Category Archives: Assisted Suicide

Physician-Assisted Suicide Hurts the Vulnerable

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Source: Al Jazeera America

In the past year, lawmakers in two dozen states have put controversial end-of-life bills up for debate. Across the country, there is growing support to allow terminally ill patients to end their lives with a prescription pill, but only five states now allow medically assisted suicide. In California, a bill that could legalize medically assisted suicide is making its way through the state Legislature. Stephanie Packer, who is battling a terminal lung disease, says she thinks passing it would be a huge mistake.

In 2012, after suffering a series of debilitating lung infections, a doctor diagnosed me with scleroderma, an autoimmune disease that causes a hardening of the skin and, in some cases, other organs. Given the progression of my disease, my doctor told me that I had three years to live.

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Orange County Register: California Assisted Suicide Bill Opens Door to Abuse

Woman with arms raised celebrates her achievement and success in the sunshine even with her disabilities in a wheelchair.

Source: The Orange County Register

By: Joseph Perkins

The (California) state Senate last week approved the so-called End of Life Act, which would allow the terminally ill to obtain lethal medications with a doctor’s prescription.

The death-on-demand law is co-authored by Sens. Lois Wolk and Bill Monning, with the tacit blessing of the California Medical Association, which previously opposed physician-assisted suicide, but now is officially “neutral” on the issue.

Wolk insists that the End of Life Act “is a compassionate addition to the existing continuum of care that may be used by modern medicine at the end of life.” Monning maintains that the legislation will allow those with terminal diseases “the autonomy to approach death on their own terms.”

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Politico: Democrats Should Not Endorse Assisted Suicide

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Source: Politico Magazine

By Ira Byock

As a life-long progressive who is rapidly approaching Medicare age, I am dismayed by the apparent resignation of the political left to the sorry state of dying in America. Just when moral outrage and radical social change are called for, my fellow progressives have embraced physician-assisted suicide as their political response to needless suffering of seriously ill people. This isn’t liberalism; it’s nihilism.

This liberal embrace of hastened death is spreading rapidly. In California, a bill to legalize doctor-assisted suicide passed the state senate last Thursday and is headed for the state assembly. In common with similar legislation in over 20 states, it was authored and co-sponsored by Democratic lawmakers touting civil liberties as their motivation.

In the 1970s this scenario was the stuff of dystopic sci-fi. Remember Soylent Green? A society decides it doesn’t have the resources or will to take good care of aging and dying people, but offers them a compassionately quick, painless and aesthetically pleasing death. Edward G. Robinson’s death scene in this 1973 movie (filmed while the actor was dying of cancer) is essential viewing for anyone who supports physician-assisted suicide.

In the 1970s and 1980s progressives championed hospice as a counter-cultural response to woefully bad care of terminally ill people. To good effect: Hospice and the specialties of palliative medicine and geriatrics demonstrated conclusively that much better care of frail elders and dying people is feasible and affordable. Meticulous communication and planning, skillful treatment of pain and other symptoms, support for patients and families in caring for themselves and 24-7 availability of professional help are all far less expensive than the current norm—in which no one attends to such details, while doctors forestall death at all costs. As a consequence, one in five people languish in intensive care units during their final days.

Dying is rarely easy, but it doesn’t have to be this hard. Having worked as a physician in hospice and palliative care teams since 1978, I know that no one needs to die in physical agony. With comprehensive whole person care, most people live in relative comfort and, despite the sadness of leaving those they love, even a sense of wellbeing during their final months, weeks and days of life.

For years it seemed like we were on a path to a future in which every person could be assured of comfort and having their dignity honored through the very end of life. Unfortunately, countervailing forces, chief among them the profit motive, supervened. Instead of transforming mainstream health care to become genuinely person-centered, hospice, palliative medicine and geriatrics are largely being absorbed within corporatized medicine. For instance, fully two-thirds of America’s hospices now belong to for-profit companies, many traded on Wall Street.

It’s great that more people receive hospice care than ever before, but quality has suffered. Across the hospice industry, the average number of dying patients assigned to each nurse has risen to untenable levels. Meanwhile, the industry’s capacity to provide continuous hospice care in people’s homes has all but disappeared, resulting in needless brink-of-death hospitalizations, avoidable pain and suffering and unnecessary costs. This is no surprise to liberals: the fiscal wellbeing of corporations too often takes precedence over the wellbeing of the people they serve.

Despite having the resources and technical know-how to reliably care well for people through the end of life, a persistent public health crisis surrounds the way we die. The public’s fear, anger and distrust are, tragically, well founded. But authorizing doctors to intentionally end peoples’ lives is nothing more than capitulation to this pervasive social irresponsibility.

An authentic, socially sound solution to this crisis is readily achievable if we can muster the will to demand it. A tectonic shift in the way healthcare is paid for—from financially rewarding quantity of services to measured quality of care delivered—has the potential to improve care for seriously ill people in transformative ways. This change began with RomneyCare, went national with ObamaCare, and will be accelerated by the “doc fix” legislation that Congress just passed and the president quickly signed.

Under these laws, accountable care and value-based payments will increasingly tie physicians’ Medicare fees to the quality of clinical outcomes and people’s satisfaction with the health care they receive. For end-of-life care, recognized quality measures include where people died and relatives’ perceptions of whether or not their loved ones’ values and preferences were elicited and honored.

This is no time to be fatalistic. Instead, it’s time to push major redesign of physician education and post-graduate training. State legislators could write bills to require medical and nursing schools and residency programs to adequately train clinicians in personalized symptom management, communication and shared decision-making, and collaborative team-based care. Legislators could mandate performance tests of basic skills in these areas before their state awards licenses to practice medicine.

Many corporate nursing homes today are little more than human warehouses. The wages and staffing levels of aides are so low that physically dependent people are destined to feel undignified. State legislatures could compel nursing home companies to employ enough nurses and aides to answer the bell when a physically dependent person—someone’s grandparent, mother or father—needs help in getting to a bathroom.

State-sponsored websites could provide easily accessible and reliable quality ratings of hospitals, nursing homes, assisted living facilities, and home health and hospice programs, helping to align market forces with public health priorities. Medicare’s star ratings of nursing homes, while far from perfect, are having a noticeably positive impact on quality of long-term care.

I’ve been making this case to state legislators who sponsor or support legalizing assisted suicide, almost all of whom are Democrats. I get a lot of “yes-but” responses: Yes but, you’ll never get doctors to practice the way you describe. The less polite refer to entrenched interests in the status quo and financial pipelines of the medical-industrial complex. Without disputing my premise, one senior blue state senator recently told me I was naïve to think anything substantial would change.

He sounded depressed, but I couldn’t let him off the hook. I pointed out that if the physician-assisted suicide bill he supports becomes law, his mother’s internist will still not have been adequately trained or have the skills needed to treat her pain or breathlessness. He will be no better at listening to her concerns or counseling her through the difficult, but normal, process of leaving this life. He will, however, be able to write her a lethal prescription.

What about this is good government?

It is said that the real worth of any society can be found in the way it cares for its most vulnerable members. In Oregon, Washington, Vermont, New Mexico and Montana where doctors can legally write lethal prescriptions, the systemic deficiencies that cause preventable distress among dying people persist. A healthy society doesn’t force its members to choose between suffering and suicide. I grew up believing that every person’s life has value and that America does not settle for less than the best. Suicide is not the answer. We are a far more generous people than that. Aged, ill and dying Americans need progressives to reclaim our commitment to bold, constructive political and social action.

Ira Byock, a palliative care physician, directs the Institute for Human Caring of Providence Health and Services. He is a professor at Dartmouth’s Geisel School of Medicine and author of The Best Care Possible.

U-T San Diego: Physician-assisted suicide bad for medicine

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Andrew D. Sumner: Physician-assisted suicide wrong, dangerous for society

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Source: The Morning Call

April 24, 2015

By Andrew D. Sumner

Senate Bill 549 to legalize physician-assisted suicide in Pennsylvania has been referred to the Senate Judiciary Committee.

As a cardiologist, I read the bill with great concern. I have cared for terminally ill patients and seen the great courage, dignity and grace with which patients have successfully faced sickness and death. If passed, SB 549 to legalize physician-assisted suicide will be a great danger to physicians, to patients and to society.

Legalizing physician-assisted suicide is dangerous for physicians. Giving doctors the power to deliberately end the lives of their patients will inevitably redefine the nature of the doctor-patient relationship and will destroy essential trust and confidence.

Physician-assisted suicide is the easy option for a busy, stressed or frustrated physician. It also gives too much power to the physician. He or she would become judge, jury and assistant executioner. A physician could convince a patient that this is a reasonable step in just the way they describe their diagnosis and prognosis.

The American Medical Association in its code of ethics highlights the dangers of physician-assisted suicide: “Physician-assisted suicide is fundamentally incompatible with the physician’s role as a healer, would be difficult to control, and would pose serious societal risks.”

Physician-assisted suicide is also dangerous for patients. The “right to die” will become the “duty to die” for senior citizens. Not wanting to be a burden, the elderly will take their own lives. Most people commit suicide due to depression. Depression is extremely common but treatable in the terminally ill.

Despite these facts, no independent mental evaluation is required prior to physician-assisted suicide. Most alarming is that in an economically challenged health care system, the cheapest form of health care for any end-stage illness is a handful of lethal medications.

Finally, physician-assisted suicide is dangerous for society. It creates a slippery slope.

In Europe, countries have slid from physician-assisted suicide to voluntary euthanasia, to nonvoluntary euthanasia and then to involuntary euthanasia. The “right” to die was given to the terminally ill, then to the chronically ill, the disabled, and finally to those not ill at all.

So-called safeguards do not in reality work. The Pennsylvania bill mandates that a consultant review the recommendation of the attending physician. This safeguard offers little protection because studies show that physicians only get a second opinion from other physicians who they know will endorse their decision about physician-assisted suicide.

Legalizing physician-assisted suicide would not give patients the right to die but would give physicians the right to kill.

A better alternative is to train more palliative-care physicians, insure adequate pain and symptom control at the end of life, encourage better identification and treatment of depression, promote hospice, and mobilize faith communities and others to provide emotional support to struggling patients and families.

H.L. Mencken summed it up, “There is always an easy solution to every human problem — neat, plausible, and wrong.”

Legalizing physician-assisted suicide is wrong. The evidence is clear. It is just too dangerous.

Andrew D. Sumner is a cardiologist who lives in Upper Saucon Township.
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