medically-assisted-suicide

Medically Assisted Suicide: Do Patients have the Right to Die?

Beth Hawkes MSN, RN-BC - 07/02/19

A terminal disease is defined as an incurable disease that is likely to result in death within six months. Medically-assisted suicide is intended for people who are going to die from a terminal illness and want a say in how they die.

Brittany Muynard was a 28 yr. who is credited with changing the conversation about medically-assisted suicide.  As a newlywed, she was diagnosed with terminal brain cancer. Her cancer took the form of a rapidly-growing, massive tumor, a glioblastoma.  Knowing that she faced memory loss, incontinence, possible loss of vision, and death within six months, she and her husband moved from California to Oregon to take advantage of Oregon's Death with Dignity Law.  She took lethal medication and died in 2014.  Brittany and her family believed her mission in life was to advocate for medically-assisted suicide.

Kevin Roster is still alive at this writing. He is a world class poker player and the father of a 9-year-old son. Kevin Roster is 36 years old and suffers from cancer. His left leg and left buttock were amputated along with a 20 lb. tumor that left him confined to a wheelchair. The cancer has metastasized to his lungs and heart. Kevin prefers to die with dignity and says, “I don’t want to wear a diaper”.  

Legislation

Recently, Maine became the eighth state to enact medically assisted suicide, allowing people with terminal illness to end their lives with a provider’s prescription. Democratic Governor Janet Mills signed the Maine Death with Dignity Act on June 14th, 2019 somewhat reluctantly. 

"It is my hope that this law, while respecting the right to personal liberty, will be used sparingly," said Mills.

The bill authorizes “a person who is 18 years of age or older, who meets certain qualifications and who has been determined by the person's attending physician to be suffering from a terminal disease … to make a request for medication prescribed for the purpose of ending the person's life.” allowing terminally ill people to end their lives with prescribed medication.

Maine joins California, Colorado, Hawaii, Oregon, Vermont, Washington, New Jersey, and Washington, D.C. as states that have legalized medically assisted suicide.

Under the law, doctors can prescribe a fatal dose of medication without fear of being arrested and persecuted. The law represents those who say that the terminally ill have a right to end their own life. 

Language Matters

Those who support the practice use the term “aid-in-dying” or “death with dignity” as opposed to “medically-assisted suicide” to frame it positively. “Aid-in-dying” has connotations of helping whereas “euthanasia” or "physician-assisted suicide" suggests something illegal and disturbing.

Difference Between Suicide and Medically-Assisted Suicide

Proponents say there is a difference between suicide and medically-assisted suicide.  People who commit suicide want to die. People with terminal illnesses don't necessarily want to die, but they have no choice. They want to control their imminent death.  Kevin Rosters does not see it as taking his own life- the cancer is taking his life. 

As Kevin Rosters says, “I want a peaceful death”. It’s the choice between dying in potentially uncontrolled pain and insufferable indignity or dying quietly with dignity. 

Opponents

Recently at its annual meeting in Chicago, the American Medical Association (AMA) reaffirmed its opposition to medically-assisted-suicide by a large margin. Delegates voted to reaffirm the AMA’s existing policy that “physician-assisted suicide and euthanasia are fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.”.

Likeminded opponents, including the Catholic church and the Christian Focus on the Family group, say it leaves the door open for abuse and coercion of those with terminal illness and those with disabilities. A top official spokesperson for the Vatican, following Brittany Muynard’s death, said “Suicide is wrong because it is saying no to life and to everything it means with respect to our mission in the world and to those around us”. Pope Francis called it “false compassion”.

Some say that hospice care can alleviate suffering but without death as its goal.

Slippery Slope

Some fear that the influence of economics will prompt insurance companies to authorize medically assisted suicide instead of paying for treatment in terminal cases.

Others fear the government may sanction end of life for conditions other than terminal illness, eroding the difference between medically-assisted suicide and government-endorsed. Could it lead to people requesting medically-assisted because they are tired of living or fear ageing?

“Assisted suicide is a dangerous public policy that puts the most vulnerable people in society at risk for abuse, coercion and mistakes,” said Matt Valliere, executive director of Patients Rights Action Fund, an advocacy group. “It also provides profit-driven insurance companies perverse incentives to offer a quick death, rather than costly continuing quality care."

Supporters

Compassion & Choices, a group that supports medical aid-in-dying, criticized the AMA’s decision to maintain its Code of Medical Ethics opposition. The group said the AMA contradicted itself by also saying that physicians can provide medical aid-in-dying “according to the dictates of their conscience without violating their professional obligations.” 

Supporters claim that continued survival can be harmful while aid-in-dying gives patients the option to maintain dignity and avoid suffering.

Hopelessness

It’s hard for most of us to imagine a life facing certain imminent death. Patients suffer a loss of purpose and hopelessness. Hopelessness is a component of unbearable suffering. Only the person experiencing the suffering can speak to what it means to realize your health is never going to improve, only worsen. Existential suffering can increase the desire to die. 

It’s a profound loss of sense of self to contemplate dying. People suffer as much from loss of autonomy as from physical pain. How hard is it to face being completely dependent and burdening your family? Who are you if you are no longer you? 

Safeguards

The law provides for safeguards. Patients aged 18 or older, must make two verbal requests and one written request. A second provider must be consulted and the patient must be screened for depression. Patients must undergo two waiting periods. 

The Prescription

The meds used an include a barbiturate such as pentobarbital and secobarbital (Seconal). Patients may be instructed to take an antiemetic before ingesting the medication. Pentobarbital mixed with chloral hydrate and morphine runs $400.00-500.00 and Seconal costs $3,000 to $5,000, which can be a barrier to some.

Medically-assisted suicide raises strong feelings and challenges us to examine our deepest beliefs. My belief is that it should be safeguarded but that every person has the right to make their own decision.