Letter: Local MDs: Dignity is not about death
Posted: 12/11/2011 09:45:27 PM EST
Sunday December 11, 2011
In his encyclical letter entitled “Evangelicum Vitae,” Pope John Paul II states, “choices once unanimously considered criminal and rejected by the common moral sense are gradually becoming socially acceptable. Even certain sectors of the medical profession, which by its calling is directed to the defense and care of human life, are increasingly willing to carry out these acts against the person.” As physicians, we took an oath to strive, to the best of our abilities, to help patients and to make every reasonable effort to do no harm. Physician assisted suicide is incompatible with that goal, and is the means to an end that we have no right to employ.
In Oregon (the first of only two states with legalized physician assisted suicide), 17 percent of the 65 persons who chose physician assisted suicide in 2010 indicated as a reason “not wanting to be a burden on family and friends.” Approximately 70 percent of persons who chose physician assisted suicide in Oregon since 1998 were at least 65 years old. Of concern when we consider this data is that there is a significant problem with elder abuse in America. Commonly, the perpetrators are relatives who potentially could have personal or financial interests in hastening the death of the family member.
Many proponents of physician assisted suicide claim that poor pain control and intense suffering at the end of life are the reasons we should legalize this act. However, Oregon data from 2010
indicates that only 10 percent of physician assisted suicide patients report poor pain control as an end of life concern, down from the 22 percent who cited intractable pain as a reason from 1998 through 2009. This can be attributed to progressive advancements in palliative care and advanced methods of pain control.
Also in Oregon, about 94 percent of the time, people blamed “loss of autonomy and being less able to engage in activities making life enjoyable” as reasons to end their lives. Many times these are signs of depression or other psychiatric conditions that may be treatable if accurately diagnosed. Some proponents say physician assisted suicide is a route to autonomy. What statement does that make about the human condition when suicide is necessary to achieve autonomy? The term “dignity” is often applied to the act of suicide, whether physician assisted or not. Webster’s defines dignity as “the quality or state of being worthy, honored or esteemed.” Does suicide warrant honor? Autonomy does not provide or relinquish dignity or vice versa.
As we move into a world of reducing healthcare costs, there is a real risk that, if legalized, physician assisted suicide could be used as a vehicle for significant financial savings in end of life medical expenses, an extreme case of health care rationing. In fact, Medicare data reports that one-third of the yearly Medicare budget is used for patients in their last year of life. The Green Mountain Care Board has been formed by the Shumlin administration and has been tasked to design a universal health care system for Vermont by 2014, which cannot be successful without significant cost containment. Surprisingly, this has already happened to a 53-year-old in Oregon without health insurance with advanced prostate cancer who received a letter stating that the state would pay for physician assisted suicide but not for the costly treatment of his cancer.
Obviously, this is not the forum for a long discussion on the topic, but we hope to stimulate more thought and questions about the stark realities of physician assisted suicide. Adopting a controversial practice of this magnitude comes with a frightening array of intended and worse yet, unintended consequences. The most important thing missing from the recent data collected by the Oregon Dept. of Health is the voice of the patient and their personal experience. It is important for all Vermonters to know that this has not been decided in our state and that those against this practice need to speak out and be active in the opposition of this dangerous and unethical option. We are adding our voice to the many others who have vigorously opposed this practice.
Brian Cunningham MD
Simon Drew MD,
Marie George MD
Eugene Grabowski MD
James Keenan MD, PhD
Colleen Kelley MD
Robert Pezzulich MD
Antonio Razo MD
Carol Salazar MD
Barth Vander Els MD