Tuesday, February 3, 2015

Ira Byock: We should think twice about assisted suicide.

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Ira Byock
Dr Ira Byock, who directs the Institute for Human Caring of Providence Health & Services in Los Angeles, wrote an excellent article concerning assisted suicide that was published in the LA Times on January 30, 2015.

The timing of his article is critical with the California assisted suicide bill being debated and assisted suicide bills currently being debated in at least 15 US states.

Byock, who identifies with a politically progressive position explains how assisted suicide is not politically progressive.

As someone who supports all those other liberal causes, yet opposes physician-assisted suicide, I'd ask my fellow progressives to shine a cold hard light on this issue. We have been the target of a decades-long branding campaign that paints hastening death as an extension of personal freedoms. We should bring the same skepticism to physician-assisted suicide that we do to fracking and genetically modified food.
Byock continues by explaining how the assisted suicide lobby has created euphemisms to confuse the assisted suicide debate.
“Suicide” is distasteful, so they promote “physician aid-in-dying,” “death with dignity” and the “right to die.” And yet all of these mean taking action to end one's own life. The news media have largely adopted the assisted suicide movement's terminology, so these euphemisms are worth unpacking here. 
“Physician aid-in-dying” makes it sound like giving someone a lethal drug is an extension of hospice and palliative care. It is not. As a palliative care physician I aid people in dying by treating their symptoms and supporting them through the difficult practical and emotional tasks of completing their lives. In more than 35 years of practice I have never once had to kill a patient to alleviate the person's suffering. 
“Death with dignity” implies that frail or physically dependent people aren't already dignified. But they are. People who are disabled or facing life's end can be cared for in ways that allow them to feel respected, worthy and valued. 
The phrase “right to die” is brilliant branding. You will not, however, find any such right within the U.N.'s Universal Declaration of Human Rights or U.S. Constitution. Americans have a constitutional right to refuse life-prolonging treatments. But there's a big difference between being allowed to die of your disease and having a doctor intentionally end your life.
Byock challenges the assertion that legalizing assisted suicide will not lead to a slippery slope.
In the 1990s, proponents in Oregon campaigned to legalize physician-assisted suicide in cases of unrelievable physical suffering. Oregon Health Authority research, however, shows that more than 75% of those who took that option didn't cite pain as a concern. Their issues were emotional or existential: feeling a burden to family, loss of autonomy or inability to do things they enjoy.

To glimpse the future, one need only look at the Netherlands, where euthanasia — a lethal injection by a doctor, not simply a prescription to be self-administered — has been available for several decades. There, people have been euthanized at their request for pain, tinnitus or blindness in non-terminal cases. More than 4,800 people were euthanized in 2013, more than 40 of them for psychiatric illness, according to the Dutch Euthanasia Review Committees.
Disability rights leader John Kelly
debated Dr. Marcia Angell in Boston.
Byock shows how the Dutch euthanasia model is being promoted in America.

... The mission of Final Exit Network ... is to enable all competent adults to end their lives whenever they deem their physical quality of life is unacceptable. The movement is also pushing to expand the means of hastening death to include lethal injections delivered by physicians. Dr. Marcia Angell, who testifies for Compassion and Choices in court cases and legislative hearings, recently wrote in the New York Review of Books: “After my husband's death, I have come to favor euthanasia as well, for home hospice patients in the final, agonal stage of dying, who can no longer ingest medication orally.” This is the practice in the Netherlands that the American assisted-suicide groups still claim won't happen here.
Byock concludes by explaining that he is concerned about health care in America but he urges progressives to support improvements to end-of-life care.
I believe that deliberately ending the lives of ill people represents a socially erosive response to basic human needs. If we can stay civil and (even relatively) calm, we can debate physician-assisted suicide while also substantially improving end-of-life care.
Ira Byock, M.D., directs the Institute for Human Caring of Providence Health & Services in Los Angeles. He is a professor of medicine at Dartmouth's Geisel School of Medicine and author of "The Best Care Possible."


Madellen said...

It is suspicious to me that AS/EU has gained support in Canada at a of time diminished access to Medicare. I refer to impossible wait lists for limited service, stingy gatekeeping for early interventions, the growth of privatization and a two tiered system, and the lack of hospice/palliative care for 70% of those in need-including children. We have an aging population with growing pressure on chronic care and end of life resources. We know that treatment on palliative care units is in fact time limited, not necessarily based on patient need or caregiver decisions, but on hospital budgets. Patients who are dying, are pressured by hospital policy to leave within 30 days! It's a fact. The cost effectiveness option is now available to end their lives, and it is indeed a chilling one. This is no exaggeration. We hear of bankrupt pension funds and tightened eligibility criterion for Canada and old age pensions. It seems to me that these forces will covertly influence termination of life decisions, even if done for overtly humane reasons. In other words, there is no clamour to change the variables which in fact increase and prolong patient suffering. The AS/EU solution simply takes the patient out of the equation. Many people I know are swayed by the appealing but empty rhetoric about humane care and relief from suffering. I think personally and as a health professional, we have a far more dangerous situation now, than most people yet realize. Margaret deMello MSW

Madellen said...

I totally agree with you. I boldly add that I'm disappointed with the National Association of Social Workers whose ambivalent practice statement neither opposes nor endorses active euthanasia and assisted suicide. It leaves professional social workers in ethical limbo. We work on the front line with patients who need health resources and we know what social and financial forces are likely to influence termination of life decisions. We also know that not everyone has equal access to health care, therefore we also know that termination of life decisions will apply disproportionality to certain communities of people, while others will have longer better remedial and terminal care.
Incidentally, we know this with certainty from population health research. Thank you for standing against this difficult and dangerous health issue.
Margaret deMello MSW
Vancouver, Canada