Doctor-Assisted Suicide: a Matter That Won’t Die : State lawmakers can no longer avoid this intense debate
Probably few issues have more confounded the medical profession over the years than what to do when terminally ill patients ask doctors for compassionate help in ending their lives. Physician-assisted suicide and euthanasia are matters that can no longer be ignored or papered over. Patients, doctors and now the courts have forced the issue. Ruling in Washington state and New York cases recently, federal appeals courts have issued strong, well-reasoned decisions that offer protection to doctors who agree to help a patient commit suicide. This means that such actions are legal now in 12 states. At least until the Supreme Court finally comes to grip with the question.
This is an issue whose time has come, despite deeply principled opposition from the American Medical Assn., many individual doctors and ethicists and the Roman Catholic and other churches. As any doctor knows, for decades colleagues have quietly complied with patient requests to die. Euthanasia is legal in the Netherlands, a pioneer in this regard, but in the United States many of those who have pushed it have faced legal consequences.
Now a new study from Washington state documents the extent to which such requests are made and honored. It found that 16% of doctors annually received one or more requests for help in suicide or euthanasia. Moreover, 24% of such requests were granted by the doctors despite legal risks, the study asserts, only slightly less than the 33% granted by legally protected Dutch doctors.
Interestingly, the reasons for suicide requests have changed dramatically in recent years. In the past, most requests were from people suffering intractable pain from cancer and other diseases. Now, however, pain is largely controllable. Patients fear more the loss of control and dignity, and the dependence and financial burden often associated with the end stage of fatal ilness. As the Washington study, published in the Journal of the American Medical Assn., put it: “Notably, neither severe pain nor dyspnea [shortness of breath] was a common patient concern, suggesting that intolerable physical symptoms are not the reason most patients request physician-assisted suicide or euthanasia.”
Or as Judge Stephen Reinhardt wrote in his majority opinion for the 9th Circuit appeals court, which struck down a Washington state law against assisted suicide: “A competent terminally ill adult, having lived nearly the full measure of his life, has a strong liberty interest in choosing a dignified and humane death rather than being reduced at the end of his existence to a childlike state of helplessness, diapered, sedated, incompetent.” As a result of Reinhardt’s ruling and a similar one issued by the more conservative 2nd Circuit last week in New York, the matter is ripe for Supreme Court review.
No longer should patients be reduced to finding ways to secretly do themselves in; the botched results of a failed suicide attempt can be horrific and expensive. Liberalizing state laws has been hampered by memories of the Nazi years in Germany, where, to their eternal shame, once-respected doctors collaborated in the elimination of the elderly, dwarfs and other “defectives.” Lacking such a dreadful history, this country should be able to arrive at a just legal resolution. Legal experts say the New York ruling, based on constitutional safeguards guaranteeing equal protection under law, was more narrowly drawn and therefore more likely to survive Supreme Court scrutiny than the 9th Circuit ruling, which was based on due-process rights.
In any case, it is time for the states to stop resisting. Washington state is likely to appeal the 9th Circuit ruling, and Atty. Gen. Dan Lungren of California, which is part of the 9th Circuit, is expected to defend the California laws against assisted suicide. The better course would be for the governor and the state Legislature to recognize the inevitable and start crafting new laws. Organized medicine must also play a role; welcome is news that the AMA has begun to review its long-standing ethical objections to doctor-aided suicide.
The big concern is that doctors would acquiesce with relatives who wanted to lift the burden of caring for a sick parent or to accelerate an inheritance. Therefore, the appropriate committees of the Legislature should start now drafting legislation requiring second medical opinions and ironclad layers of medical protection against abuses. Otherwise, the Legislature will yet again find itself relegated to irrelevance by a voter initiative or the courts.
