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Subscribe to RSSOf the numerous ballot initiatives that will be decided at the state level on Tuesday, none is more hotly contested than the Massachusetts bill to decide whether to legalize physician-assisted suicide. The citizens of Massachusetts, my home state, should vote to legalize.
The proposed measure allows terminally ill patients to be given access to lethal drugs. A terminally ill patient is defined as someone with six months or less to live. The patient’s terminal diagnosis and mental competency must be attested to by two doctors. Patients would have to make a request to their doctor twice orally and once in writing. The written request would have to be witnessed.
Yet even with such restrictive conditions, opponents of the proposal say doctors should never, as a matter of professional ethics, intentionally hasten the death of one of their patients, even one who is terminally ill. The codes of medicine and nursing ethics reject helping patients die.
Many professional organizations, including the American Medical Association, agree. The AMA "strongly opposes any bill to legalize physician-assisted suicide" because the practice is "fundamentally inconsistent with the physician's role as healer." The Massachusetts Medical Society also opposes the bill. “Allowing physicians to participate in assisted suicide would cause more harm than good,” Dr. Lynda M. Young, the society’s past president told Massachusetts legislators earlier this year. “Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer."
Some disability groups and religious organizations are fighting hard to get a "no" on the “Question 2,” initiative as well. They believe that the terminally ill who are disabled deserve better palliative care and emotional support rather than a prescription of deadly medicine. They also worry that people may feel compelled or coerced into choosing death because their care is expensive, they see themselves as a burden to others or because relatives are thinking that they do not want to spend the grandchildren's college tuition to keep grandpop going in a nursing home or ICU. Given the current push to contain medical costs, the biggest fear is that the vulnerable will get the bum’s rush to the hereafter.
These objections are concerning, but not convincing. Two states have already enacted legislation very similar to that proposed in Massachusetts. The disturbing scenarios against legalizing physician-assisted suicide for the terminally ill are not supported by what has happened in Oregon and Washington.
Although there are requests from the dying for lethal pills, few ask and almost no one takes them. In Washington in 2010, 68 physicians wrote lethal prescriptions for 87 patients, 51 of whom took the pills and died. The rest never took the pills. That is an incredibly tiny number relative to all those who are terminally ill in Washington. The Oregon experience is the same.
The critics are worrying about a shift to mass suicide inspired by heartless doctors and families pressuring dying patients to end it. That has simply not happened in Oregon or Washington. There is no persuasive evidence that the dying are being rushed, duped or bullied to die by anyone.
The interesting thing is that many people find it more empowering to have the ability to end their lives if they want to do so. Many say the ability to choose gives them the strength not to do so.
The question about a doctor’s involvement can be overcome by giving each physician the right of conscience to be involved or not. Some doctors will want nothing to do with assisted suicide. Others will. Given the polarizing nature of physician-assisted suicide, the decision ought to be each physician’s to make. Medicine does not have to be all in or all out.
The proposed Massachusetts law is very restricted and contains important safeguards. Experience in other states shows little reason for worry about abuse or misuse. Instead the more people who are going to die know they can end their lives sooner if they choose, the more many of them fight harder to live. Making assisted suicide possible in Massachusetts rightly puts a choice in the hands of a very few who may not use it, but value having it.
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I think Massachusetts did that with the development of the meningitis serum that has recently been distributed throughout the US. Oops, maybe they were supposed to have state level approval first!
Assisted suicide = Victim has a choice
Abortion = Victim has no choice
Abortion is the law of the land. When life is devalued to this level, it is only a matter of time before assisted suicide will be the law of the land.
Just one person's opinion... Not forcing it on you all... Sorry if this steps on toes...
There is no victim in abortion. it is not a life.
Sorry if the truth ruffles fathers...
Concernedone
In assisted suicide there is no victim, abortion might avoid a child being a victim. These are matters of choice, if you are against, fortunately you have a CHOICE not to do it... There is no "devaluation" of life... If you take a dog to "Sleep", Why not a human?
I think it should be reserved as a last resort option, but I see no problem with letting people escape a life that would otherwise be filled with prolonged pain and suffering.
Oh, so now we are starting to treat people like dogs, right? Last time I checked, nothing was too painful that a daily morphine regimen couldn't remedy. (And please do not try to sit here and lecture ---- if the government knew how to manage money, it wouldn't even have crossed your mind.) Try to stay alive. There is much more planned for you to do here on earth.
mongoose, you've obviously never experienced the kind of pain that no amount of morphine can ease. or watched someone you love suffering in the agonies of being alive and trapped within their body with that kind of pain. I have. lots of other people have. and many of us don't want to be forced to live with that pain until it kills it. you want to suffer? go ahead. but I doubt very much that weeks of that kind of suffering is 'what is planned' for someone 'to do on earth'. you either have no firsthand experience, or not a drop of empathy
I'd recommend you check with my Father-in-Law on that, except you can't, pancreatic cancer took him very quickly a couple of years ago. But he spent a good two months in agonized semi-conciousness, before it did him in.
Past a certain point, pain meds are worthless.
As if you know...
Right on, Dr. Caplan! It is far more important for these laws to be extended to people who are not terminally ill, but whose illnesses disable them to the point where they are physically unable to commit suicide except by starvation/dehydration, which is difficult in our society for many reasons. The former can only be made to suffer for six months, but the latter group might suffer for decades. You will get plenty of outraged comments from people whose religions forbid suicide - well, as for abortion, then they are free to not choose that option for themselves. As an agnostic, I want to stop existing as fast as possible after I have stopped living, or after my life has become nothing but misery. My doctor should be able to help me with that if need be.
From the religious point of view I'm actually curious. For starters I am religious but if (as you said) I am no longer able to truly live, then I wish for a quick end of existence. Some of those on the religious side say that 'it is against Gods will' to choose death, but in the instance of terminal diseases, would it not be argued that Gods will was side stepped if life is prolonged by medicines? If a person with cancer 'would have' died without Chemo but because of it had their life extended for a few years but sadly are now incapable of sustaining quality life, why would some religious persons claim that assisted suicide is against His will when by their theory his will was that the person was to die a few years back? I don't think you can have it both ways. You can't decry medicine for relieving a person from the horrible pain of a slow incurable disease and allowing them to slip into peaceful death by saying it's against Gods will, while at the same time extending the life of a person using medicines when that person should have died without it. For me, if medicine can cure the disease or help the sick and suffering, fantastic. That goes for both a quality of life and a quality of death.
I am completely for someone being able to die in the most peaceful manner possible, if that is his or her wish. However, it's a dangerous road we are on when physician assisted suicide becomes an acceptable treatment method for terminal illness. I've already seen family members urging for their elderly/"loved ones" to be placed hospice even well before the person has been given the diagnosis of being terminal. Those discussions include, "but we don't have anywhere for dad to stay" or "her care is so expensive" or "he/she is old so it's just their time."
Say the insurance company/medicare/medicaid decides that physician assisted suicide is the only "approved treatment" that is covered given the terminal diagnosis, the hospital turns up the pressure to move the patient out to clear a bed, doctors are given a bonus for cost reductions, etc. Once nationally accepted, are you so naive as to really think that those factors won't play into the decision at certain places on whether or not to end life? Since it is an approved treatment do we force the physician to do it if someone signs the approval? Can a hospital revoke privileges if a physician refuses? Can an insurance company terminate a physician's/hospital's in-network contract (often worth millions of dollars) if they are found to not use such recommended "approved treatments?" Can the federal government require that all hospitals offer physician assisted suicide?
Believe me when I tell you that many recommendations in hospitals regarding care are already being made with financial considerations a strong driving force and doctors are under significant pressure by admin to cut costs. Most people would be surprised these days at how much.
Lots of questions to be answered. Just be careful what you wish for.
Mike, where does it say that anyone at all would ever have the right to say that assisted suicide would be the only "approved treatment". I'm sorry, but that would never happen, for so many reasons. You are painting a portrait of a scenario that can't and never will occur, so it's an illogical argument.
I know firsthand that hospitals are often run like businesses, and yes, the bottom dollar is looked after; however, I also know firsthand that by far MOST physicians are ethical, conscientious people. I can't think of any physician I personally know (and I know a lot- I'm a healthcare provider myself) that would ever push for assisted suicide as a means to render their own personal or financial gain, whether there is pressure from administration or not.
Rochomp, I've dealt with enough insurance companies and HMO's that have refused cancer treatment because it was costly and supposedly "experimental" even though it was the accepted treatment. I've also seen them promote treatments that were way out of date because they weren't considered experimental but they were cheaper. So depending on morality by insurance companies is naive.
I've also seen hospital admins push for physicians to discharge people (those w/o money) who should not (imo) be discharged and I know of fellow dr's that felt the pressure to do so and complied. There is a gray area in many circumstances. For instance one can say that a patient w/Alzheimers is ok to take care of themselves when 10 other docs would say no way. Yes most dr's are highly ethical individuals but when it comes to admin saying you "legally" can do XYZ, doesn't mean you morally should. New dr's especially feel pressured when admin starts questioning expenses. There are a ton of cases where profit has won out over healthcare, look at the cases of patient dumping where poor patients were put on street corners outside of homeless shelters when they medically should have never even been cleared for discharge. So sadly I don't see it outside of the realm of possibility.
The current system with Hospice allows for pain management for the terminally ill. Personally I think docs should stay in the healing and out of the killing business. Dr. Mike
Mike, I appreciate your response- I don't disagree with you on a lot of what you said. I don't trust insurance companies worth a lick- they are the last place I expect to see any moral decisions made. With that said, I still have faith in the morality of healthcare providers. If you really are a doctor, Dr. Mike, do you really look at your colleagues and think they could be that easily swayed to end the life of another human being- at least through assisted suicide- due to some pressure from hospital administration? If yes, I think that's extremely sad. I have been surrounded by medical people my whole life, and I now also work in healthcare myself. I hope to God it's not exceptional that my personal experiences with practitioners has been largely positive, and I that I view this group as a whole as intelligent, ethical, and independent thinkers.
Roch, I appreciate your vote of confidence in dr's! Hope I didn't give the wrong impression in my attempt at brevity. Overall, I definitely have the deepest respect of the majority of my colleagues and agree the vast majority ethically would never be easily swayed by admin pressures but there are gray areas in medicine when it comes to life vs death and family vs. patient wishes and care vs. admin cost control. A significant portion of my practice involves work with patients/families in those gray areas, so I see the life/death and financial questions asked more often than many others. Also moral standards do not always match legal/ethical standards.
These days with the internet bs that abounds it's hard enough maintaining the trust of patients to put their lives into someone's hands. Putting doctors in the business of ending lives only imo detracts from that trust. It's hard enough sometimes to get patients to agree to needed treatments that make them miserable to begin with, without having them also afraid that their doc is trying to kill them off. Thus I oppose such and many other dr's feel similarly. That said, I have no problem with recommending hospice or aggressive pain management for those who are terminally ill. You'd perhaps be surprised at how many perceive that hospice already is assisted suicide and it's hard enough already fighting that perception. You'd also perhaps be surprised at how many people when told they have cancer, HIV, etc that their first thought is that they've been given a death sentence when the likelihood of survival and a good quality of long life is very high.
First and foremost, it is a physician's job to help the patient. Whether that be healing them or helping them prevent a prolonged miserable death. If they have the capacity to do so, these patients are likely to kill themselves anyway. I'd rather they have the option and guided knowledge of a peaceful painless death.
Agreed. Life should be about quality not quantity. If a patient is dying and there is no cure for them what makes anyone think they won't try to find their own 'way out', especially if they are in pain. Given the choice it is more humane to allow them to die quickly, painlessly and on their own terms with family as opposed to prolonging the suffering just to get a few more days or weeks out of them.
For the first time, I agree with everything Caplan says here. He even turns a couple of colorful phrases, like "...get the bum's rush to the hereafter".
He also (rightly) makes an argument that has been made regarding allowing concealed weapon permits: we don't have to speculate about what might happen; we can look at what HAS happened, and that is that all those horror stories from the naysayers didn't come true.
Finally: "The codes of medicine and nursing ethics reject helping patients die." I wonder: do those codes also reject covering up/lying about/whitewashing malpractice? Tell me that doesn't happen. You don't get to (or you shouldn't get to) follow your code of ethics just when it's convenient, or looks good.
The Hippocratic Oath states do no harm. Evidently, to some, this means, make sure that a patient lives out their last few months in agony and pain, rather than end their suffering with dignity and choice. I don't get it.
I'm guessing the the word 'harm' is open to interpretation.
I don't get it either. I'll readily accept a Physician's Assistant to do it if it's going to be a problem.
The AMA comes out strongly against physician-assisted or even physician-guided euthanasia. The AMA is also firmly against any form of hospice care. Following AMA guidelines, around 80% of all organ donors "living will" instructions are ignored.
The reason is that terminal patients are a "gold mine" in income for both physicians and hospitals. Terminal patients are simply good business. In most circumstances terminal patients in a hospital get 8 to 150 times more charges than the same patient in a hospice. Prolonging death with futile treatments and buying minutes of additional life are very, very profitable. And terminal patients require fewer skilled services than say, a young accident victim. Physicians and hospitals are very good at taking the families of terminal patients into skipping donation of organs (because that would be a horrible thing to do to Dad) and ignoring living will requests such as no resuscitation and no mechanical means to be used unless specifically authorized by the patient and no others. They foist off useless treatments (Wouldn't you want your Dad to have all the medicine he can afford?) And painful and futile rounds of chemotherapy, radiation, bone marrow transplants, hormone treatments, and surgery.
Any physician can tell you exactly how to "spend down" and move money around to qualify for Medicaid. They openly discuss among themselves how lucrative terminal patients are. A terminal stroke patient can often be parlayed at a $2 million profit.
Physicians are against euthanasia as a right because they do not want people to die and have any money "left on the table." In an ideal physician world, terminal patients would come in, sign all their family's assets to the medical folks and then just go out in the woods somewhere and die.
Of course the AMA strongly opposes physician-assisted-suicide,
Doctors always know best. Besides it is poor
form for a parasite to actually kill a host.
It makes more sense to rack up billings, order unnecessary tests
and treatments. Most importantly there are expensive drugs that need to be prescribed over the long haul. Big Pharma owns the AMA and would never let
this happen. It would be a poor business
decision.
Our pets should not have more rights than we do when it comes to a death free from prolonged and unnecessary suffering. The idea will not be to end life, that decision will have already been decided by the patient's illness. The idea will simply be to shorten the period of lingering suffering which can sometimes accompany the process of dying, depending upon what you are dying from. One of the best ways to protect against any abuse of this opportunity is to always make sure that everyone has free access to a public hospice for the terminally ill, where patients are always guaranteed free access to as many pain medications as they want. (In fact, this is actually the way that many caring physicians down through history have enabled patients to die with dignity, by placing a bottle of pain pills on the patient's bedside table, with instructions to take as many as they need, but also with careful instructions written on the bottle about the overdose levels and any dangers.) - RC
(Oftentimes this bottle of pain pills was accompanied by a bottle of sedatives as well.) - RC
(When caring physicians don't do this, many patients have often secreted their pain and sedative medications away until they finally had enough saved up to finally do the job, while often requesting the maximum amount along the way to alleviate their symptoms.) - RC
(Be sure to sign a living will along the way, to ensure that no extraordinary medical measures are taken in event of a medical crisis.) - RC
Fantastic advice from Rick. If you end up gorked, comatose or demented, your local hospital not only will not euthanize you at your loved ones' request, but might well insist on actively keeping your carcass "alive" through aggressive treatment because your family can't prove you wouldn't have wanted that - as if most of us would! It's usually an act of unselfish love to have a pet put to sleep when there is nothing left for him but suffering. Why should we assume that the same willingness to let a family member go must have an evil motive?
I was a Hospice nurse for many years. I have seen "good deaths" and really awful ones. A few patients committed suicide in much more disturbing ways than an overdose of pills. Some patients stockpiled meds so that if they decided to die, they were in control. None of those people did OD. When palliative care and hospice care are done right, much is done to ease suffering of all kinds (physical symptoms, emotional pain, family and spiritual suffering). Many people do not access these services until the last 2 weeks of life, robbing them of the opportunity to get many issues addressed. So if there were more use of existing palliative and hospice care, that would obviously be of great benefit. Remember too that a Living Will is not a LEGAL document in most states, and is only as good as the Health Care Proxy you choose to speak for you when you no longer can. it's heartbreaking when a family over rides the wishes of a patient and prolongs thier life with unecessary treatments. If the proposed law in MA required a psych consult, it would be a better written law. The tv ads against it are rediculous.."a doctor would not be present." Just how many deaths of terminally ill patients does an MD attend? VERY FEW. Hopefully this proposed legislation leads to more open discussions of end of life care, whether it passes or not.
When I see the arguments for ethical issues, whether it be euthanasia, abortion, war, capital punishment--the thinking never seems to go beyond the level of opinion. God wants it. I want it. We, or our legislators, should go beyond the level of opinions to make intelligent decisions.
If you are interested in the morality of euthanasia, the pros and cons, from the points of view of self centered ethics, God based ethics and society base ethics you might check out the "Euthanasia" chapter in Book 4 (On Human Values) in the free ebook series "And Gulliver Returns" --In Search of Utopia-- It is found at
When people want to die and it is good for society (reduced medical costs and reduced population), it even has approval in some Biblical passages—maybe tradition must step aside in favor of the good of the people who are most involved. The Dutch and other countries are recognizing this. Anyone who has spent time with elderly people in hospitals and sanitaria knows this.
We have physician-assisted suicide in my state and I haven't seen anything bad with it, other than the condition that the person be terminally ill (I know someone who committed suicide because he was in unbearable pain 24 hours a day, it wasn't killing him so he shot himself in the head in the police department parking lot).
IMO the right to life includes the right to die. Nobody should be forced to live against their will, it's one of the cruelest forms of punishment.
But before anyone comes in and says that this is the fabled "death panels", Oregon doesn't have them anymore than Canada does.
Unfortunately this will always be a "moral" argument. If we start arguing from any other level - for example using medical costs, statistics of hospice care, etc - then we become the very "numbers" that we want to avoid in this type of debate. It is about human life and the argument of choice, so the basis will always be the morality of it.
It is time for us to find it acceptable to make our own choices, to live with our own choices and not for others to force their opinions onto us simply because their morality is offended.
Anyone who opposes death with dignity needs to watch the documentary "Dying in Oregon". It is an INTENSE documentary about the act that was passed here, and they do a good job of explaining all sides of the issue. If you've seen someone you love suffer unbearable amounts of agony and begging for death, you know that you have no right to deny anyone the choice to end their suffering.
Also watch "The Sea Inside", great movie!
It's my life, it's MY choice. I don't need do-gooders out there telling me what I can and can't do with my personal and well thought out choices.
This is another example of the ethics of a given group becoming a law impressed upon the rest. There are aspects of our lives where no one has the right to interfere. The only opinion that matters under these circumstances is the patients and if a Dr. will not accept that they can, and should, be replaced.
Well it sounds like the vast majority of th epublic are for it including myself. Why isn't this legal in every state?
Some people raise concerns about unethical doctors, people being forced by family members to do it, etc.
The recent ads on television against physician assisted suicide are pathetic. Pain management in most cases of terminal illness is a joke, and if you've ever seen someone you love in the last stages of cancer and how their pain is "managed" you'd probably agree that being able to make your own decision about taking the 100 capsules of seconal is far more humane.
As a past hospice worker I agree with assisted suicide.It should be done at the patients discretion.I have seen people die screaming in pain because family members will not give meds except on a strict schedule.There is nothing wrong with putting someone in pain under with meds and not let them come back up.I have had patients plan thier death and take matters into thier own hands when the time comes.I admire those people,they did it for themselves and for thier loved ones.We must all learn to let go.If quality vs quanity take the quality and allow people to die with peace and dignity if this is what they choose.It is selfish to keep them alive to suffer the indignity. I myself will chose death..
I wish all those who oppose assisted suicide a long and painful death.
Let's set the "pet" myths aside. We can get our pets put down because the law says we can as long as we do so humanely; the law doesn't care much about the "why." In spite of what we like to think, statistics from animal welfare organizations bear out the crueler reality - more pets are killed because they're peeing on the rug, have an illness too expensive to treat, or the owner can't afford them any more than are killed because they're dying in pain. But we get to tell our friends whatever we like about why we did it, even if it had more to do with our comfort than what the animal would have wanted.
I have seen to many times doctors suggest you only have six months to a year to live only to see the person to go on to live a full life. It's not necessarily a mistake or poor judgment, but human medical practice is an guess at best and a doctors first guiding rule is CAUSE NO HARM, can't do that if you assist in suicides.
Just because a doctor says a person will die in 6 months doesn't mean that they would go ahead and commit suicide. That is simply dumb. If that person knew they had a terminal illness and is in severe pain without relief, it is a different story.
So true. I don't think all people in that situation want to die. They want control of their life.
And if they do choose the option, that's OK. They have a right to do so and it's THEIR life. Remember, death is the one thing that is inevitable. And I would certainly choose peace over unnecessary months of pain.
Ya know, you try to reason with people etc but sometimes they just don't get it. Doctor assisted suicide? Absolutely ridiculous! The people promoting such garbage need to be thrashed behind the woodshed.
May I ask why you might object to such an arrangement?
Have you ever seen a loved one suffer and wish for death? If they are going to die soon anyway, why would you want to FORCE them to prolong the suffering? So you selfishly can put off feeling sad?
Well, I dunno about doctor assisted... but ending one's life should be one's prerogative.
Just like I can decide to donate my organs on my drivers license, I should be able to request death on conditions and circumstances of my choice.
I have a humble inheritance to pass on to my children. I would rather the State not insist that it be drained off into the medical industry. It's only a couple of hundred thousand...and those bustards could claim it all in a single week of intensive care.
...and they could, and most certainly would, attach my estate to pay themselves for their unwanted and unwelcome services.
Come to think of it, I'd be a bit of an idiot to expect justice from the government in matters like this...and I will make my own arrangements on these matters... and I won't need a doctor.
Assuming of course, that I'm not suddenly injured and rendered incompetent...in which case, the money will go to the danged villains in the medical industry... under penalty of law...
The late and great Dr. Jacob "Jack" Kevorkian will be recognized, and accepted, as a courageous American hero, whether next week, year, decade, or century. He will be honored. The living must learn to let go. The reasons are obvious.
I also believe that it should be a person's choice to die. I don't want to end up in a hospital draining my bank account waiting for the inevitable. If I will end up dying anyway, I would rather be able to make my own decision. So what if a doctor says I have only six months and I MAY end up living longer, what about the quality of the time I have left. This is a decision that should be made by the person who is suffering.
Most of us work hard our entire lives for what in the end? If I have money left at the end of my life, I would rather it go to make life easier for a loved one or charity, (my Medical Care Givers make enough already!)