Why the AMA & Everyone Else Should Oppose Assisted Suicide
As a practicing physician with over 30 years of experience, I am honored to be an advocate for the ethical care of all patients regardless of their stage of life. Since assisted suicide became legal in California and Oregon, I have experienced first-hand the abuses this practice incentivizes.
The American College of Physicians (ACP) has recently reiterated its opposition to assisted suicide, and the American Medical Association’s (AMA) Council for Judicial and Ethical Affairs (CEJA) appropriately recommended that the AMA do the same. I couldn’t agree more, and I applaud both organizations for pointing out the ethical problems with assisted suicide.
Unfortunately, however, the AMA House of Delegates just rejected this recommendation, passing up a golden opportunity to reaffirm opposition. The matter will now be taken up once again by CEJA.
I cared for two patients in my hospital in Northern Nevada who were seeking transfers to their home states of California and Oregon for life saving treatments. With these particular treatment options, both patients had an excellent chance of cure. Without the treatments, both would likely die from their diseases.
When I spoke with the medical directors of the patients’ insurance companies, both of them told me that they would cover assisted suicide but would not approve coverage for lifesaving treatment. Neither the patients nor I had requested assisted suicide, yet it was readily offered. Instead of the best treatment options, my patients were offered the cheapest option — a quick death through lethal medications — perfectly legal to do in those states, but certainly unethical.
Any law legalizing assisted suicide is bad policy for many reasons. First, legalizing assisted suicide actually limits your choices and access to health care. As my experiences prove, patients that would not be terminal with treatment are being offered assisted suicide instead. Assisted suicide is not about freedom, autonomy, or choice — it limits choice, reduces your health care options, and cuts costs by creating a perverse incentive to deny you care.
“Compassion and Choices”, the group pushing for assisted suicide across the country, was originally known as “The Hemlock Society.” The founder of the “Hemlock Society,” Derek Humphrey, said in his book, “Freedom to Die,” that “in the final analysis, economics, not the quest for broadened individual liberties or increased autonomy, will drive assisted suicide to the plateau of acceptable practice.”
Another underlying premise proponents use to push assisted suicide is that you should fear horrible, unending pain at the end of life. This is a scare tactic and is simply not true. In fact, “pain” is not even in the top five reasons for requesting assisted suicide according to 20 years of data from Oregon. The top three reasons listed are loss of enjoyment in usual activities, burden to family, and loss of autonomy. These are important social issues that need careful multidisciplinary attention, psychological care, and skilled physicians who are patient enough to help resolve these concerns.
We can and should do more to properly control physical symptoms as well as psychosocial difficulties at the end-of-life. Increasing education and training in palliative care can help accomplish that goal. Caring for patients physically, emotionally, and spiritually at the end-of-life — not providing suicide — is where our precious medical education resources should be allocated.
The real story here is the slippery slope of risks surrounding legalization of assisted suicide. The problem is not just limited to residents of the states where assisted suicide is legal; it is crossing state borders and permeating the attitude of the decision makers that determine your care. The delegates of the AMA who are considering the issue of assisted suicide as public policy should have taken notice — as should we all — of the very real and negative impacts assisted suicide has on patients, their families, and society as a whole.
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 the Governor-elect of Nevada for the American College of Physicians and is an Associate Professor of Medicine and Academic Hospitalist at the University of Nevada, Reno School of Medicine. Views expressed are those of Dr. Callister as an individual.