Tuesday, January 12, 2010

Washington State doctors won't rush into assisted suicide

I few days ago I read an article by Matt Gouras from the Associated Press that was titled: Doctors won't rush into assisted suicide.

Link to the article: http://billingsgazette.com/news/state-and-regional/montana/article_950bf20a-fe1a-11de-8841-001cc4c002e0.html

I found the article interesting because it got to the meat and potatoes of the issue.

I hope that the premise of the article - doctors won't rush into assisted suicide - is true, but I am cautious knowing how Compassion & Choices, the leading euthanasia lobby group, actually controls the workings of the Oregon law and they appear to have more information about the assisted suicide deaths in Washington state than the State Government.

Nonetheless the article correctly stated:
"The court decision made Montana the third state where it is legal, but the state has no specific laws outlining guidelines for doctors like they do in Oregon and Washington. That will leave Montana doctors on their own to determine how to proceed if they choose to help a dying patient commit suicide.

The Supreme Court said nothing in the law prevents a doctor from prescribing death-inducing drugs to terminally ill, mentally competent patients. And the court said doing so would be a defense against homicide charges.

But doctors, just because they could have a defense to charges of murder, aren't likely to rush into the process. They are hoping the Legislature ­ until now hesitant to wade into the debate ­ will craft a legal framework for assisted suicide."

The article is correct in stating that the court said that the doctrine of competence would be a successful defense against any assisted suicide prosecution in Washington state, but the court did not say that physicians could not be prosecuted.

The other fact is that the court narrowly opened the door to assisted suicide in Montana based on an interpretation of the legislative framework in that state. That means that the the open door to assisted suicide could be closed by legislative means.

The court did not suggest a regulatory regime. Even in Oregon where assisted suicide is defined within the law abuses occur, such as when Barbara Wagner was denied medical treatment but offered assisted suicide or palliative care.

The court also erred in its decision when it stated that the right to refuse medical treatment is the same as assisted suicide. Ethically and in real life these circumstances are very different.

The article quoted Dr Margaret Stockwell, who helps to run a hospice program at a hospital in Helena. She stated:
"Frequently we give medications that provide comfort with the possibility of hastening death, but that's not the point to hasten death, the point is to provide comfort," she said. "Feeding tubes and machinery are not a very good idea at that point. There are situations where enough is enough."

This means that to provide comfort (using analgesics to relieve pain and suffering) may hasten ones death, but the point of the comfort care is not to hasten death but provide comfort. The point of assisted suicide is to be directly and intentionally involved with causing the death of another person. This is different by its intention and in its reality. She is also saying that withdrawing medical treatment is often necessary and only allows natural death to occur and it is not the same as ingesting a lethal dose to cause death.

Another explanation: when a person provides comfort care or withdraws life-sustaining treatment, the patient may die. But sometimes they don't and most often they do not die immediately. When a person ingests a lethal dose, they die from the lethal dose and when the lethal dose is properly prepared, they never survive.

In other words, assisted suicide results in the direct and intentional death of the person. Withdrawing treatment allows natural death to occur, but sometimes a person actually continues to survive. Clearly it is ethically and in reality different than assisted suicide.

The ACLU of Montana, that supports assisted suicide, stated through its spokeswoman Amy Cannata:
"Right now it is pretty unclear for doctors.... The court said death with dignity is a defense in homicide. I don't think that will put many doctors at ease to help patients who want and need this aid in dying. I don't know that if I was a physician that would be enough safeguard for me to say, 'yeah I will help you.'"

It is clear that the issue of assisted suicide is not settled in the state of Montana. It is also clear that the court settled one confusion and created a new confusion.

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