End-of-life issues are among our most emotionally and religiously charged community concerns. The definition of “death” might require greater clarity when considering medical and technological advances that have moved patient diagnosis from the physician’s examination to the laboratory. Enacted law regulating medical practice further muddies the water.
Canada’s Supreme Court recently lifted the Assisted Suicide (AS) ban but has given federal and provincial governments 12 months to craft necessary legislation. Until then, the ban on doctor assisted suicide stands.
A handful of U.S. states passed AS laws and include Vermont, Oregon, Washington, Montana and New Mexico. The practice is allowed for those who are critically ill. Each state has very specific parameters for patients requesting an end to life. The patient must personally administer prescribed medication.
In Europe, terminal illness as well as medical conditions causing unbearable suffering might allow physicians to prescribe lethal drugs. The Netherlands has allowed AS since 1984. Belgium law further allows those (terminally ill) less than 18 years of age as candidates for AS with parental consent. Switzerland has allowed AS since 1942. Switzerland also allows non-citizens to seek AS. Other countries including Colombia, Luxembourg and Great Britain have policies that do not shut the door on AS.
The American Civil Liberties Union supports euthanasia as the right of a competent terminally ill person to avoid excruciating pain and embrace a dignified death. The Hemlock Society agrees. Others argue medical advances can suspend death and disallow nature from taking its course. Others justify AS mentioning the exorbitant costs of maintaining a terminally ill patient desiring a dignified death.
Those against suggest that AS policy could bias doctors and medical providers for financial reasons. Particularly for those patients who cannot afford required ongoing care. Medical insurers could weigh in. There are concerns that the Hippocratic Oath sees assisted death as a primary taboo. “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect….”
Forty million Americans lack health insurance. Few have coverage that could cover the costs of long term skilled care. Costs to manage chronically ill patients are astronomical. Fears are valid that patients unable to afford such care might be victimized by policies allowing assisted suicide. Many in authority want to run government like a business. These bottom liners give validity to economic concerns influencing AS decisions.
The Oregon experience suggests no such prejudice against the poor or ethnic minorities, but concerns are valid. Careful monitoring on a case-by-case basis by a state health department or other appropriate agency should be instituted. The underserved should not face harm should physician assisted suicide become national law.
The primary justification for AS should be the terminally ill’s dignified death. Patients should have choice for this request. Each case then must be viewed on its own merits. Such an option would allow more humane patient medical management. Careful monitoring will thwart abuse.
Marc Yacht is a semi-retired physician living in Hudson Florida. Column courtesy of Context Florida.