Death with indignity

In response to the May 24 commentary, “Death with dignity opponents misguided,” by Ethel Schwalbe, it would be better stated that the “Death with Dignity Act” is misguided. At the very least, it is potentially harmful.

Probably the most concerning problem is the inability to create safeguards or contain assisted suicide to clear boundaries. The bill may attempt to minimize potential for abuse, but there is no way to guarantee that abuses will not occur. In looking at the practice of physician assisted suicide in the Netherlands, history speaks for itself. The truth is that in the Netherlands, the guidelines for use of physician assisted suicide are more strict than even Oregon’s law. How is it then, that the practice has been expanded to include infants, the depressed and the chronically ill? With availability of excellent palliative care (focus on relief of suffering while promoting best quality of life, ideally by an interdisciplinary team), why is it that the percentage of deaths from euthanasia have continued to increase?

Why is it that now an alarming 80 percent of euthanasia deaths are not requested by the patient? To make matters worse, only 40 percent of all assisted suicides and euthanasia deaths are even reported. Keep in mind that according to a report in the Journal of the American Medical Association, “virtually every guideline set by the Dutch…has failed to protect patients, or has been modified or violated.” These are not simply “horror stories” to be lightly brushed off. Oregon is only earlier in the process, but is following the same dangerous path.

And what of the “horror stories” from the Oregon experience? I consider it a horror that the first known assisted suicide victim in Oregon was a depressed patient, and the doctor who wrote the lethal prescription knew the patient for only 2 1/2 weeks! In another case, a patient in the early stages of dementia and under family pressure received assisted suicide, despite that a psychiatrist concluded she was not an appropriate candidate. The family then found a psychologist who noted that the patient had memory problems and the family may have been somewhat coercive, but approved the assisted suicide, anyway. Why have fewer than one-third of Oregon’s suicides received psychiatric counseling? It is not possible to guarantee protection particularly for the most vulnerable, the frail, the elderly, the poor, the physically and mentally handicapped.

Read the Maine Death with Dignity Bill. Note for yourself, that the bill only speaks to a person being “capable” of making the decision, not necessarily “competent.” The term “capable” is defined as “not incapable.” Competency, which is a legal term with meaning in the courts, is not clearly addressed in the bill. A patient can be capable of voicing a request for assisted suicide, but not be competent to make health care decisions, and may still qualify under the act.

Contrary to what Schwalbe stated, there is no requirement to notify family. There is only a “request” that the family be notified. Even the requirement for involvement with a “palliative care specialist” is vague and may not assure that patients have access to the best pain and symptom management. Regarding reporting, the only requirement is for the physician to keep a medical record. There is no requirement to report on a death certificate, hence the great difficulty in actually collecting data regarding appropriate or inappropriate use of physician assisted suicide.

Mainers for Death with Dignity has received over 90 percent of their funding from outside of Maine. And just why is it that nowhere in the bill do we find the term physician-assisted suicide, though that is clearly what we are talking about? Instead, the phrase “death in a humane and dignified manner” is used repeatedly, creating an illusion that we have perfect safeguards and no dangers.

The ballot summary reads: “Should a terminally ill adult who is of sound mind be allowed to ask for and receive a doctor’s help to die?”

Sound almost innocuous? It most definitely is not. Don’t be fooled by the supposed “safeguards” referred to in the ballot summary. This bill has serious flaws and I urge you to vote no.

Susan Cheff, M.D. is a family physician currently practicing in Old Town and was the medical director of hospice at St. Joseph Hospital in Bangor from 1997 to 1998.