In Oregon, of the exceedingly few patients who have requested a lethal prescription — 1,545 in 18 years — about 35 percent never uses it; for them, it is merely a means to self-affirmation, a reassuring option.
Instead of using our energies to obfuscate and obstruct how patients might want to end their lives when faced with life-limiting disease, we physicians need to reassess how we can help patients achieve their goals when the end is near.
Let me emphasize at once that my view of this tragic form of self-destruction is the same as that of the suicide intervention movement and the rest of society, which is to prevent it wherever possible.
I do not encourage any form of suicide for mental health or emotional reasons.
I believe that there is a second form of suicide -- justifiable suicide, which is rational and planned deliverance from a painful and hopeless disease.
I don't think the word 'suicide' sits too well in this context but we are stuck with it.In extreme cases, when even morphine isn’t enough, patients are given anesthesia to ease their deaths.The last time I administered what is called terminal sedation, another accepted strategy, was in the case of a patient with abdominal cancer whose intestines were perforated and for whom surgery was not an option.The patient, who had been writhing uncontrollably in pain, was finally comfortable.Yet terminal sedation, necessary as it was, felt closer to active euthanasia than assisted suicide would have.Some doctors skirt the question of assisted suicide through opiate prescriptions, which are almost universally prescribed for patients nearing death.Even though these medications can slow down breathing to the point of stoppage, doctors and nurses are very comfortable giving them, knowing that they might hasten a “natural” death.That resistance is traditionally couched in doctors’ adherence to our understanding of the Hippocratic oath.But it’s becoming harder for us to know what is meant by “do no harm.” With the amount of respirators and other apparatus at our disposal, it is almost impossible for most patients to die unless doctors’ or patients’ families end life support.While the way people die has changed, the arguments made against assisted suicide have not.We are warned of a slippery slope, implying that legalization of assisted suicide would eventually lead to eugenic sterilization reminiscent of Nazi Germany.