We are continuing our review of the presentations given at 2017 Convention in April. You may also find these presentations in our quarterly member publication, MCFL News. In this presentation, three physicians discuss how doctor-prescribed suicide will change their profession
Dr. William Lawton began his presentation on a physician’s perspective concerning doctor-prescribed suicide (DPS) by reflecting on the traditional ethic of the Hippocratic oath: to give no deadly medicine and to do no harm. He said, “Hippocrates understood what we as a culture increasingly do not understand: that a physician cannot be both healer and killer and maintain the trust of his patient.”
Lawton, an Associate Professor at the University of Massachusetts Medical School and specialist in Internal Medicine and Kidney Diseases, illuminated the dangers looming as insurance companies and government seek ways to save money by steering patients with limited finances toward assisted death. He cited the 2016 case of Stephanie Packer, a 33-year-old California wife and mother with scleroderma, who was told at age 29 that she had only three years to live. When Packer’s physician prescribed an expensive chemotherapy drug her insurance company refused to pay and told the physician that drugs to put her to death were covered with a co-payment of only $1.20.
He noted that persons who are poor, disabled, or part of a minority in Massachusetts will be vulnerable to denial of care if doctor-prescribed suicide is legalized. “Poverty disproportionately affects our people of color and our people with disabilities,” Lawton said. “Patients who are poor are vulnerable as insurers and government entities have balked at paying for lifesaving drugs. Minority distrust of physicians inhibits their access to adequate healthcare. Physicians who discard patient protection add to this long rooted distrust.”
Included in legislation to legalize DPS in Massachusetts is a requirement that a doctor discuss feasible alternatives, including palliative care, with patients managing life-threatening illnesses. Insurance companies and government agencies can deny other treatments and select doctor-prescribed suicide as a ‘treatment option.’ There will be less focus on extending life and eliminating pain and more focus on cheap options.”
He continued, “Despite reassurances, all is not well in states where DPS has been legalized. In August 2015, Dr. William Toffler, Professor of Family Medicine at Oregon Health and Science University, a practicing physician for 35 years, noted: ‘Proponents claim the system is working well with no problems. This is not true. There has been a profound shift detrimental to our patients, degrading the quality of medical care, and compromising the integrity of my profession. There is new fear and secrecy and a fixation on death. People with serious illnesses are sometimes fearful of the motives of doctors or consultants.'”
Lawton said the issue is not about giving patients the right to commit suicide. “This is about giving the doctor the right to kill. DPS gives too much power to doctors to be the judge, jury, and assistant executioner. Even single judges do not have this much power. There’s a stunning lack of accountability. It undermines the trust essential to the doctor-patient relationship.”
Dr. Laura Lambert, a surgical oncologist, palliative care physician, and Associate Professor of Surgery at the University of Massachusetts Medical School, addressed the physician’s role in alleviating non-physical or “existential suffering,” the kind of suffering that seeks relief in a request for DPS. “There is not a fear of dying. Instead there is a fear of pain, of losing one’s autonomy, of becoming a burden on the family. Existential suffering exists outside of the physical realm and manifests itself as a fear of isolation.”
Lambert mentioned a patient with advancing stage four cancer whose oncologist became too busy to meet with her. “This patient was suffering more from her profound feelings of isolation and abandonment,” Lambert said. “She needed her physician to be with her and walk with her. Someone
facing mortality has reflections on the meaning of existence, asking, ‘What is the meaning and purpose of my life?'”
Lambert said physicians need to learn the art of existential healing. “Doctors are trained to fix and to cure. However, there’s no focus on the nature and essence of healing. The way we heal is with our presence. Suicide is a social illness driven by alienation. We counter this with human interaction.
“My concern is as we ‘normalize’ DPS, as it becomes the law of the land, doctors will totally ignore their role as healers. It will become just another item on the checklist.”
Drs. Lawton and Lambert were joined by Dr. Vainuupo Jessop, a board certified anesthesiologist currently completing his fellowship in critical care medicine at the UMass Memorial Medical Center, for a panel discussion on the impact of DPS on healthcare.
Jessop noted that DPS harms the way physicians are taught to use criteria. “We’re supposed to practice ‘evidence-based medicine,'” he said. “We prescribe the best treatment for patients based on objective data. If you legalize DPS, you flip back to subjectivity because you lack data. No one’s going to let you have studies that compare the value of killing one patient versus treating him. DPS can lead to a subjective judgment when a physician concludes that a patient with multiple health conditions may be better off dead.”
Jessop said the benefit of the palliative care team for terminally ill patients is to treat physical, mental, spiritual, and emotional health problems. “This shifts the burden away from the patient’s family,” he said. “DPS does just the opposite. It puts the burden back on the patient.”
Lawton added that DPS will impact the doctor/patient relationship and change the way medicine is practiced. “We go down a slippery slope once doctors start to suggest it to their patients. This gives physicians unprecedented power. We’re also learning lessons from doctors in Europe and Netherlands where DPS or euthanasia was legalized for cases of unbearable suffering for those with terminal diagnoses. The law continues to expand and is being used to cover non-terminal conditions such as dementia, chronic lung disease, or even people who are just tired of living.”
The panel discussion ended with Jessop responding to the argument that a person’s autonomy, or personal choice, includes the ‘right to die.’ “Keep this in mind,” Jessop said. “The people who believe they have a right to die will affect everyone else’s right to live.”