The evolving policy on physician-assisted suicide
October 1, 2009 4 minutes read
The evolving policy on physician-assisted suicide
Article says four groups adopted policy in 2008
Calling it "a significant turning point in American society's evolution to empower terminally ill patients with information and choices about how they will die," an article by the director of legal affairs for Compassion & Choices points to four medical professional and health policy organizations that have adopted policy to support physician-assisted suicide.
Compassion & Choices, however, refers to this as "aid in dying."
The organizations that have adopted such policies, according to the article, include the American Public Health Association, the American Medical Women's Association, the American College of Legal Medicine, and the American Medical Student Association.
"Certainly, if you look at polling across the country, the public support for the choice of aid in dying . . . has certainly grown over time," says Kathryn L. Tucker, JD, director of legal affairs for Compassion & Choices.
Tucker also stresses that the choice of aid in dying is something she views "as a medical term of art which refers to a physician who writes the prescription to a mentally competent, terminally ill patient [who] can self-administer to bring about a peaceful death, if they find their dying process unbearable."
"There's a lot of poll data that reflects that, but apart from that is that there's growing support for this intervention in the medical community," Tucker tells Medical Ethics Advisor.
Tucker suggests that the support from these medical organizations in 2008 "is very much tied to an evidence-based review of what has happened in Oregon."
There are organizations, however, such as the American Medical Association in Chicago, that do not support physician-assisted suicide.
Currently, both Oregon and Washington allow physician-assisted suicide.
A third court case, Baxter v. Montana, has been heard by the Montana Supreme Court, and the parties are waiting on that court's decision, perhaps to be decided by the end of the year, Tucker says.
Going on record
Tucker says she credits the American Public Health Association with "speaking out, because it is a public health issue . . . in a couple of senses."
"One, we know that where aid in dying is not affirmatively legal, it goes on in the back alley, covertly, and that we know from studies that when that back alley practice happens, it's more dangerous for patients, there are more complications, and it's much more stressful for the patient and the family," she notes.
Tucker says that by "back alley" practice — a term familiar to abortion proponents — she is suggesting that studies that show the practice of physician-assisted suicide "goes on everywhere."
"What we don't know is when it happens covertly, meaning, in an extralegal environment or in an environment where there haven't been boundaries established either by the legislature or by a court decision, then what you have is a completely unregulated, covert practice," she says.
In unregulated environments, she says, you have physicians who "don't feel comfortable, and in fact, feel fearful about discussing a particular case with a colleague, for example, and so that doesn't happen. And you miss that second opinion, or collegial input, that you might otherwise have."
She points out that in Oregon and Washington, where physician-assisted suicide is legal, both states require a second physician opinion in a lengthy process toward granting the permission to seek a lethal prescription.
"So, you lose that. You lose the opportunity for really candid and open discussion, where the physician feels comfortable exploring whether the patient has considered a full range of options, such as hospice, aggressive palliative care, etc.," Tucker notes.
A bioethicist's perspective
Rosamond Rhodes, PhD, is a professor of medical education and director of bioethics education at Mount Sinai School of Medicine in New York City. In the late 90s, she published an essay titled, "Physicians, Assisted Suicide, and the Right to Live or Die." That essay was included in the book Physician-Assisted Suicide: Expanding the Debate, for which she also served as an editor.
One of the aims of the article, she states within it, is "to show how the concept of a right to life actually supports the case for physician-assisted suicide."
There are other essays in the book that offer the polar opposite view of any participation by physicians in contributing to a dying patient's right to end his or her own life.
Rhodes says that there are "significant majorities all over the country [that] support allowing people to make these decisions for themselves."
She tells Medical Ethics Advisor that the Patient Self-Determination Act of 1990, a federal law " requires that every state have a mechanism to allow patients to refuse medical treatment, including life-preserving, life-prolonging treatment."
"So, as federal law, we recognize that a patient may require a medical treatment to continue living, and we know that discontinuing the treatment will hasten the patient's death. Yet, people are required — by law — to honor the patient's request," Rhodes says.
In a scenario that many doctors face daily with ventilator-dependent patients by making a decision based on the patient's request to remove the ventilator, there is very little difference with the scenario presented by physician-assisted suicide, Rhodes says.
"As far as I'm concerned, there is no significant moral or factual difference between withdrawing life-preserving treatment and any other way of hastening death," she tells MEA.
Reference
- Kathryn L. Tucker. At the Very End of Life: The Emergence of Policy Supporting Aid in Dying Among Mainstream Medical & Health Policy Associations. Harvard Health Policy Review. 2009. 10; 1:45-47.
Sources
- Rosamond Rhodes, PhD, Professor, Medical Education; Director, Bioethics Education. Mount Sinai School of Medicine, New York, NY. E-mail: [email protected].
- Kathryn L. Tucker, JD, Director of Legal Affairs, Compassion & Choices. E-mail: [email protected].
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