Doctor/Medical Assisted Suicide

[DrPhil]

This spans beyond Dr. Jack Kevorkian.

Originally Posted by article

Dr. Richard Wesley has amyotrophic lateral sclerosis, the incurable disease that lays waste to muscles while leaving the mind intact. He lives with the knowledge that an untimely death is chasing him down, but takes solace in knowing that he can decide exactly when, where and how he will die.

Under Washington State's Death With Dignity Act, his physician has given him a prescription for a lethal dose of barbiturates. He would prefer to die naturally, but if dying becomes protracted and difficult, he plans to take the drugs and die peacefully within minutes.

“It’s like the definition of pornography,” Dr. Wesley, 67, said at his home here in Seattle, with Mount Rainier in the distance. “I’ll know it’s time to go when I see it.”

http://www.msnbc.msn.com/id/48637191...h-health_care/


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There is so much that goes into this topic. GCers, what do you think about the states that have legalized assisted suicide and the states for which it remains illegal? What do you think about the larger issue of assisted suicide?

If you do not want to share your opinion, feel free to just vote in the poll.

[Kevin]

That said, the Washington State law makes a lot of sense. The law only serves people with a terminal diagnosis. There was probably some concern that the law would be expanded to include folks without terminal disease or that doctors and/or insurance companies would pressure folks into selecting life-ending treatment, but that simply hasn't happened. Some are going to object on religious grounds. In states like mine, those folks are going to be in the majority for quite some time.

[AXOmom]

I'm not going to express an opinion at this point, but just as an informational note - Oregon was the first state to pass a Death with Dignity Act (1997 I believe). Washington followed in 2009.

[DrPhil]

State laws on assisted suicide.

Originally Posted by AXOmom

I'm not going to express an opinion at this point, but just as an informational note - Oregon was the first state to pass a Death with Dignity Act (1997 I believe). Washington followed in 2009.

1994. Oregon was ahead of their time.

Originally Posted by Kevin

That said, the Washington State law makes a lot of sense. The law only serves people with a terminal diagnosis. There was probably some concern that the law would be expanded to include folks without terminal disease or that doctors and/or insurance companies would pressure folks into selecting life-ending treatment, but that simply hasn't happened. Some are going to object on religious grounds. In states like mine, those folks are going to be in the majority for quite some time.

I agree, especially with the bolded.

[AOII Angel]

Meh. Patients don't need a physician to assist them to commit suicide, IMHO. A physician has a duty to do no harm. I think it puts physicians in a tough position.

[Kevin]

Originally Posted by AOII Angel

Meh. Patients don't need a physician to assist them to commit suicide, IMHO. A physician has a duty to do no harm. I think it puts physicians in a tough position.

"Harm" is an awfully difficult word to define.

At some point, wouldn't not carrying out the express wishes of the patient when they have a very painful death approaching and a no hope terminal diagnosis actually be harmful?

I responded "maybe, depends on the illness" for the record. I don't think physician assisted suicide should be available for anyone without a terminal diagnosis and a short amount of time to live. Once the decision is made, it's awfully tough to reverse course. Also, I don't want anyone with mental illness to think of physician assisted suicide as a means to deal with the symptoms of their illness.

[DrPhil]

Originally Posted by AOII Angel

Meh. Patients don't need a physician to assist them to commit suicide, IMHO. A physician has a duty to do no harm. I think it puts physicians in a tough position.

I agree. I actually agree with aspects of both sides of the issue.

Thanks for providing one medical doctor's perspective.

[AOII Angel]

Originally Posted by Kevin

"Harm" is an awfully difficult word to define.

At some point, wouldn't not carrying out the express wishes of the patient when they have a very painful death approaching and a no hope terminal diagnosis actually be harmful? No. They can commit suicide without the help of a physician. It's been done for millennia.

I responded "maybe, depends on the illness" for the record. I don't think physician assisted suicide should be available for anyone without a terminal diagnosis and a short amount of time to live. Once the decision is made, it's awfully tough to reverse course. Also, I don't want anyone with mental illness to think of physician assisted suicide as a means to deal with the symptoms of their illness.

The physician's job is not to carry out every wish of the patient. That does not constitute harm.

[Kevin]

Originally Posted by AOII Angel

The physician's job is not to carry out every wish of the patient. That does not constitute harm.

I didn't say that at all.

Ever hear the phrase "Doing more harm than good"? Physicians have been known to be guilty of that from time to time despite trying to do no harm. In some cases, the best course of treatment for a patient is for that patient to die. Why not let physician assisted suicide ensure the patient's passing is as peaceful as possible?

Under the Washington law, the physician isn't actually the person pulling the trigger, so to speak. They simply provide a surefire and pain-free means to an end. The physical act of suicide is done by the patient according to the law, even if that means knocking some pills into the feeding tube or whatever.

[ComradesTrue]

Originally Posted by Kevin

In some cases, the best course of treatment for a patient is for that patient to die. Why not let physician assisted suicide ensure the patient's passing is as peaceful as possible?

Yes, there are many, many occasions when the best course of treatment is to let a patient go comfortably. However, there are already procedures in place for that- hospice care.

What many aren't aware of is that often the physician recognizes when artificial life-extending measures are futile and they DO recommend hospice care. It is often the families, who for a whole gamut of reasons (denial, guilt, hope, faith, etc), are unwilling to let the loved one go peacefully and request "full code" status. (this would be the case when loved one is unable to make own medical decisions and next of kin is required)

However, hospice care and families unwilling to let grandmama go peacefully is a whole 'nother topic and not what Dr Phil is asking about. Therefore, I won't dereail. Just wanted to clarify that artificial measures to extend life in a futile situation are done at patient and family request, not because a physician just wants to. There is also not a need for physician assisted suicide to allow a patient to die comfortably. Hospice is an excellent alternative.

#marriedtoanoncologist #heartragicfamilystoriesdaily

[DrPhil]

Blondie93, please feel free to discuss a range of topics that fuel your opinion on physician assisted suicide.

I tried to include other alternatives in the poll.

[AGDee]

I'm for it, not just in terminal illness cases but in severe disability which precludes any quality of life such as quadraplegia at the C1 or C2 level, severe stroke impairment that will not improve, etc. It isn't really possible for all patients to do it by themselves because some are physically unable to obtain the means.

I'm also pro-hospice, but have seen people suffer up until the very last minute, even while hospice was trying to keep them comfortable. If pain is so great that no pain meds can touch it and a patient is terminal and conscious, it's a pretty awful situation.

I also think "do no harm" can be interpreted a lot of ways. I also struggle with the religious arguments against it. The argument I usually hear is that it is "playing God" and such things should be left up to God. But I never hear that argument go in the other direction. Most (not all) are ok with taking all kinds of medical extreme measures to prolong a life. Isn't this playing God too? Where do we draw that line? People used to die from all kinds of infections that we now treat easily with penicillin. People died of heart problems that are much more easily treated now. If our time and manner of death is all predetermined, then why treat anything? For these reasons, I don't buy into that argument. I just can't understand where the line is. It's one of my first questions for Him when I die. (I have a whole list of these types of questions)

These are all reasons why it is important for people to have patient advocates and Living Wills, if they feel strongly about not being in certain circumstances.

[Splash]

I think it should be legal under extremely strict conditions. Just some, but not limited to:

-A terminal illness where the patient will die in a set amount of time (Not necessarily the amount, but 3 months as an example)
-The choice to be able to choose death in this situation must be signed and document FAR prior to the decision being made. A set amount of time AND that the person has not been yet deemed terminal - they need to make the decision to be able to choose death if they want, when they are of a more sane mind
-Over 18, I don't think parents should be able to choose for children. I think any children or ANYONE who is dependent upon someone else's decisions (a mentally retarded person for example) should NOT be eligible for choosing death. It needs to be a decision the person makes themself

Some others, but I think if it is legal, these are certain provisions that must be upheld

[AOII Angel]

Originally Posted by Blondie93

Yes, there are many, many occasions when the best course of treatment is to let a patient go comfortably. However, there are already procedures in place for that- hospice care.

What many aren't aware of is that often the physician recognizes when artificial life-extending measures are futile and they DO recommend hospice care. It is often the families, who for a whole gamut of reasons (denial, guilt, hope, faith, etc), are unwilling to let the loved one go peacefully and request "full code" status. (this would be the case when loved one is unable to make own medical decisions and next of kin is required)

However, hospice care and families unwilling to let grandmama go peacefully is a whole 'nother topic and not what Dr Phil is asking about. Therefore, I won't dereail. Just wanted to clarify that artificial measures to extend life in a futile situation are done at patient and family request, not because a physician just wants to. There is also not a need for physician assisted suicide to allow a patient to die comfortably. Hospice is an excellent alternative.

#marriedtoanoncologist #heartragicfamilystoriesdaily

Exactly. This is a far different discussion than life extending procedures for the elderly patients that family members just won't let die. SOME physicians may do these procedures in a misguided attempt to make more money, but for the most part, the problem lies with a lack of education (remember the while death panel debate when the Obama administration dared to suggest that physicians get paid for discussing end of life issues with patients) or guilt that prevents patients and their families from agreeing to stop. Futile care is NOT something that physicians enjoy forcing on patients.

Originally Posted by AGDee

I'm for it, not just in terminal illness cases but in severe disability which precludes any quality of life such as quadraplegia at the C1 or C2 level, severe stroke impairment that will not improve, etc. It isn't really possible for all patients to do it by themselves because some are physically unable to obtain the means.

I'm also pro-hospice, but have seen people suffer up until the very last minute, even while hospice was trying to keep them comfortable. If pain is so great that no pain meds can touch it and a patient is terminal and conscious, it's a pretty awful situation.

I also think "do no harm" can be interpreted a lot of ways. I also struggle with the religious arguments against it. The argument I usually hear is that it is "playing God" and such things should be left up to God. But I never hear that argument go in the other direction. Most (not all) are ok with taking all kinds of medical extreme measures to prolong a life. Isn't this playing God too? Where do we draw that line? People used to die from all kinds of infections that we now treat easily with penicillin. People died of heart problems that are much more easily treated now. If our time and manner of death is all predetermined, then why treat anything? For these reasons, I don't buy into that argument. I just can't understand where the line is. It's one of my first questions for Him when I die. (I have a whole list of these types of questions)

These are all reasons why it is important for people to have patient advocates and Living Wills, if they feel strongly about not being in certain circumstances.

The problem with some of these impairments is that these people can't be judged as able to make their own decisions. How can you "assists" them to commit suicide when they are not competent? That isn't suicide or assisted suicide. That is murder, and that is definitely asking too much of a physician. Unfortunately, there is some suffering in this world. I do believe we CAN do better in controlling pain. Treating the pain adequately may hasten death, so be it. I believe in withholding life extending measures, ie. feeding tubes, vents, when those measures will not provide a quality life for the patient or they have no chance of recovery. I do not believe in specifically causing a patient's death, and I thing the vast majority of physicians see it that way.

Your entire second paragraph is nonsensical.

[Kevin]

And yet... from the New England Journal of Medicine, an abstract:

BACKGROUND

Since the Oregon Death with Dignity Act was passed in November 1994, physicians in Oregon have faced the prospect of legalized physician-assisted suicide. We studied the attitudes and current practices of Oregon physicians in relation to assisted suicide.
Full Text of Background...

METHODS

From March to June 1995, we conducted a cross-sectional mailed survey of all physicians who might be eligible to prescribe a lethal dose of medication if the Oregon law is upheld. Physicians were asked to complete and return a confidential 56-item questionnaire.
Full Text of Methods...

RESULTS

Of the 3944 eligible physicians who received the questionnaire, 2761 (70 percent) responded. Sixty percent of the respondents thought physician-assisted suicide should be legal in some cases, and nearly half (46 percent) might be willing to prescribe a lethal dose of medication if it were legal to do so; 31 percent of the respondents would be unwilling to do so on moral grounds. Twenty-one percent of the respondents have previously received requests for assisted suicide, and 7 percent have complied. Half the respondents were not sure what to prescribe for this purpose, and 83 percent cited financial pressure as a possible reason for such requests. The respondents also expressed concern about complications of suicide attempts and doubts about their ability to predict survival at six months accurately.
Full Text of Results...

CONCLUSIONS
Oregon physicians have a more favorable attitude toward legalized physician-assisted suicide, are more willing to participate, and are currently participating in greater numbers than other surveyed groups of physicians in the United States. A sizable minority of physicians in Oregon objects to legalization and participation on moral grounds. Regardless of their attitudes, physicians had a number of reservations about the practical applications of the act.

http://www.nejm.org/doi/full/10.1056...99602013340507

This, of course, was a survey taken a long time ago, even before Oregon legalized physician assisted suicide. It'd be interesting to see where things stand now, but I couldn't find such an article. From the more recent literature, I think you overstate your case when you say the "vast majority" of physicians feel as you do. I've read several polls at this point, some conducted by professional researchers and I might go so far as to say physicians are 60/40 against physician assisted suicide.

Originally Posted by AOIIAngel

The physician's job is not to carry out every wish of the patient. That does not constitute harm.

I don't think anyone would suggest that you're wrong. At least not in absolute terms. That doesn't mean that the physician has the sole authority for deciding what is in the patient's best interests and what is harmful. Doesn't the medical community employ ethics panels for that very reason? Because physicians on their own can sometimes lack objectivity?