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Physician-Assisted Suicide and the Rise of the Consumer Movement

Physician-Assisted Suicide and the Rise of the Consumer Movement

©AlexeiZinin/ Shutterstock

“Death with dignity” is such a catch-phrase right now in the media. But for those of us who suffer in our dark thoughts every day, we are living “life with dignity.” Each day we live and make it through is a success. —Anonymous1

When my 89-year-old mother was in her final days, and I was at her bedside, she asked me a plaintive question: “Honey, how do I get out of this mess?” The mess, of course, was her increasing debilitation and weakness as her chronic illnesses began to sap her strength. As a physician and as her son, I felt a wave of anxiety wash over me. I was sure my mother was going to ask me if I could help her end her life—something I could not do in good conscience, either as a physician or as a son.

Fortunately, my mother did not ask me to assist in her death, and home hospice care later proved a valuable resource in helping my mother through her final days. Characteristically, as a strong, vibrant woman who was reluctant even to take an aspirin for a headache, my mother usually spurned the opiate medications repeatedly offered her by the hospice nurses. She found dignity in keeping her mind sharp and clear, and bearing whatever pain her last days would bring her. My mother’s stoical resolve was sometimes hard for my family to tolerate, but we respected her wishes.

Physician-assisted suicide worldwide

All this is in stark contrast to the modern-day movement that sees “death with dignity” as virtually synonymous with physician-assisted suicide (PAS) or physician-assisted dying. Which term is used often seems to depend on one’s attitude toward the process, and it is difficult to avoid “value-laden” terminology.2 The term “assisted dying” seems to find favor among those who believe that physicians should be allowed to prescribe lethal drugs to terminally ill patients who want to end their lives. So-called “death with dignity” legislation is now on the books in 4 US states (California, Oregon, Vermont, and Washington), which permits physicians to write prescriptions for lethal drugs under certain carefully prescribed circumstances: for example, when a mentally competent adult with a terminal illness is likely to die within a few months and makes multiple requests for assistance in dying. In much of Europe, assisted dying is a much broader notion. For example, as the BBC notes:

In the Netherlands, the patient’s suffering must be unbearable, with no prospect of improvement. The suffering need not be related to a terminal illness and is not limited to physical suffering such as pain. It can include, for example, the prospect of loss of personal dignity or increasing personal deterioration, or the fear of suffocation.3

Canada is now debating similar legislation, and one Canadian proposal seeks to extend assisted dying to persons with intractable mental illnesses—including mature adolescents.4* It remains to be seen whether that component of assisted dying ever finds its way into Canadian law, but the mere consideration of the proposal has set off alarm bells among medical ethicists.

In 2013, a Massachusetts initiative to permit death with dignity by allowing terminally ill patients to be given lethal drugs was narrowly defeated by voters (51% to 49%). The initiative was strongly opposed by, among others, the Massachusetts Medical Society, which declared that “. . . physician-assisted suicide is inconsistent with the physician’s role as healer and health care provider,” according to then-president Lynda Young, MD.5 “At the same time,” Dr. Young said, “. . . we recognize the importance of patient dignity and the critical role that physicians have in end-of-life care,” including “the alleviation of pain and suffering at the end of life.”

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