Dr. Trembley practices internal medicine in the Northeast Kingdom of Vermont. In italics below is his wonderful letter. The main body of the letter is in blue. Dr. Trembley sent it to the senators on the Health and Welfare Committee, before they voted it out. He sent it to colleagues with the note in black to urge them to contact their senators.
Though we all need to contact our senators, and indeed every senator, our Vermont doctors and other medical workers are the most important citizen voices against this bill. They have first hand experience with death and dying. In spite of this, some are remaining silent. One told us the whole idea makes her so sick she can’t even express her thoughts. We urge her and anyone, physician or not, who has not spoken out to make yourself heard NOW. Your email or phone call, whether you are able to express your ideas perfectly or not, can provide the tipping point that causes this causes this too-close-to-call vote to go our way, against legalization of assisted suicide in Vermont.
The physician assisted suicide bill is currently in the Senate Health and Welfare Committee. They have concluded testimony and are preparing to vote on whether to move the bill forward this Friday, Feb 1st. If you feel as strongly as I do about this subject I urge you to send a message to the members of this committee. I’ve included the text of my e-mail with the appropriate links.
I have been a practicing internist in the Northeast Kingdom for the past 27 years. I’ve had the unique honor, privilege and pain of shepherding countless patients and friends through their last months and moments of life. I’ve comforted, relieved pain and suffering, and experienced the transformative moments with family and the dying as they come to final acceptance, love and letting go. I believe I have a good perspective on this issue and the Bill now before your committee.
As is true of all the medical colleagues I have spoken with, I will not participate in a planned decision to intentionally end someone’s life. I will treat a dying patient’s pain and suffering aggressively with the help of hospice, even if the medications necessary to keep them comfortable could shorten life. That is ethical and my duty, but I cannot reconcile that with an intentional act, requested out of fear, that may rob patient and family of important time for grieving and reconciliation. The Bill would call for me to certify a patient has less than 6 months to live, yet in my experience all of us physicians are notoriously inaccurate with end of life predictions. I have also witnessed family discourage sick elderly from accepting appropriate and potentially life saving treatment for what we sometimes suspect are financial and inheritance considerations. The elderly are particularly vulnerable to coercion. Many elderly, particularly if chronically ill, view themselves as a burden, and may seek to end their lives for that reason, perceiving they will relieve loved ones.
As someone who treats primarily the geriatric population, I hear daily my patients’ fears and concerns of becoming incapacitated. We use those opportunities to have frank discussions about limiting care and avoiding futile care. I promise them I will do my best to keep them healthy, active and functional, but when it is their time I will not push futile care with little hope of ensuring any meaningful survival. Yet, there are also many patients or their families who insist on aggressive heroics and resuscitation despite advanced age and debilitating chronic illness. Instead of debating intentionally ending life, we would be better served putting our efforts toward a meaningful discussion and education on reasonable choices and limitations of care near end of life, as well as coordinated, compassionate, and competent palliative and hospice care.
Robert Trembley, MD