Assisted Suicide

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Jason Negri, M.S., J.D., of the Patients’ Rights Council, recommends that the term Doctor-Prescribed Suicide be used instead of Physician-Assisted Suicide or Medical-Aid-in-Dying, as it more accurately describes the process. His seminar on May 21st sponsored by the Long Island Coalition for Life Educational Trust was extremely informative.

One of the most glaring misunderstandings is that a patient takes “a pill” and slips away peacefully. However a massive dose of drugs is required – 90 to 100 pills. A doctor writes the prescription, but is not usually present when the individual ingests the pills. A therapeutic dosage for Seconal or Nembutal (barbituates) is 100 -200mg. A doctor-prescribed suicide dose is 90 to 100 times the usual therapeutic dose – 9000 to 10,000mg. Individuals often require “help” from a family member or friend to complete the process.

 

Negri warned that the Assisted Suicide/Euthanasia movement in the United States today is similar to the abortion movement pre-Roe (prior to 1973). Prior to the very public assisted suicide of Brittany Maynard in 2014, there were 5 to 8 states a year considering doctor-prescribed suicide. Negri stated that this year there are 28 states with proposed legislation.

Wesley Smith, in the Spring 2017 issue of the Life Legal Defense Foundation’s Lifeline magazine stated that the “greatest efforts [are] focused in Hawaii, Massachusetts, New York and New Jersey. While this issue mostly plays out at the state level, there is potential for the debate to go federal. In 1997, the United States Supreme Court ruled 9-0 that there is no constitutional right to assisted suicide. I believe advocates would like to try again for an assisted suicide Roe v. Wade – such as they recently achieved in Canada – but they would need around twenty states to legalize in order to make another go at it. Opponents of assisted suicide could strike a body blow by amending the Controlled Substances Act to prohibit the use of federally regulated drugs in the intentional ending of life. Indeed, during the Bush years, the Department of Justice interpreted the CSA to that effect, but that interpretation was deemed invalid by the United States Supreme Court, for failure to follow proper administrative procedures. It is worth noting, however, that the Court ruled that Congress could pass such a prohibition. Perhaps some intrepid congressperson or senator will take up that important cause.”

 

Alex Schadenberg, executive director of the Euthanasia Prevention Coalition, reported at LifeNews.com (6/5/17) on a Canadian study that examined the reasons behind euthanasia cases in four major hospitals in the Toronto area. “The results of the study demonstrate that the main factor behind euthanasia deaths relates to existential distress. Indeed, the primary reason given by patients concerned the loss of autonomy – and not the unbearable pain that was conveniently sold to us from the beginning. Other reasons included fear of becoming a burden to those around them, fear of losing one’s dignity, or the fact of no longer appreciating one’s life. In other words, the Canadian picture continues a portrait well known in other parts of the world, in which the same motives are evoked to request assisted suicide. This pattern also confirms what we already knew: euthanasia is primarily a question of how we relate to others and how society views vulnerable people. Moreover, when loss of autonomy is evoked as an indignity that deserves death, we should first see it as a petty social judgment that affects all persons who suffer from a disability or a serious illness. Furthermore, we have the duty to fight this pernicious and intolerable verdic.”

 

Margaret Somerville reported at MercatorNet.com(5/22/17) that Dutch professor Dr. Theo Boer, a former member of one of Holland’s five Euthanasia RegionalReview Committees (2005-2014) will soon publish a study which shows, in Boer’s words, “the assumption that euthanasia will lead to lower suicide rates finds no support in the numbers. The percentage of euthanasia deaths of the total mortality rate tripled from 1.3% in 2002 to 4.08% in 2016. During that same period, the suicide numbers did not go down: From being 1,567 in 2002, they went up to 1,871 in 2015, a rise of 19.4%. The suicide rates reached a relative low of 1,353 in 2007, compared to which the 2015 numbers constitute a rise of 38.3%. This is even more significant given the fact that from 2007 on euthanasia started becoming available to people with chronic diseases – psychiatric diseases, dementia, and others…For the sake of comparison, I have looked at the suicide rates of some countries which are close to the Netherlands in terms of ethnicity, age, religion, and language, but which, with the exception of Belgium, lack the option of euthanasia. If the suicide numbers in the Netherlands have gone up, one would expect, at least a similar increase in the suicide numbers would occur in countries without the option of euthanasia. However… the Netherlands of all countries show the biggest increase in the suicide numbers.”

 

The national disability rights group Not Dead Yet countered the recent May 9th Albany lobby day for assisted suicide proponents by wearing hot pink Not Dead Yet– The Resistance t-shirts. The Albany Times Union reported “Opponents of aid in dying have said that if legislation is approved, medical research, health care providers and the disabled could be negatively impacted. Opponents also have warned that without proper oversight, there is potential for abuse by those who want to end the burden of caring for a terminally ill loved one.” Adam Prizio, manager of governmental affairs for the Center for Disability Rights, and Not Dead Yet’s attorney in the friend-of-the-court brief filed in the NY assisted suicide case that was heard in the NYS Court of Appeals in late May stated, “There’s no way to open this door just enough. No matter where you open it, some number of people with disabilities will be killed through coercion, through abuse, or through insurance companies trying to save money.” Schadenberg concluded, “In the face of this real ideological scourge, we must continue to promote a benevolent and inclusive vision that values those who are made vulnerable by sickness, old age, or disability by giving them the means to live with dignity and to be accompanied and comforted until their last breath.”

There are two physician-assisted suicide bills currently in committee in the NYS Legislature: A.5261B (Paulin) /S.5814 (Bonacic) and A.2129A (Rosenthal) / S.3685(Savino). A lawsuit has also been filed by an assisted suicide advocacy organization to overturn NY’s ban. NewYork’s current law prohibits assisting in suicide by anyone, including doctors who prescribe lethal doses of drugs. This law was challenged in 1994 and upheld as constitutional by the US Supreme Court in Vacco vs.Quill in 1997.

The 2011 Code of Medical Ethics of the AmericanMedical Association states, “Allowing physicians to participate in assisted suicide would cause more harm than good. Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.” The 2015 position statement of the MedicalSociety of the State of New York reads in part,”Compelling arguments have not been made for medicine to change its footing and to incorporate the active shortening of life into the norms of medical practice.

“The Memorandum of Opposition of the New York Association on Independent Living (NYAIL) states,” Assisted suicide legislation reinforces the idea that people with disabilities are burdensome and our lives are not worth living. Fears of becoming disabled and facing functional loss are often reported by doctors as reasons patients request assisted suicide. Proponents of assisted suicide often cite a loss of dignity as a reason to terminate one’s life. The disability community strongly opposes the belief that requiring the assistance of another individual activity of daily living such as dressing, bathing, and toileting is undignified or a legitimate reason to legalize physician-assisted suicide.

“Proponents of physician-assisted suicide often argue that this option is necessary to prevent suffering at the end of life. This is not the case as there are alternative options to prevent suffering. It is already legal in New York for individuals to create an advance directive to cease treatment under any circumstances they choose and to refuse treatment at any time. Palliative care is available and can provide pain relief to ensure a person is not in pain…NewYork should invest in educating the community about these options and focus on promoting and expanding palliative care so that it is an available option for anyone facing painful illness…The concern arises when a physician is permitted to sanction and actively facilitate such an act. People trust their doctors, yet doctors are sometimes wrong. Certainly, there are numerous instances where individuals have been told they have a terminal illness, only to live long, fulfilling lives. A CBS report last year found that12 million Americans annually are misdiagnosed. Yet patients tend to trust their doctors and may choose assisted suicide if it is presented as the best option without accurate informed consent, giving up good months or years of life.

“Furthermore, there is a significant risk that people may be steered into this decision for financial reasons. Government and private health insurance companies and healthcare providers would find physician-assisted suicide far less expensive than providing lifesaving treatments. Direct coercion is not even necessary. If insurers deny, or even merely delay, expensive life-saving treatment, the person will be steered toward assisted suicide. People with disabilities and serious illnesses should not be pressured into assisted suicide for economic reasons.

“The proposed legislation is based on the laws in Washington and Oregon, which have proven to have ineffectual safeguards against abuse. There is nothing in the legislation to effectively prevent a coercive family member or caregiver from doctor shopping with the individual to find a physician who will provide the fatal drug. There is nothing in the proposed legislation that would prevent an abusive caregiver or family member from steering the individual toward physician-assisted suicide, witnessing the request form, picking up the lethal dose, and even administering the drug. With no independent witness required at the death, there is no assurance of self-administration or even consent.

“Finally, the New York assisted suicide bills to contain no reporting requirements aside from a few entries in the medical record and the request form, which are subject to the strict confidentiality requirements of HIPAA. The proposed bills are simple immunity statutes, protecting everyone involved in the death except for the patient, no questions asked.”

The NYS Catholic Conference position paper on assisted suicide states, “New York State rightly spends millions of dollars each year in efforts to prevent suicide…. legalizing assisted suicide would send an inconsistent message by saying that some lives are not worth living. This double standard would be based entirely on disability, as patients fear “losing autonomy” or “being a burden” to others because of their disabilities from the terminal illness. LiftingNew York’s ban on assisted suicide would provide a deadly, unnecessary option to patients, many of whom fear pain, depression, and abandonment. These persons can be significantly helped through pain relief, palliative care, and the hospice environment and compassionate loving care.”

On September 11, 2015, the California legislaturepassed ABX2-15, the “End of Life Option Act,” whichlegalizes physician-assisted suicide. On October 5, 2015,California Governor Jerry Brown signed the bill saying hewouldn’t want to be in pain in his final days. Carol Tobiasof National Right to Life said the law “shows a blatant dis-regard for the lives of California’s medically vulnerablecitizens and sends a message to these citizens that theirlives are less worthy to be lived. The so-called ‘right to die’movement promotes these laws as simply ‘another medical option at the end of life,’ but their real goal is euthanasia on demand for any reason. There are no real safeguards…Itis a well-established fact that nearly every terminally illpatient who desires death is suffering from treatable de-pression…Rather than treat clinically depressed patients…the system that would be established by the Californiabill…indicates that you instead help the patients kill them-selves.” An article about the bill’s passage written by IanLovett in the New York Times referred to an observationby Dr. Aaron Kheriaty, director of the medical ethics pro-gram at the University of California, Irvine, School ofMedicine, “…[Kheriaty] said that low-income and underin-sured patients would inevitably feel pressure to end theirown lives in some cases, when the cost of continued treat-ment would be astronomical compared with the cost of afew lethal pills.” (www.lifenews.com, 10/5/15)

Jacqueline Harvey, Ph.D., and bioethicist with theCharlotte Lozier Institute, wrote an open letter to GovernorBrown regarding this bill. Her letter noted that “grosslyinappropriate tactics [were] employed to pass this hastylegislation without the vetting that killed virtually identicallegislation just months ago…The evidence on the dangersof assisted suicide has killed over 175 bills in 35 statessince the early ‘90’s. Assisted suicide bills fail 99.95% ofthe time when treated like every other piece of legislationand subjected to expert testimony, debate and possibleamendment…When legislators hear about the dangers ofassisted suicide in hearings, they reject it virtually everytime…This is what you will ensure for California, notmerely the death and destruction that legal assisted suicidewill wreak, but a bogged-down Assembly condemned todeal with the issue for years to come.” Harvey continued,“Consider that ABX2-15 was only passed by hijacking ses-sions you convened to focus on finding budgetary solutionsin health care and transportation …the healthcare financetopic in particular places you in a position of suggestingsuicide is a cost-containment measure in healthcare, like inOregon where requests for real treatment will not be paidfor, but suicide is completely covered. To affirm this be-havior by signing this bill would foremost result in badpolicy…As we end suicide prevention week, let your lega-cy be talking the suicidal down from the ledge – not givingthem a push.” (www.lifenews.com 9/16/15)

The American College of Physicians (ACP) sent a let-ter to Governor Brown on 9/16/15 urging him to veto thislegislation. The letter stated, “This is a physician-assistedsuicide (PAS) bill. ACP does not support PAS as an appro-priate action…Terms such as ‘end of life option’ and ‘aid-in-dying’ used in the bill are confusing and obscure what isat stake when physicians are asked to facilitate suicide. Weare deeply sympathetic to the concerns and fears patientsand their families have at the end of life. However, PAS isnot the answer and in fact, ACP sees it as abandonment ofthe dying patient. It is not the role of the physician to giveindividuals control over the cause and timing of death-themedicalization of suicide. The physician must always act inthe best interests of the patient as healer, comforter andtrusted advisor. PAS undermines trust in patient-physicianrelationships and trust in the profession of medicine. Pro-ponents of PAS claim it is an act of compassion in keepingwith the physician’s role as comforter. However, this argu-ment incorrectly assumes that physicians can only providecomfort for certain patients through facilitating suicide. Infact, physicians can and do provide comfort to dying pa-tients. It is a lack of awareness of these services and a per-ceived concern that patients will not have access to thiscare that helps drive interest in PAS as an option. We needto ensure that all patients have access to palliative care andhospice services at the end of life rather than promote sui-cide. Surveys show that many individuals do not knowwhat palliative care is but when told its definition, theyoverwhelmingly respond that they would want it for them-selves or their family members if they were severely ill…The highest priorities for care of dying patients should beexcellent palliative care, including alleviation of pain andother symptoms.”

The ACP letter concluded, “Patients often fear pain at the end of life, but physicians have an ethical obligation to treat pain with competence and compassion. Aggressive management of pain at the end of life is ethically acceptable, even when the risk of hastening death is foreseeable if the intent is to relieve pain…Procedurally, we were also very troubled by the last-minute inclusion of the PAS bill in the special legislative session on health care financing, bypassing usual procedures. We also note the paradox of access to PAS where there is no general right to health care. In Oregon, the irony of difficulties getting coverage for palliative services and pain drugs under the state’sMedicaid program-but no problem receiving PAS paid forms a covered service-has been noted…PAS is especially troubling in an environment of cost control in health care and continuing disparities in care. We hope you will join ACP in advocating that society should encourage those who seek suicide with a physician’s help to instead be provided with full access to the care and compassion that can alleviate their suffering. No Californian, or any American, should have to fear an undignified or pain-filled life or death. Providing greater access to palliative and hospice care needs our full attention. In this way, physicians can fulfill their mission and give dying patients and their families the care, compassion, and comfort they need and deserve.”

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