Page 13 - Delaware Medical Journal - April 2018
P. 13
OPINION
Physician-
Assisted Suicide
Misses the Mark
on Improving
End-of-Life Care
John J. Goodill, MD
“I don’t mind dying, I just don’t want to be there
when it happens.” — Woody Allen
“We are all caught up in an inescapable mutuality (and) what affects one directly, affects all indirectly.” — Rev Martin Luther King, Jr.
HB 160, The End of Life Options Act, is a bill legalizing a physician’s writing for a lethal dose prescription for qualifying patients with terminal illness. This bill may be considered in our current state legislative session and so the issues it raises deserve some attention.
This activity goes by many names: Death with Dignity (Oregon), physician aid in dying (PAD), legalized physician aid in dying and physician assisted suicide (PAS). PAS is now legal in seven states and there seems to be momentum to increase that.
The Medical Society of Delaware (MSD), through its Committee on Ethics and Executive Board, has recently updated its its opposition. The discussion and vote on these committees was not unanimous and through this process MSD clearly heard there were members who did not agree with this position. MSD understands there are good, well-intentioned people on both sides of this issue.
In an effort to get a better understanding of the perspective of the whole membership, MSD has developed a short survey on this topic that, at the time of this writing, will be sent out soon. It is hoped that all members
will lend their voice to this conversation by completing the survey.
The following is my personal perspective on the subject of PAS. (I am not thrilled with this nomenclature because of the negative “death with dignity” or “physician aid in dying” terminology.) My perspective is informed by daily experience with patients/ families in my role of a palliative care physician, as well as having a longstanding interest in medical ethics.
I have heard too many compelling stories of
wonderful stories of beautifully engineered deaths with the ingestion of a lethal dose of medication. While this may be the best for those very rare situations/patients, I know PAS will not help the majority of patients and families that I see every day who are
as they can for as long as they can.” The bestseller Being Mortal, as well as the 2014 Institute of Medicine (IOM) report Dying
in America, do a great job of cataloging the grace. Much of the public is fearful of losing control, being abandoned, and suffering in their dying days (hence the staying power of the Woody Allen quote at the beginning of this writing). No wonder the popular support for PAS as a solution.
The American Academy of Hospice and Palliative Medicine (AAHPM) in 2016 took a “position of studied neutrality on the subject of whether PAD should be legally permitted or prohibited. However, as a matter of social policy, the Academy has concerns about a shift to include physician- assisted dying in routine medical practice, including palliative care.”
There are, currently, several fully legal methods to hasten a person’s death that many do not take advantage of. They include: withhold/withdrawal of life support;
palliative sedation; and voluntary stopping of eating and drinking. Unfortunately, there is also much fear and misunderstanding about these approaches to care, as well as hospice. These patients and their caregivers/ families struggle in a disjointed health care system that is geared to do things to them instead of listening to the patient about what matters most, informing them honestly about their prognosis and care options, and fully empowering them to make the best choice for their care. Our health care system gives good “lip service” to “patient-centered care;” it just doesn’t deliver on it very well.
In order to move forward in improving end- of-life care in Delaware, the Delaware Health Care Commission (DHCC), commissioned
a task force to examine the issues and this group submitted its report in 2016. The report did not include a recommendation for PAS. It did include a recommendation for a statewide clearinghouse group to coordinate efforts of like-minded groups across the state. It included recommendations to increase efforts within the community
and health care systems for meaningful advance care planning, including the use of Delaware Medical Orders for Scope
of Treatment (DMOST). It also included recommendations to increase education on and access to palliative care and hospice for health care professionals and the public. We have only begun to put these recommendations into practice.
Some practical concerns I have about PAS include the fact that it does not address the majority of needs of patients and families as they face the end of life (as outlined
in Being Mortal). If made legal, PAS can easily move from the option of last resort to an option considered much earlier in the end-of-life journey, especially if the other options are not available or not affordable.
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