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Ronald W. Pies, MD
Ronald W. Pies, MD
Joshua Pagano, DO
The stigma surrounding both suicide and physician-assisted suicide is a challenging topic. One of our readers tackles it.
FROM OUR READERS
I recently read an excellent article here called
The preference of many patients with terminal illness is to pass away peacefully while surrounded by family and friends. This pastoral scene is unlikely to come true in states that discourage discussing the topic of physician-assisted suicide by making it illegal. The threat of legal actions against those who help the dying hasten their deaths is a significant deterrent.2 But perhaps most devastating is that the shadow of stigma prevents meaningful communication and closure with loved ones. The family members of those who have chosen their time and place to die with dignity describe a feeling of gratitude that they were able to be there with their lucid loved one as they gently fell asleep for the last time.3,4
Ronald W. Pies, MD
Ronald W. Pies, MD
Joshua Pagano, DO
Nine states—California, Colorado, Hawaii, Maine, New Jersey, New Mexico, Oregon, Vermont, and Washington—and the District of Columbia have passed laws legalizing medical aid in dying. One in 5 Americans now has access to this option. While vocal opponents may give the misleading impression that the majority of physicians are against assisted
Medical aid in dying has gained momentum over the years, as many patients find it necessary to fight for the option to end their suffering. I am reminded of Brittany Maynard, who, in 2014, was diagnosed with terminal brain
Many opponents are concerned with the possibility that physician-assisted suicide may target traditionally vulnerable populations. However, Maynard’s journey illustrates that the opposite is true—only the most privileged with the greatest resources are able to successfully obtain medical aid in dying. Al Rabadi and colleagues (2019) conducted quantitative research with a retrospective observational cohort study of all the lethal medications prescribed for medical aid in dying in Oregon and Washington from the passage of those states’ death with dignity laws until 2017.10 A demographic analysis of the 76% of patients who chose to ingest their prescribed lethal medication shows that 51% of them were male, 95% of them were white, 72% of them went to college, and 89% of them had health insurance. The speculation that physician-assisted suicide will target marginalized groups has been shown to be mistaken. As in the rest of health care, only the most privileged are accessing this service.11
It is worth noting that, as with many prescriptions, after receiving their lethal prescription, a patient will not necessarily use it—indeed, many patients do not.12 Twenty-four percent of patients in Oregon and Washington chose not to take their lethal prescriptions.10 Merely having the option to use it is sufficient reassurance. The peace of mind of knowing they can choose to take it offers enormous comfort.2 One advocate, Dan Diaz, reflects, “This truly is an option. If a person has decided on their own to apply for and qualify for the prescription, then you get to focus on living life.”13
The stigma surrounding both suicide and physician-assisted suicide is a challenging topic. On one hand, some of the previous efforts to distance physician-assisted dying from suicide have increased the
On the other hand, there is something distinctly different about the terminally ill person who is staring at the last 6 months of their life—6 months filled with loss after loss, indignity after indignity, and grief after grief, all inexorably culminating in a slow death by starvation. To conflate this wish for a physician-assisted death with the suicidal thoughts of someone suffering with mental illness invalidates the reality-based appraisal of the terminally ill patient’s very stark situation. The desire to avoid both foreseeable and inevitable suffering is rational. And finally, perhaps most undeniably, my sympathy for those who request medical aid in dying comes from within. For, I cannot in good conscience deny someone a choice that I myself would want as an option under the same grim circumstances.
Dr Pagano is a forensic psychiatrist at Cherry Hospital in Goldsboro, North Carolina.
References
1. Pies R.
2. Houghton K.
3. Aleccia J.
4. Hampton M.
5. Kane L. Life, death, and painful dilemmas: ethics 2020. Medscape. November 13, 2020. Accessed December 8, 2021.
6. Brenan M.
7. Lipka M.
8. Maynard B.
9. Karlamangla S.
10. Al Rabadi L, LeBlanc M, Bucy T, et al.
11. Hannig A.
12. Will GF.
13. Calfas J.
14. Friesen P.
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