Several years ago there was an Academy Award–winning documentary about climate change: An Inconvenient Truth. The purpose of the movie was to demonstrate that those who denied the reality of climate change did so only by ignoring the scientific evidence to the contrary. The title of the movie often comes to mind when I hear advocates of legalization of physician-assisted suicide, also known as right-to-die laws (RTD), present their case.
Proponents often cite religious values—especially those of the Catholic Church—as the basis for concerns about legalization or opposition to RTD laws. Non-proponents are generally thought to be those who toe the Church line on abortion rights and who oppose same-sex marriage.
I am not a Catholic nor do I have any particularly strong religious beliefs. I am strongly pro–abortion rights and believe that adults should be able to marry whomever they wish regardless of gender. I also believe that it is highly unethical for physicians to impose their religious or political views on their patients and allow these to affect how they care for them. However, I do have major concerns about the RTD laws.
My concerns are based on science, not religion. As a pain medicine specialist and psychiatrist, I believe that the already existing laws and those that have been proposed have major holes that could result in people requesting death because of potentially treatable health problems.
With the recent passage of an RTD law in California, there are now 4 states that have similar laws (Oregon, Washington, and Vermont are the others). Several other states, including New York, are considering such legislation.
There are obviously many areas of concern apart from untreated pain. The Affordable Care Act has provided health insurance to millions who didn’t previously have it, but there are still millions of uninsured people in our country who have limited access to anything other than emergency care.
Psychiatrists have proper concerns about making sure that no patient who requests death is allowed to die if the request is the result of a treatable mental illness such as depression. All the RTD laws seek to prevent this: they require that if the attending physicians believe a mental disorder is a potential factor in the request, they need to make a referral to a mental health specialist, usually defined in the laws as a psychiatrist or licensed psychologist.
Any psychiatrist who has been involved in consultation/liaison psychiatry can readily recognize inherent problems in the laws. Most non-psychiatrist physicians have limited training in mental illness, so relying on them to identify such illness is a chancy proposition.
1. Angell M. The Supreme Court and physician-assisted suicide: the ultimate right. N Engl J Med. 1997;336:50-53.
2. Oregon Public Health Division. Oregon’s Death With Dignity Act: 2014. https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf. Accessed December 21, 2015.
3. California Legislative Information. End of Life. 2015. http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB128. Accessed December 21, 2015.
4. King SA. Pain and suicide. Psychiatric Times. 2013;30(6):21.
5. Hudson PL, Kristjanson LJ, Ashby M, et al. Desire for hastened death in patients with advanced disease and the evidence base of clinical guidelines: a systematic review. Palliat Med. 2006;20:693-701.
6. Nahin RL. Estimates of pain prevalence and severity in adults: United States. 2012. J Pain. 2015;16:769-780.
7. National Institutes of Health. Draft: National Pain Strategy. http://iprcc.nih.gov/National_Pain_Strategy/Draft_National_Pain_Strategy.htm. Accessed December 21, 2015.