DOCTOR ASSISTED SUICIDE

Assisted Suicide:  The act of assisting someone to take their own life by providing the means and instructions to do so. 

 

Doctor Assisted Suicide is illegal in the vast majority of states.   Only Oregon, Vermont, Washington, California, Hawaii, and Colorado have legalized Doctor Assisted Suicide.  The law is less clear in Montana, where Physician Assisted Suicide was legislated by judicial order.  Although Doctor Assisted Suicide is not legal in Washington, D.C., 45 out of 50 states have prohibited assisted suicide it in spite of many concerted attempts by the Death with Dignity Coalition (now known as Compassion and Choices; formerly known as the Hemlock Society). 270 Attempts have been made to legalize Doctor Assisted Suicide.

 

Euthanasia:  The direct killing of a person by injecting a lethal substance.

 

Euthanasia is illegal in all 50 states.  In the Netherlands, euthanasia is legal, with or without the consent of the patient.  Assisted Suicide is also legal in the Netherlands, Luxembourg, Canada, and Belgium.  Although Assisted Suicide is prohibited in Switzerland, it is widely practiced, and people come to Switzerland from all over the world for assistance with suicide.  Chronically ill children, of any age, can now be euthanized in Belgium.  The Netherlands has adopted guidelines allowing parents to consent to direct killing of newborn infants with disabilities.

 

Good Intentions Can Have Grave, Unintended Consequences

 

Many who support Physician Assisted Suicide have the best of intentions.  They claim they support it to reduce the physical pain of dying not only for themselves, but for their loved ones as well.  No one wants a painful death.  And human life does not need to be extended by every medical means possible, but the person should never be killed intentionally.  Public policy must never involve the taking of innocent human life. Each person deserves love, support, protection, respect, care, and dignity at all stages of life.

 

Some claim to support Doctor Assisted Suicide as a form of emotional “insurance” for themselves, should they want to use it in the future.  However, enacting public policy in which Doctor Assisted Suicide becomes a medical treatment turns common sense, compassionate care and medical ethics on its head.  The very person entrusted to care for patients, could now serve as an agent of death, while heading down a slippery slope with grave consequences.

 

When Oregon enacted the nation’s first Doctor Assisted Suicide legislation in 1997, it was touted as being all about “choices” and so-called Death with Dignity.  There was no need to participate in the practice unless the terminally ill patient clearly specified as such.  Oregon boasted of the alleged safeguards in place to protect patients from abuse or coercion in the Death with Dignity Act. You may recall, however Oregon resident, Barbara Wagner, who sought chemotherapy treatment to fight cancer.   Her request for chemotherapy was denied by the Oregon Health Plan.  But they did offer to pay $50 for lethal prescription drugs to end her life. Barbara Wagner told local newspapers that it’s cruel for someone “to say to someone, ‘we’ll pay for you to die, but not pay for you to live.”

You may recall Stephanie Packer, a valiant terminally ill mother of 4 who took a red eye flight from California to Maine In April 2017.   She traveled 3,000 miles, accompanied by her  caregiver, to warn Mainers of her horrific first-hand       experience with California’s so-called Death with Dignity Act.  She testified before the Maine legislature and at a press conference, warning Mainers of the dangers of Doctor Assisted Suicide. Stephanie Packer testified that her insurer denied costly health care treatment but offered Doctor Assisted Suicide for a $1.20 co-pay. Doctor Assisted Suicide is the ultimate patient abandonment. 

Doctor Assisted Suicide has far-reaching consequences. In fact, Oregon reports their overall suicide rates are increasing each year. Oregon’s suicide rate is currently 41% higher than the national average.  When one life is devalued, we are all at risk. 

 

As our health care costs rise along with our aging population, more and more people are increasingly vulnerable to being coerced (directly or indirectly) into poor quality, inexpensive health care.  Persons with disabilities, chronic diseases and depressed persons are also at risk for this dangerous public policy.

 

Over 90% choose assisted suicide to maintain autonomy, not because of pain.

 

According to Oregon’s Public Health Department, the overwhelming reason cited for choosing physician assisted suicide is fear of losing autonomy.  Listed below is a summary of the Department’s findings.

 

Reasons for Choosing Doctor Assisted Suicide:

#1           Loss of Autonomy (91.5%)

#2           Decreased Ability to Engage in Enjoyable Activities (88.7%)

#3           Loss of Dignity (79.3%)

#4           Loss of Control of Body (50%)

#5           Becoming a burden on others (40%)

#6           Physical pain or fear of physical pain (23%)

 

Rather than working with patients to end their lives, doctors should be working to respond to patents’ needs as they approach the end of life.  There are many options available including hospice, palliative care, pastoral support, specialty consultations, family counseling, and the like. With advances in palliative care and palliative sedation, doctors can keep patients comfortable so they don’t feel pain.  If you or a loved one does not receive adequate pain management from your physician, find another doctor.  Suicide should never be prescribed as a medical treatment.  We believe in killing the pain, not the patient.

 

Our Most Vulnerable Populations are Placed at Risk

 

Citizens and policy makers need to resist pressure from instituting public policy that can endanger the weak and marginalized in our society:  the elderly, those suffering from depression, and persons with disabilities.  Not Dead Yet is a national, grassroots disability rights group that opposes legalizing assisted suicide, which they consider to be a deadly form of discrimination.  Marilyn Golden, of the Disability Rights Education & Defense Fund, stated that if Physician Assisted suicide is enacted, “some people’s lives will be ended without their consent, through mistakes and abuse. No safeguards have ever been enacted or proposed that can prevent this outcome, which can never be undone.” 

 

Other Reasons Assisted Suicide Legislation is Dangerous for Maine

 

Make no mistake. When human life is readily expendable in one area, all lives are in jeopardy.

 

Did you know Maine’s suicide rate is already higher than the national average?  Seven times more people die from suicide than homicide in Maine.  

 

Additionally, Maine is the grayest state in our nation.  If an assisted suicide bill were ever to be enacted in Maine, it could have grave, unintended consequences by making assisted suicide the only affordable “health care” option for many Mainers. Elder abuse could increase here in Maine. The so-called “right to die” could all too quickly become the “duty to die” for our elderly who may erroneously consider themselves to be a burden on their loved ones.

 

Doctor Assisted Suicide (or Patient-Directed Care at the End of Life) bills purport the illusion of choice.  However, informing the patient of a range of treatment options does not mean the patient will have the ability to access all treatment options. Patients may find their insurance will not cover all the “feasible alternatives” their doctors informed them about, but it will cover doctor-prescribed death, (as Barbara Wagner from Oregon experienced when her HMO declined chemotherapy to treat her cancer, but offered to pay $50 for a lethal prescription so she could kill herself instead). The last to receive medical treatment could become the first to receive physician assisted suicide.

 

We are better served to focus on true compassionate care for our vulnerable populations with programs such as Hospice, palliative care, POLST, Advance Directives, prevention of elder abuse, and proactive programs which focus on improving pain management and the quality of life.

 

Maine citizens deserve safe, ethical, and sound public policy which is based in common sense and compassion.  Good public policy requires we consider the long term effects on all people; not just the short term effects on a few people.  For example, what message would passage of a Physician Assisted Suicide bill send our teens, already at risk of suicide, at a vulnerable time in their lives---that some suicide is ‘ok’, while other suicide is not?  If Maine ever enacted Assisted Suicide legislation, the effects of Maine’s Teen Suicide Prevention legislation would be feckless.

 

All persons deserve our best care and protections at all stages of life. Government must never classify suicide as a compassionate “choice” or a form of medical care.  It defies common sense and true compassionate care, while placing all citizens at risk, especially our most vulnerable.

 

Background/Overview of Doctor Assisted Suicide

 

A Unanimous Supreme Court
The US Supreme Court ruled on this issue in June of 1997. While their opinion does allow for individual states to decide the issue on their own, this does not mean the Court found no problems with this issue. All nine justices agreed that it was too dangerous to create a constitutional right to assisted suicide. The Court was clear in communicating the dangers of creating a right to assisted suicide - especially among the elderly, disabled, and others who may feel pressure to commit suicide.

"The State's interest here goes beyond protecting the vulnerable from coercion; it extends to protecting disabled and terminally ill people from prejudice, negative and inaccurate stereotypes, and 'societal indifference.' The State's assisted suicide ban reflects and reinforces its policy that the lives of terminally ill, disabled, and elderly people must be no less valued than the lives of the young and healthy, and that a seriously disabled person's suicidal impulses should be interpreted and treated the same way as anyone else's."

U.S. Supreme Court in Washington v. Glucksberg, No. 96-110, 1997 WL 34094 (U.S. June 26, 1997)

 

Destroys the Physician-Patient Relationship
Doctors take an oath to be healers, not killers. Granting doctors the power of law to participate in the death of their patients is not only morally wrong but is in direct violation to the Hippocratic oath. Legalizing assisted suicide would give doctors a radical new authority – deciding whether or not a patient should continue living.

   "Physicians typically make recommendations about treatment options,

    and patients generally do what physicians recommend. Once a

    physician states or implies that assisted suicide would be 'medically

    appropriate,' some patients will feel that they have few, if any, 

    alternatives but to accept the recommendation."

    N.Y. State Task Force on Life and the Law, Supplement to When Death Is Sought; 

    Assisted Suicide and Euthanasia in the Medical Context, April 1997, p. 5.

 

25% Of the Suicides May Fail
Proponents of this legislation argue for a "humane and dignified death". Yet many of these same people admit that as many as 25% of those who try to kill themselves will fail and may linger for days before dying. This is clearly not "humane and dignified".

   "Evidence I have accumulated shows that about 25 percent of assisted

    suicides fail, which casts doubts on the effectiveness of the Oregon

    law.... The Oregon way to die will only work if in every instance a doctor

    is standing by to administer the coup de grace if necessary. The only

    two 100 percent ways of accelerated dying are the lethal injection of

    barbiturates and curare or donning a plastic bag."

 


   "In a controlled study in the Netherlands, 90 people were given, at their

    request, nine grams of barbiturate by mouth. Sixty-eight died quickly --

    within two hours, The rest lingered as long as four days; in 15 instances

    the doctor gave a lethal injection because the oral drugs were causing

    protracted suffering to the patient, the family and himself [the doctor]."

    "Here is where the Oregon law, which forbids injections could be

    disastrous."

    Derek Humphry (co-founder of the Hemlock Society and author of the suicide manual,       Final Exit), Letter to the Editor, New York Times, 12/3/94, p. 14


"[I]n 20% of the patients who received a barbiturate [orally], a muscular relaxant [curare-like injection] was needed to end life after the five hour time period." Many, though not all, attempts to legalize physician-assisted suicide, both in America and Australia, are limited to just physician-assisted suicide and do not allow euthanasia. From the above facts, it should be abundantly clear that this limitation is headed for disaster...."

G.K. Kisma, "Euthanasia and Euthanizing Drugs in the Netherlands," in M.P. Battin and A.G. Lipman, eds., Drug Use in Assisted Suicide and Euthanasia (New York: Pharmaceutical Products Press, 1996), pp. 200 & 207. 
"One in four Oregonians who try to kill themselves under Measure 16 is likely to experience a lingering death that could go on for hours, maybe days, says a study by a leading euthanasia doctor [Dr. Pieter Admiraal] from the Netherlands."


In response to a question about whether a doctor would know what prescription and dosage to give a patient to "ensure a successful death": "I doubt anyone could say what dose would be successful. In the Netherlands, they initiate the suicide with drugs by mouth, but they have the option of moving to intravenous drugs. I don't think we would have that option, under Measure 16."

Peter Rasmussen, M.D., Testimony before the Oregon House Committee on Judiciary, Subcommittee on Family Law, 3/11/97

 

Problems With Defining Terminal Illness
The assisted suicide bills apply to those with a "terminal disease" that is "incurable and irreversible" and will "produce death within 6 months". Predicting death is an inexact science at best. Doctors can and do make mistakes. And there is no requirement that death be expected to occur despite provision of lifesaving medical treatment. Therefore people with diabetes, kidney disease, or respiratory failure (they are terminally ill but will not die within six months) could be candidates for assisted suicide. In other words, Doctor Assisted Suicide legislation could apply to those with permanent disabilities.

   "A total of 1375 [Oregon] physicians (50%) were not confident that they

    could predict that a patient had less than six months to live. Moreover,

    761 (28 %) indicated that they were not confident they could recognize

    depression in a patient who requested a prescription for a lethal dose of

    medication."

    Melinda A. Lee, M.D., et al., "Legalizing Assisted Suicide--Views of Physicians in

    Oregon." New England Journal of Medicine, 2/1/96, pp. 310-315.

 
   "The fact that deaths were not nearly as predictable as most would think 

    should radically change our comfortable assumptions that we know who

    is terminally ill, and that we could provide different care, and advise them

    with high confidence."

    Joanne Lynn, M.D. (referring to a study on the accuracy of doctors' prognoses),

    "Doctors Poor at Predicting Time to Death," Reuters, 3/18/97. 


   "Statistical estimates of prognosis to designate a category of 'terminally

    ill'  patients for policy purposes [like assisted suicide] is unavoidably

    arbitrary, will often be contested, and have differential effects upon those

   dying with differing disease."

   Joanne Lynn, M.D. et al., "Prognoses of Seriously Ill Hospitalized Patients on the Days 

   before Death: Implications for Patient Care and Public Policy," New Horizons, 2/97, pp.

   56-61.

 

"Safeguards" are Quickly Eroded
It is impossible to limit assisted suicide to "terminally ill", competent patients. Legalizing assisted suicide would establish a strong likelihood that guardians of terminally ill incompetent patients be allowed to authorize the direct killing of their wards. One need only look to the Netherlands for an example of what is likely to happen.

   "…Dutch efforts at regulating assisted suicide and euthanasia have

   served as a model for proposed statutes in the United States and other

   countries. Yet the Dutch experience indicates that these practices defy

   adequate regulation. Given the legal sanction, euthanasia, intended

   originally for the exceptional case, have become an accepted way of

   dealing with serious or terminal illness in the Netherlands. In the process,

   palliative care is one of the casualties, while hospice care lags behind

   that of other countries. 

   Herbert Hendin MD, American Foundation for Suicide Prevention 
   Chris Rutenfrans, PhD, Department of Justice, The Hague 
   Zbigniew Zylicz, MD, Hospice Rosenhuyvel


Does Not Adequately Protect Vulnerable Patients
The New York State Task Force on Life and the Law convened by former Governor Mario Cuomo issued a 220 page report in May 1994 unanimously recommending against practices similar to those proposed by LD 916. "No matter how carefully any guidelines are framed, assisted suicide and euthanasia will be practiced through the prism of social inequality and bias that characterizes the delivery of services in all segments of our society, including health care. The practices will pose the greatest risks to those who are poor, elderly, members of a minority group, or without access to good medical care."

"In light of the widespread failure of American medicine to treat pain adequately or to diagnose and treat depression, legalizing assisted suicide and euthanasia would be profoundly dangerous...The risks would be most severe for those who are elderly, poor, socially disadvantaged, or without access to good medical care. The risks for these individuals, in a health care system and society that cannot effectively protect against the impact of inadequate resources and ingrained social disadvantage, are likely to be extraordinary."

 

N.Y. State Task Force on Life and the Law, Supplement to When Death is Sought - Assisted Suicide and Euthanasia in the Medical Context, May 1994; p. xiii.

 

The Slippery Slope & the Netherlands Experience
In the Netherlands, euthanasia has become an accepted part of Dutch medical practice. Euthanasia was originally adopted in much the same way as it is being introduced in America -- to increase patient autonomy and provide a compassionate solution for those who are suffering with terminal illness. Arguments that voluntary euthanasia would lead to involuntary euthanasia were dismissed.

 

The Netherlands situation began with assisted suicide for terminally ill adult patients only. The practice soon was expanded to non-terminal, adult patients (those with cancer or advanced multiple sclerosis). Children were then allowed the right even if their parents disapproved. By 1990 the practice had been extended to include non-voluntary situations – patients who had not otherwise requested assisted suicide. And in June of 1994, the Dutch Supreme Court expanded lethal injections to those with mental suffering who were otherwise in good health.

 

According to Dutch physician, Richard Fenigsen, euthanasia is practiced "on a very large scale", not only in terminal cases, but also on people with various chronic ailments and with psychological disorders. "Many doctors arbitrarily terminate patients' lives without patient's request, consent or knowledge", says Dr. Fenigsen.

 

Data from a government study show that over 5000 people die each year by euthanasia -- 19.4% of all deaths. Over half of those deaths can be classified as involuntary euthanasia. "Low quality of life", "no prospect for improvement", and "the family could not take it any more" were among the reasons cited most often for terminating the patients life without his or her consent.

 

Depression and Suicide
Most terminal patients seek suicide not because they are ill, but because they are depressed. Depression is treatable and it is the depression, not the disease, which makes such persons suicidal. Suicide rates in persons with terminal illness are only between 2-5%.

 

The American Journal of Psychiatry in 1986 concluded: "The striking feature of (our) results is that all of the patients who had either desired premature death or contemplated suicide were judged to be suffering from clinical depressive illness; that is, none of those patients who did not have clinical depression had thought of suicide or wished that death would come early."

 

Suicidologist Dr. David C. Clark notes that depressive episodes in the seriously ill are not less responsive to medication than depression in others. And psychologist Joseph Richman, former president of the American Association of Suicidology, says "effective psychotherapeutic treatment is possible with the terminally ill, and only irrational prejudices prevent the greater resort to such measures."

"Lots of my dying patients say they grow in bounds and leaps, and finish all the unfinished business. (But assisting suicide) is cheating them of these lessons, like taking a student out of school before final exams. That's not love, it's projecting your own unfinished business."

 

Dr. Elisabeth Kubler Ross 
"Psychiatrists' confidence in their ability to determine whether a psychiatric disorder such as depression was impairing the judgment of a patient requesting assisted suicide was low."

 

Linda Ganzini, M.D., et al., "Attitudes of Oregon Psychiatrists Toward Physician-Assisted Suicide," American Journal of Psychiatry, Nov. 1996, pp. 1469-1475. 
"In addition, one third of the respondents (Oregon physicians) are not confident they could recognize depression in a patient asking for a lethal dose of medication."

 

The New England Journal of Medicine, Feb. 1, 1996, Vol. 334, No. 5, p. 313. 
"The diagnosis of depression is difficult to make in medically ill patients."

 

K. M. Foley, M.D., Memorial Sloan-Kettering Cancer Center, Cornell University, in The New England Journal of Medicine, Vol. 336, p. 55-58. 
"In my experience, cancer patients don't want suicide. They want help. They want to live" Dr. Carroll has treated approximately 8,000 cancer patients in 30 years and has experienced only 5 suicides.

 

Dr. Ron Carroll, Maine Center for Cancer Medicine

 

The Alternatives - Hospice Care
Offering suicide to a dying patient is not compassionate care. Doctors who offer death communicate hopelessness, not compassion. It sends the message that the lives of elderly, disabled, and dependent citizens are not worth living. Hospice care is a positive alternative which addresses the emotional, spiritual and physical needs of dying patients.

 

"From our extensive experience working with individuals who are dying, what they have asked for is good pain and symptom management, the support of family and friends, comprehensive, compassionate health care and resolution of spiritual issues."

 

Maine Hospice Council Executive Director, Kandyce Powell

 

...And Pain Management
The better response to patients in pain is not to kill them but to make sure that the medicine and technology currently available to control pain is used more widely and completely.

 

A 1992 manual produced by the Washington Medical Association, Pain Management and Care of the Terminal Patient says "adequate interventions exist to control pain in 90- 99% of patients." (Research shows that only .04% of patients treated with morphine become addicted)

"We frequently see patients referred to our Pain Clinic who request physician assisted suicide because of uncontrolled pain. We commonly see such ideation and requests dissolve with adequate control of pain and other symptoms, using combinations of pharmacologic, neurosurgical, anesthetic, or psychological approaches.

 

July 1991 Journal of Pain and Symptom Management, Dr. Kathleen Foley, chief of Pain Services at the Memorial Sloan Kettering Cancer Center in New York

 

What Suicide Proponents Have to Say...
"Predicting the outcome of social legislation with certainty may not be possible. It may be that the safeguards in the Act [Measure 16] do not exclude the possibility that a request for aid in dying could result from pressure on the patient from venal or cruel relatives. Nor can misdeeds by unethical physicians be excluded with certainty." 


Peter Goodwin, M.D. (chairman of Oregon Right to Die during the 1994 Measure 16 campaign), "Oregon's Physician-Assisted Suicide Law: An Alternative Positive Viewpoint," Archives of Internal Medicine, August 11/29, 1997, pp. 1642-1644.


Hemlock Society Endorses Nonvoluntary Direct Killing
In a "slippery slope" development long predicted by euthanasia opponents, the Hemlock Society USA, the leading group promoting the legalization of assisting suicide, on issued a statement endorsing killing individuals --such as people with Alzheimer's disease and children with disabilities--who are legally incapable of making the decision themselves. The statement was issued in the context of a Louisiana case in which a jury December 4 convicted David Rodriguez of second degree murder in the shooting death of his 90-year-old father, who had Alzheimer's disease.

 

"A judicial determination should be made when it is necessary to hasten the death of an individual whether it be a demented parent, a suffering, severely disabled spouse or a child. Consultants should evaluate what other ways might be used to alleviate the suffering and, if none are available or are unsuccessful, a non-violent, gentle means should be available to end the person's life."

 

"Even with such a law, there are many people suffering from chronic and terminal illnesses who ... are not competent to make this decision and are in those instances assisted to die by a loved one." The statement said that in such cases "mercy killing is not a cold-blooded, malicious crime but one in which the motivation is kindness and relief of suffering."

 

"In the case of a minor or an incompetent adult, the law now allows life or death decisions to be made by a designated health care agent and/or a family member in most jurisdictions," the Hemlock USA statement said. "If the Rodriquez death had been the result of a decision to forego life- sustaining medical treatment no criminal liability would have ensued. In such instances, the person ‘dies naturally.' Some provision should be made for a situation in which life is not being sustained by artificial means but, in the belief of the patient or his agent, is too burdensome to continue."

 

Hemlock Society USA Executive Director Faye Girsh December 3, 1997

 

Burke J. Balch, J.D., Director of National Right to Life's Department of Medical Ethics, commented, "It should be noted that Girsch's statement endorses the killing not only of those who are ‘terminally ill' but also just ‘chronically' ill--which in Hemlock's definition undoubtedly covers people with permanent disabilities. Then, Hemlock drops the requirement that euthanasia be voluntarily chosen by a competent adult. The agenda of the euthanasia movement is now in the open for all to see: not respect for individual choice, the slogan with which they deceived the people of Oregon, but elimination of those whose ‘quality of life' does not meet Hemlock's standards."


The "Right to Die" Becomes the "Duty to Die"
"Simply put, an individual's so-called 'right to die,' over time, can be transformed into a demand by society that certain individuals have a 'duty to die.'"

 
C.T. Canady, "Physician-Assisted Suicide and Euthanasia in the Netherlands: A Report of Chairman Charles T. Canady to the Subcommittee on the Constitution of the Committee on the Judiciary," House of Representatives, 104th Congress, Sept. 1996, p. 21. 
"There can be a duty to die before one's illnesses would cause death, even if treated only with palliative measures.... Finally, there can be a duty to die when one would prefer to live. Granted, many of the conditions that can generate a duty to die also seriously undermine the quality of life. Some prefer not to live under such conditions. But even those who want to live can face a duty to die."

 

John Hardwig, Ph.D., "Is There a Duty to Die?", Hastings Center Report, March-April 1997, pp. 34-42.

What We Have Learned From Oregon
(Physician Assisted Suicide)

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