assisted suicide


Why A Leading End-Of-Life Specialist Opposes Assisted Suicide

By Dr. Ira Byock
Guest contributor

Dr. Ira Byock, considered one of the country’s leading palliative care specialists, is the chief of palliative care at Dartmouth Hitchcock Medical Center and author most recently of “The Best Care Possible.” He opposes Question 2, the Massachusetts ballot question that would allow terminally ill patients to request prescriptions for life-ending drugs, and here he explains why:

My take is as a doctor who has been caring for seriously ill people for over 30 years. I’m also a lifelong political progressive. But I have a different perspective on physician-assisted suicide than many liberal Americans and many of the voters in Massachusetts.

Dr. Ira Byock

Dr. Ira Byock

One thing on which we all agree is that there is a true national crisis that surrounds the way Americans are dying. The folks who are trying to legalize physician-assisted suicide are well-intended but I think they’re making a serious error. The crisis that surrounds our way of dying is a crisis of our own making: A chilling admixture of excessive medical treatment on one hand and near social abandonment on the other. While doctors are not the cause of this, we’re not entirely free of blame either.

Medical education is deficient not only in instruction on pain but on communicating with patients, discussing diagnoses, helping patients and families sort through their business and reach a satisfying sense of life completion. Many of the people I meet who are facing the end of life are suffering not just from their physical conditions but from the indignities our health system imposes: The inability to pay medical bills, watching family savings dwindle…

‘It will quite literally be easier to get a lethal prescription in Massachusetts than to have hospice care through the end of your life.’

I don’t practice in Massachusetts but I’m appalled that some of the prominent spokespeople in favor of physician-assisted suicide are physicians who have no experience in caring for dying patients. Some are part of Big Medicine, the medical-industrial complex which takes care of us really well as long as it can bill us, but doesn’t have much use for us when our conditions become incurable and billing opportunities wane.

Proponents of Question 2 allege that those of us who are physicians who oppose assisted suicide are somehow protecting our own sensibilities and the profession. They have turned our stance on its head. The prescription against physicians killing patients has been in place since the beginning of the medical profession as a progressive value to protect vulnerable patients.

Physicians always have more power than patients and once it is legal, physicians will agree to write a lethal prescription when they cannot imagine anything else to do for a patient. But I know from 34 years of clinical experience that the limitation is within the physician – in his or her ability to imagine what else we might do. Perhaps the physician is undertrained in end-of-life care, or exhausted and spent, or has had a fight with a spouse or is simply over his or her head. That’s why we work in teams. That’s why we have professional principles that stop us from doing things that violate medical ethics. Continue reading

Share The Story Behind Your Opinion On Assisted Suicide — Here’s Mine

(Photo illustration by Alex Kingsbury/WBUR)

Yesterday, we took a look at the contributions flowing to both sides of Question 2, the measure on assisted suicide that is on next month’s Massachusetts ballot.

As I noted, I was struck by the hundreds of small individual contributors to support Question 2, also known as Death With Dignity — about 500, by my rough count. Several dozen contributed to the opposition as well.

And here’s what I thought: I bet just about every one of the people on either side of the issue has a story. They’ve witnessed a death, and that experience influenced their opinion. So here’s an open invitation: Won’t you share your story in the Comments section below?

Here’s mine:

As I’ve written here before, my mother was in a terrible accident that left her in a persistent vegetative state, and when all hope was gone, we brought her home to die in accordance with her very clear wishes.

We couldn’t just give her an overdose. But we could “withhold care,” so we stopped her tube feedings to let her effectively starve to death. She lay in a hospital bed at home for nine days, slowly fading. Even knowing her wishes, and with support from the most saintly and sensitive hospice workers, it was a nightmare.

At one point, a hospice doctor told us that if my mother showed any signs of discomfort, her morphine dose could be increased. I remember snapping at him something like: “Why in the world would we wait for her to show ‘signs of discomfort’? Crank the morphine all the way up now! Why let there be even a chance of pain? The point here is for her to die, and if the morphine depresses her breathing and hastens that along, so much the better!”

Continue reading

Showing You The Money: Donations For And Against Assisted Suicide

suicide finance

(Source: The Massachusetts Secretary of State’s Website)

In ages of yore, you had to trek into a state office building and shuffle through piles of papers to discern which political forces were backing which candidates and ballot initiatives. These days, thankfully, everything is only a click or two away.

I was wondering about the funding of Question 2 — also known as Death with Dignity and physician-assisted suicide — and all I had to do was drop in to this crystal clear section of the Secretary of State’s Web presence. It lists the groups that support or oppose Question 2, how much money they’ve taken in and how much they’ve spent. (My, my, it also shows about $1 million in support of medical marijuana and only about $3,000 in opposition — but that’s another topic.)

If you drill down just a bit, by clicking on a particular sum, you can see specifically who contributed, and how much. For example, I clicked here to see the breakdown of the $2 million in contributions to the main Question 2 opposition group, The Committee Against Physician Assisted Suicide.

Expectably, there’s a strong Catholic presence. There’s also $250,000 from American Family Association Inc., with the notation that it was refunded. The Associated Press reported last month that the American Family Association is a Mississippi-based group with anti-gay views, and the Question 2 opponents returned the money “in the interest of more focused debate.”

If you click on Dignity 2012, major supporters of the measure who’ve pulled in nearly $500,000, you see money from two national organizations, Death With Dignity National Center and Compassion & Choices, and then a very long list of mainly small donations from individuals.

I didn’t count carefully, but a rapid scroll through suggests there are about 500 names there, while I see only about 40 names of individuals on the list of donations to the opponents. Readers, if you scan the lists, does anything else strike you?

Reader Connects Health Rationing Argument To ‘Death With Dignity’

third rail

( via Flickr/Creative Commons)

The New York Times letter page carries a bounteous harvest of responses today to a provocative recent opinion piece titled “Beyond Obamacare” that began, “We need death panels.”

Opinion writer Steven Rattner went on:

Well, maybe not death panels, exactly, but unless we start allocating health care resources more prudently — rationing, by its proper name — the exploding cost of Medicare will swamp the federal budget.

But in the pantheon of toxic issues — the famous “third rails” of American politics — none stands taller than overtly acknowledging that elderly Americans are not entitled to every conceivable medical procedure or pharmaceutical.

Today, one reader responds by connecting dots between rationing and physician-assisted suicide (which is on the upcoming Massachusetts ballot and was discussed today on WBUR’s Morning Edition.) Readers, thoughts?

To the Editor:

Steven Rattner wants to reduce medical costs by not offering “every treatment, regardless of expenses or efficacy” in the last year of life. That’s reasonable — if and when we give the elderly (I am one of them) the right to choose their own gentle death, something that many religions would obstruct.

But even before we get to that, let’s consider the 76 million baby boomers who are or will be retiring and will drain Medicare. Would they be willing to join me in choosing death with dignity? Or would they prefer heart transplants at 85?

Baltimore, Sept. 17, 2012

What Mass. Can Learn From Oregon About Dying With Dignity

Death is an emotional thing.

And debate over whether to allow terminally ill patients to end their lives by taking a lethal dose of medication — the question facing Massachusetts voters in November — is particularly fraught. Just listen to the charged on-air exchange between supporters and opponents of Question 2 — aka, The Death With Dignity Act, aka, physician-assisted suicide — on Radio Boston earlier this week.

So we thought it might help to start with some cold, hard statistics from the state that knows the issue best.

In 1994, Oregon voters approved the first-in-the-nation right-to-die law allowing terminally ill adults to obtain and use prescriptions from their physicians for self‐administered, lethal doses of medications. After a failed repeal effort, the law was enacted in 1997. Each year, Oregon’s Public Health Division is required to collect certain information and issue annual reports. Here are some of the latest stats from Oregon:

• Since the law was passed in 1997, a total of 935 people have had Death With Dignity Act prescriptions written and 596 patients have died from ingesting medications prescribed under the DWDA.

• Of the 71 DWDA deaths during 2011, most (69.0%) were aged 65 years or older; the median age was 70. As in previous years, most were white (95.6%), well‐educated (48.5% had a least a baccalaureate degree), and had cancer (82.4%).

• Most (94.1%) patients died at home; and most (96.7%) were enrolled in hospice care either at the time the DWDA prescription was written or at the time of death. Most (96.7%) had some form of health care insurance, although the number of patients who had private insurance (50.8%) was lower in 2011 than in previous years (68.0%), and the number of patients who had only Medicare or Medicaid insurance was higher than in previous years (45.9% compared to 30.4%).

• As in previous years, the three most frequently mentioned end‐of‐life concerns were: decreasing ability to participate in activities that made life enjoyable (90.1%), loss of autonomy (88.7%), and loss of dignity (74.6%). Continue reading

Mass. Medical Society Opposes Measures On Pot And Assisted Suicide

medical marijuana sign

(Photo: Laurie Avocado via Wikimedia Commons)

This just in from the Massachusetts Medical Society:

The Massachusetts Medical Society, the statewide professional association of physicians with more than 24,000 members, today officially declared its opposition to the November ballot questions on physician-assisted suicide and medical marijuana.

“These are important health care questions for the state,” said Richard Aghababian, M.D., the Society’s president, “and patients deserve to know what we think and where we stand on these issues.”

Dr. Aghababian said the Society’s positions on Question 2, Prescribing Medication to End Life, and on Question 3, Medical Use of Marijuana, are consistent with the organization’s long-standing policies against physician-assisted suicide and the use of marijuana as medicine, as voted by member physicians of the organization’s House of Delegates.

He said the Society has prepared printed and online materials on both questions stating the reasons behind its opposition and is making those materials available to physicians and patients.

The society has posted its materials on suicide here and on marijuana here. And I see they’re using the hashtag #question2 on Twitter.