Dear PCC member,
The following is a well-written opinion editorial by Dr Daniel Phillips,
a Eugene physician specializing in Gastroenteroly. This appeared
December 2 in the Eugene (Oregon) Register-Guard. Please share
this with anyone who may find it of interest.
William L. Toffler MD
National Director, Physicians for Compassionate Care
December 2, 1999
Commentary: Doctor-assisted suicide affects us all - negatively
By DANIEL PHILLIPS COLUMNIST
STEVE DUIN WRITES in a column in The Oregonian that was reprinted
in The Register-Guard on Nov. 15 that physician-assisted suicide
is a personal decision that is nobody else's business. By implication,
he believes that the rest of society is not harmed by Oregon's law
that permits physician-assisted suicide to occur. On the contrary,
the case Duin made reference to demonstrates that we are all harmed
by physician-assisted suicide.
The story was reported in The Oregonian on Oct. 17. It described
the case of an elderly woman with cancer who requested, and ultimately
received, physician-assisted suicide. A psychiatrist evaluated her
and felt that she was cognitively impaired and that her family appeared
to be pressuring her. The conclusion was that she was not a candidate
for assisted suicide. Her daughter requested a second opinion. A
psychologist evaluated the mother, thought she was competent, but
noted the daughter "may be somewhat coercive." Because there were
differing opinions, a Kaiser Permanente Health System administrator
made the final decision that she was eligible for assisted suicide.
On Aug. 29, the daughter reported, at her mother's request she prepared
the lethal medication. Her mother took it and died that day.
Two features make this case a special cause for concern. Both of
the mental health professionals who evaluated the situation felt
there were elements of coercion involved in this woman's decision
to take her own life. Second, a Kaiser Permanente Health System administrator
made the final decision about her eligibility for physician assisted
suicide - not the patient's original family physician, not her treating
oncologist and not the psychiatrist who originally evaluated the
patient. This administrator, while reportedly an ethicist, and who
we have no reason to believe acted other than with good intent, had
a conflict of interest. A health care system that is likely to benefit
financially by this patient's premature death pays the administrator's
But how are we, as a society, harmed by this? What occurred was
a violation of the spirit, if not the letter, of the law that Oregon
voters passed. Proponents stated the law would not permit the coercion
of individuals to commit suicide. Unfortunately, the safeguards did
not work. In fact, they were doomed to failure from the beginning.
Legalizing physician-assisted suicide made coercion inevitable. We
have no way of knowing what was said behind closed doors in this
or other cases of physician assisted suicide that may have compelled
a "suicide." It should go without saying that society is harmed when
we fail to protect individuals from the acts of others that would
terminate their life prematurely.
One cannot defend what happened by saying it doesn't matter because
the individual had a terminal illness. If it is wrong to pressure
a person into committing suicide, it is wrong no matter what their
life expectancy. To believe otherwise removes a whole class from
protection by the laws of the state. To accept this means that murder
of the terminally ill would not be a crime.
Oregon law allowed physician-assisted suicide to occur in a situation
where there was real doubt that the victim's choice was a free one.
However, even if it was a free choice, society is still harmed. Committing
suicide has never been the issue. Before Oregon passed the law permitting
physician-assisted suicide, there was no law, nor should there have
been one, prohibiting suicide, as wrong as anyone may personally
believe it to be. But that is not the issue here. The issue is state-sanctioned,
physician assisted suicide. This state is now on record as saying
that it is proper for physicians to administer death. This affects
us all. It appropriately introduces an element of distrust into the
relationship between physician and patient. A person should not have
to wonder: Will my physician be there for me at the end and use whatever
dosage of pain medicine is necessary to control my symptoms, or will
my physician avoid the hassle and offer me suicide instead?
When we medicalize suicide, it allows us to think of this as a normal
part of the caring process. The result is to further desensitize
society to the taking of human life. Physician-assisted suicide is
a giant step toward euthanasia. The logic is quite clear: If physician-assisted
suicide is a right, how we can we deny this right to those who are
not able to swallow the pills? To be "fair" they will need to be
offered a lethal injection.
Physician-assisted suicide has one last negative consequence. While
controversy over physician-assisted suicide has had a positive outcome
in the short run by focusing attention on care of the terminally
ill, in the long run, we will make far less progress as long as the
simple expedient exists of removing them. The dearth of hospice care
in the Netherlands where physician-assisted suicide is allowed speaks
eloquently of that.
The story of this one woman should cause us all to reflect on the
Pandora's box we opened in voting in Oregon's law.
Dr. Daniel Phillips is a Eugene physician specializing in gastroenterology.
Copyright © 1999 The Register-Guard