Assisted suicide is the wrong prescription

The following article was published by Kevinmd on March 15, 2024.

By Dr Joseph E Marine

America expends much time, effort, and resources when people become seriously ill, bringing many face-to-face with their own mortality. For patients and their families, it is an emotional and difficult time under the best of circumstances. As a cardiologist, I participate in the decision-making that comes at this time, and it has provided me with the honor of delivering care that has allowed patients to rebound from acute illness and to live better with chronic heart disease. But it has also provided me with the privilege of helping people nearing the end of life.

Because I practice medicine within an excellent hospital system, I know that our health care system has the capacity to provide life-saving care in dire circumstances. But I also know that not everyone has equal access to this care. For people with disabilities, people of color, older Americans, and others who lack access, they too often face inequitable barriers to care.

While our health care system is geared toward healing, we all will die. However, creating new public policy that would allow medical professionals to help their patients take their own lives with a prescription for lethal drugs is fraught with danger and has significant consequences for the health system and for our society. The medical profession crossing a red line from neither hastening nor prolonging death into the realm of intentionally causing it for some people, based on subjective criteria, has had terrible consequences throughout history.

Based on my experience, research, and observation, I have come to oppose legalization of assisted suicide, which is also known by several confusing euphemisms. Regardless of the term used, it creates great societal risk.

While downplaying the role of palliative and hospice care programs, advocates of assisted suicide continue to promote dangerous and misguided public policy that would transform suicide into a “medical treatment.” These policy proposals and legislation violate many basic principles of patient safety, erase critical civil and legal protections for vulnerable patients, and do nothing to address the real needs of patients with advanced illnesses and disabilities.

Assisted suicide is not medical care. It has no basis in medical science, practice, or tradition. In states that have passed assisted suicide laws, few physicians are willing to participate. In Oregon in 2021-2022, the median duration of the patient relationship with the physician prescribing assisted suicide was only five weeks, indicating that patients are getting the prescriptions from a small number of willing providers who do not know them well and not their regular physicians. The American College of Physicians and the American Medical Association, the two largest medical societies in the country, have consistently discouraged physician participation and not supported the legalization of assisted suicide.

Furthermore, the lethal drugs used in assisted suicide have never been scientifically tested for efficacy in causing death, and the U.S. Food and Drug Administration has never approved any drugs for this purpose. Rather, the drug recipes for assisted suicide have been invented by euthanasia practitioners, using methods known only to themselves. Moreover, the movement away from the use of barbiturates towards various combinations of other sedative-hypnotic and cardiac drugs indicates that assisted suicide physicians are experimenting with these poison cocktails without any conventional safeguards or oversight, in violation of the principles of the Declaration of Helsinki. Continued experimentation also suggests that the drug cocktails may not be “working” as well as proponents claim.

Proponents of assisted suicide assert that the enabling laws have “strong safeguards”; however, a close look at the facts shows that these safeguards are an illusion. The law in practice can be routinely violated because it relies entirely on self-reporting, with broad criminal, civil, and professional immunity given to physicians, protection of records from discovery and subpoena, no witnesses to consumption of drugs, falsification of death certificates (the cause of death is not reported as suicide but as the underlying illness), and no routine audits, investigations, or supervision by an independent safety monitoring board. In addition:

• Some patients have not died quickly and have suffered as a result, in some cases taking 2 to 3 days to die.
• Most other countries with legal assisted suicide use intravenous drugs because of complications and failure in up to 20 percent of patients who use pills.
• In Oregon, which has had assisted suicide for 25 years, officials admit that in the 80 percent of cases with no medical witnesses, they have no way to know if complications occurred. Without witnesses, the state does not know whether the drugs were self-administered or whether some patients were assisted to die in other ways.
• In states with assisted suicide, some patients have lived up to 3 years after receiving a prescription, in violation of the law, which requires a 6-month prognosis, with no accountability or consequences for the physician.
• 15 to 20 percent of U.S. patients referred for hospice care survive their 6-month prognosis, and 6 percent are found not to be terminally ill.
• Patients with some advanced illnesses have a 50 to 75 percent incidence of clinical depression, and at least one patient received a prescription in Oregon despite a history of severe depression and suicidality. Yet fewer than 2 percent of Oregon patients who received assisted suicide prescriptions had a formal mental health evaluation.

These facts are clear evidence that assisted suicide laws are not providing adequate protection for vulnerable patients and are ripe for abuse. What patients with advanced illnesses and disabilities need instead is more support and greater access to excellent palliative care, hospice care, and pain management programs. America has some of the best health care in the world. We should use it and not undermine our health care system with assisted suicide laws. It is the wrong prescription.

Joseph E. Marine is a cardiologist.