she take her own life with lethal drugs? We had felt much
discouragement during the prior three years, but not the deep despair
that we felt at that time when her physician, her trusted physician,
subtly suggested that suicide should be considered. His subtle message
to her was, "Your life is no longer of value, you are better off
dead." Six days later she died peacefully, naturally, with dignity
and at ease in her bed, without the suggested lethal drugs. Physician-assisted
suicide does destroy trust between patient and physician.
11. Money and Physician-Assisted Suicide
Derek Humphry, founder of End of Life Choices, has said that assisted
suicide can help solve the problems of health care costs. What
is cheaper for HMOs or Medicaid programs, assisted suicide or caring
for a patient? A newspaper report in 1998, indicated that two assisted
suicides paid for by Oregon Medicaid cost $99 for both of them.
Oregon has been in an economic and medical crisis. Half of Oregon
doctors in 2003 will no longer take care of Oregon Medicaid patients.
Significant state budget deficits stopped benefits for many Oregonians
in the state's Medically Needy Program in 2003. This resulted in
many serious medical problems and even deaths. Loss of mental-illness
medications resulted in suicides. Loss of anti-seizure medications
resulted in a patient going into a million dollar coma before his
recent death. Patients with HIV/AIDS lost funding for their medications.
Patients needing organ-transplants were taken off the transplant
list because would not receive state financial support for anti-rejection
drugs. Patients lost funding for their pain medications. One of
the physicians in our organization received a call from a patient
in March, 2003, requesting "assisted suicide". He said he had an
11-year history of chronic pain. He said, "The state has stopped
paying for my pain meds because of the Medicaid cutbacks." "If
they won't pay for my pain meds, then they might as well pay for
my suicide." With the social and financial inequality in our society,
assisted suicide poses the greatest risk to those who are poor,
elderly, members of a minority group, or without access to good
12. How Do People Die with Assisted Suicide?
Assisted suicide deaths are a result of acute barbiturate poisoning.
The typical drugs are Seconal or Nembutal, ninety to one hundred
100-mgm capsules. The symptoms of acute barbiturate poisoning are:
face reddened, then ashy pale, then blue; seizures may occur; respiratory
failure with slowed breathing; loss of cough reflex, fluid collects
in throat, gurgling with breathing; coma; possibly death. If the
person does not die, the following may occur: recover completely;
agitation, nightmares, hallucinations, anxiety or abnormal thinking;
hallucinations for weeks, Parkinsonism, acute schizophrenia, dementia,
or permanent brain damage. The normal duration of action of barbiturates
is to have the onset of action in 10 to 15 minutes, with a total
duration of 3 to 4 hours. That is why they are called short-acting
barbiturates. The Oregon physician-assisted suicide reporting information
indicates that for each year from 1998 to 2002, many patients have
lived far beyond the usual duration of the barbiturates. The longest
time from ingestion of the barbiturates to the time of death was:
11 ½ hours in 1998, 26 hours in 1999, 6+ hours in 2000,
37 hours in 2001, and 14 hours in 2002. This raises the question
of actually how are these patients dying, since they are living
beyond the duration of action of the barbiturates. Are other devices
such as suffocation bags being used in some patients? In Oregon,
we are dependent on self-reporting from physicians involved in
assisted suicide. The Oregon state Health Department obtains very
limited information regarding how these patients die. The Oregon
assisted suicide law actually prohibits investigation of many details
of the deaths. In The Netherlands which is much more open in their
reporting regarding assisted suicide than is Oregon, physician-assisted
suicide resulted in complications in 7%, failure in completion
of the suicide in 16%, and lethal injection used in 20% of patients.
13. Assisted Suicide "Safeguards" in Oregon are not being Followed
"Safeguards" were included in the Oregon physician-assisted suicide
law because of the dangers of assisted suicide. The stated "safeguards" include:
being capable, not being depressed, no coercion, self-administration,
and life expectancy of less than 6 months. Yet, reports in the public
press have described that among those who have died from assisted
suicide there are: patients who are depressed; patients who are demented;
patients and families "doctor-shopping" until they find a doctor
who will write a prescription; patients with swallowing problems
requiring assistance in taking the medication (not self-administered);
coercive family members; doctors being coerced/intimidated into writing
the lethal prescription; patients living as long as a year after
being determined eligible. A Deputy Oregon State Attorney General
wrote that Oregon's assisted suicide law may discriminate against
those who are paralyzed and can't swallow. This would lead to lethal
injections. A doctor in Oregon unlawfully ordered a lethal injection
for a patient; he was not prosecuted, and he had only a two-month
suspension of his medical license.
14. The Conflict of Autonomy and Assisted Suicide "Safeguards"
The assisted suicide movement exploits autonomy and self-determination
as their main argument for the legalization of assisted suicide. "Safeguards" were
placed in Oregon's assisted suicide law because assisted suicide
is dangerous. The problem with "safeguards" in physician-assisted
suicide laws is that they act as a "barriers or roadblocks" for
access for those outside the boundaries of the "safeguards".
Based on "autonomy" arguments, those outside the boundaries want
access to assisted suicide. This is why these "safeguards" are
not always being followed, and why the boundaries around assisted
suicide have stretched and will continue to stretch like a rubber
band. The nature of unbounded autonomy ultimately leads to loss
of autonomy; in the future assisted suicide and euthanasia may
be the only "choice" for some people.
15. The Arguments in Favor of Assisted Suicide are Harmful to People
In describing reasons for assisted suicide, the proponents of assisted
suicide demean and demonize people with disabilities. Assisted suicide
advocates de-value those who have disabilities, by playing on the "horror
of dependency" for those with serious illness. People with disabilities
have expressed fear that they may become the next targets of the