7 important reasons to oppose physician-assisted suicide | T. Brian Callister
This opinion column was submitted by T. Brian Callister, MD, FACP, SFHM, a board-certified internal medicine specialist and hospitalist. Views expressed are those of Dr. Callister as an individual.
Assisted suicide is a deadly public policy that should be rejected by the Nevada Legislature for seven key reasons.
First, legalizing assisted suicide limits choice and access to health care. I have witnessed this firsthand. I had two patients, one from California and one from Oregon, that needed lifesaving treatments, but the insurance medical directors in both cases denied the lifesaving treatments, but offered assisted suicide instead. Neither my patients nor I had requested the lethal drugs. My patients would not have been terminal with treatment. Once assisted suicide becomes a “treatment option,” it is the cheapest option and provides a perverse incentive for insurers to deny treatment. Assisted suicide limits choice and reduces health care options.
Second, Nevada’s proposed assisted suicide legislation requires physicians to refer the patient to someone who is willing to prescribe the lethal medication even if the referring physician considers this practice unethical. By forcing physicians to discuss assisted suicide as a “treatment option,” it will further encourage insurance companies to cover the cheapest option, rather than lifesaving treatments.
Third, there is a misconception about pain at the end of life. No one has to die in pain thanks to advances in palliative care. If someone is suffering needlessly, they need to change physicians. The data also supports this. In fact, “pain” is not even in the top five reasons for requesting assisted suicide based on data from Oregon, the state where assisted suicide has been legal the longest. The top reasons for requesting assisted suicide include loss of enjoyment in usual activities, burden to family and loss of autonomy. These are important social issues, but they are treatable with multidisciplinary care.
Fourth, a physician’s ability to predict life expectancy in terminal illness is often not accurate — the medical literature shows the average margin of error is 50 to 70 percent. Assisted suicide, like hospice, requires a physician to “certify” six months or less to live. Physicians are frequently wrong — we put people on hospice all the time, and we take them off all the time, after they have outlived their prognosis. Patients often live months and even years longer than we thought with a good quality of life.
Fifth, the safeguards in assisted suicide laws are weak. Having two physicians certify that the patient is terminal with six months or less to live is not a safeguard. Physicians refer to like-minded physicians. Physicians also exercise a lot of influence with their patients regarding important health decisions. Jeanette Hall was considering assisted suicide, but her doctor said no and encouraged treatment. Some 17 years later, she is an oft-cited opponent of assisted suicide. "If my doctor had believed in assisted suicide, I would be dead," she said.
Sixth, the “suicide contagion” that comes with legalizing assisted suicide is real. The CDC reported that after the Oregon assisted suicide law passed, general suicide rates in adults age 35-64 increased 49% in Oregon as compared to a 28% increase nationally. In addition, the U.S. Department of Veterans’ Affairs reported that “the veteran suicide rate in Oregon was significantly higher than the national average” after Oregon legalized assisted suicide.
Finally, “doctor shopping” and elder coercion will follow legalized assisted suicide. The Oregon experience has proven that it is easy to find a willing physician to comply with an assisted suicide request. Elder abuse is rampant in America. Nothing in the proposed assisted suicide law will prevent an interested party from looking for a physician to prescribe assisted suicide with no health care professional or witness required to be present at the death. Such a situation is ripe for abuse.
State legislators considering the issue of assisted suicide as public policy should take notice of these real-world experiences and pay attention to the very real and negative impact it can have on patients and their families. Assisted suicide is an affront to human dignity on every level and should be vigorously opposed by all.
T. Brian Callister, MD, FACP, SFHM is a board-certified internal medicine specialist and hospitalist who is nationally recognized as an expert in both care transitions across the continuum and end of life care. He is a member of the Executive Committee of the Board of Governors for the American College of Physicians, serving as governor for Nevada; and is a professor of medicine at the University of Nevada, Reno School of Medicine. Views expressed are those of Dr. Callister as an individual.
Join the conversation:How to submit an opinion column or letter to the editor