A new survey of Bay Area doctors who treat people with AIDS has found that the controversial and illegal practice of helping patients kill themselves is “surprisingly” common.
The 1995 survey, published today in the New England Journal of Medicine, found that about half of the 118 responding doctors said they had agreed to help at least one patient commit suicide by prescribing lethal doses of sedative drugs.
The practice has become more acceptable to doctors since the researchers conducted a similar survey in 1990. At that time, 28% of respondents said they would be “likely” to fulfill an AIDS patient’s request for suicide assistance. In 1995, that figure was 48%.
The findings appear at a curious historical juncture. Interest in the dilemma of physician-assisted suicide is at an all-time high, with the Supreme Court considering whether mentally competent, terminally ill people have a constitutional right to enlist doctors’ help in dying. Meanwhile, powerful new drugs that fight HIV and AIDS are staving off disease and improving short-term survival rates, arousing high hopes among doctors and patients alike.
Whether the success of new anti-AIDS drugs would discourage doctors from abetting patients’ suicides in the future was unclear, said the study’s director, Dr. Donald Abrams, an AIDS specialist at San Francisco General Hospital and UC San Francisco.
The study’s lead author, Lee Slome, a clinical psychologist in private practice in San Francisco, said the survey doesn’t support one legal stance or another. “It was done independent of the legal debate,” she said. “But it does show that [physician-assisted suicide] is a reality” in that community.
Advocates of legalizing physician-assisted suicide said the findings are in keeping with the AIDS community’s pioneering role in wresting control over health care decisions from the medical establishment. Indeed, some ethicists have regarded San Francisco AIDS patients as a model for how assisted suicide should be implemented.
But opponents cautioned that just because the survey suggests that the practice is increasingly acceptable, that is no reason to legalize it. “You don’t do ethics by looking at surveys,” said Dr. Barbara Paul, an internist in Napa and chairwoman of the California Medical Assn.'s bioethics committee. The CMA opposes legalization of the practice.
Other researchers discussed what they believed were potential shortcomings in the study. Only 52% of the 228 doctors who were mailed the survey responded, possibly skewing the findings in favor of the practice, since doctors strongly supportive of it may have been more inclined to fill out the questionnaire. Also, the study did not look at how many of the patients who were given a prescription for a potentially lethal dose of sedatives actually committed suicide.
Still, the San Francisco survey uncovered physician participation in suicide at levels much higher than other studies found. A survey of 355 cancer specialists published last year found that 13.5% had helped a patient commit suicide.
To gauge the Bay Area doctors’ general attitudes on the divisive issue, the current survey presented an ethical “vignette” involving a hypothetical AIDS patient named Tom who wanted help committing suicide. The survey then asked doctors if they would help Tom or not, and 48% said yes.
But Dr. Leslie Blackhall, medical director of the Ventura-based Assisted Home Hospice, who opposes the practice, criticized the yes/no answer to the vignette as superficial. “I would ask Tom what he was worried about,” said Blackhall. She said that she would redouble efforts to control his pain and deal with his emotional problems.