The article in italics below appeared in the July 31 2012 blog of the Boston Globe and can be read there at the link below:
We like it a lot, especially because it brings up a reason we had never considered for being troubled about the lack of a requirement that a physician be present when the patient ingests the lethal overdose of prescribed barbiturates: “…there is no guarantee he would ever receive it.”
That the patient might not receive the drugs is concerning if we consider that a caregiver or relative picking up the drugs could do anything he wants with them as long as the patient doesn’t report him: we can envision their being used by another person than the patient to commit suicide or being sold in the illegal drug market the way so many prescription pain medications are.
Another possibility opened up by the failure to require witnesses has, however, long been our main concern. Proponents, including the physician whose pro-assisted-suicide article is juxtaposed with this one in the Globe blog, assert that many patients find security and assurance in having the means to commit suicide, but never actually do so. Requesting and filling a prescription for these drugs, therefore, does not necessarily mean a patient will actually use them. Under assisted suicide laws in Oregon and Washington and proposed in other states, the lack of required witnesses means we can never know how many of those who do die from a lethal overdose ingest the drugs without their full consent because of pressure or are actually murdered by someone who knows that the poisoning death of a patient who has requested assistance in suicide will never be investigated.
Dr. Barbara Rockett/ Newton-Wellesley Hospital
Physicians, in their care of patients, must establish a physician-patient relationship based on mutual trust and respect to be able to render the best care to their patients. Centuries ago the physician Hippocrates wrote the Hippocratic Oath, which many of us took when we became physicians and guides us in the ethical practice of medicine. It states that when treating patients, physicians will “First do no harm.” It goes on to state that “I will give no deadly medicine to anyone if asked nor suggest any such counsel.” Physician-assisted suicide is in direct conflict with this statement which, when followed, has protected the patient, physician, society and the family, and at the same time has committed doctors to compassion and human dignity.
As a practicing physician, I have cared for many patients throughout their lives, extending through to their last days of life. Their needs must be honored and their dignity preserved, which might require alleviation of pain, treatment of depression if it exists, as well as support for them and their families. Palliative or hospice care must be offered when appropriate.
I was impressed with the courage and fortitude of many in wheelchairs and on canes and on crutches who might require this care and who testified before the Judiciary Committee at the State House in opposition to physician-assisted suicide. We physicians must assure them that we will always be there to protect them and administer the care that they might require.
It has been demonstrated that the highest cost of medical care exists in the last six months of life. We must resist advocating for physician-assisted suicide as an alternative to spending money caring for these patients. We as physicians must avoid the so-called slippery slope of attempting to save money by doing less for our patients rather than rendering the proper care to them. To substitute physician-assisted suicide for care represents an abandonment of the patient by the physician.
Massachusetts has had the outstanding reputation of training medical students, residents, and fellows in the care of patients. Let’s not put a blemish on that reputation by advocating for physician-assisted suicide.
The present initiative does not require that the physician be present when the patient takes the medicine, so there is no guarantee that the patient will ever receive it.
One of the most difficult and often inadequate determinations that a physician has to make is the attempt to predict when a patient might die. An example of this occurred when my husband, a neurosurgeon, saw a patient who had been operated on by the renowned neurosurgeon Dr. Harvey Cushing for the most malignant type of brain tumor. The surgery was followed by radiation therapy. He was told that he had six months to live, so he spent his savings doing all the things he had hoped to do in life. When the six months were over, he could not get a job, he could not get insurance, and he was very upset that he was given a bad prognosis. That was 40 years before my husband saw him. Thinking that the diagnosis might have been incorrect, pathologists reviewed the slides and applied all the modern techniques, only to find that the original diagnosis was absolutely correct. He did, in fact, have the most malignant type of brain tumor. Although this is a rare case and illustrates the exception to the rule, it shows that exceptions can occur and that there are outliers to the statistics.
More than 75 percent of the physician members of the Massachusetts Medical Society have voted to oppose physician-assisted suicide. Since their meeting in 1999, the members of the American Medical Association have voted to oppose physician-assisted suicide and have been consistent in their opposition, stating, “The AMA opposes physician-assisted suicide as antithetical to the role of the physician as healer. We are committed to providing the best end-of-life care.” At a meeting in 2003, the AMA went on to state, “Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would impose serious societal risks.”
The Massachusetts Board of Registration in Medicine has imposed a requirement on physicians seeking to be licensed in Massachusetts that they must complete a course in end-of-life care and another in opioid prescribing. These courses educate the physician in the compassionate, considerate, and supportive care that must be offered to patients at the end of life. Reasonable prescribing of opioids should be offered only when necessary and should not be substituted for other needs such as treatment of depression.
Dr. Lonnie Bristow, former president of the AMA, has made the following statement: “There is a great deal of concern in this nation about the issue of physician-assisted suicide. It is important, in fact, incumbent among the American Medical Association to spell out its position on this important issue. Just what is our position? Simply put, we oppose it. We believe that physician-assisted suicide is unethical, it is fundamentally inconsistent with the pledge that physicians make to devote themselves to healing and to life. We believe laws sanctioning physician-assisted suicide serve to undermine the foundation of the patient-physician relationship, which is grounded in the patient’s trust that the physician is working wholeheartedly for the patient’s health and welfare.”
Physician-assisted suicide has been falsely advertised as death with dignity. Believe me, there is nothing dignified about suicide. I ask the voters of this Commonwealth, as they enter the voting booth, to vote for dignity for life and not for death. Please vote no on physician-assisted suicide.
Dr. Barbara A.Rockett is a physician at Newton-Wellesley Hospital and former president of the Massachusetts Medical Society.