Physician-Assisted Death

Religion and Ethics Weekly
Originally posted October 31, 2014

Cathy Lynn Grossman, senior national correspondent for Religion News Service, talks with R&E host Bob Abernethy about the case of 29-year-old Brittany Maynard, who was given six months to live after being diagnosed with advanced brain cancer. She made headlines when she pledged to end her life with the help of a doctor rather than continuing to endure her debilitating symptoms.

Several other videos on the topic can be found here.

Terminally ill 'death with dignity' advocate dies

By Steven Dubois and Terrence Petty
The Associated Press
Originally published November 2, 2014

A terminally ill woman who renewed a nationwide debate about physician-assisted suicide has ended her young life with the lethal drugs available under Oregon's Death With Dignity Law. Brittany Maynard was 29.

Maynard, who had brain cancer, died peacefully in her bedroom Saturday "in the arms of her loved ones," said Sean Crowley, a spokesman for the advocacy group Compassion & Choices.

Weeks ago, Maynard had said she might use the lethal drugs Nov. 1, just a couple weeks short of her 30th birthday. Last week, she said she might delay the day. But she went ahead with her original plan.

The entire article is here.

A Contemporary Death: Death with Dignity and Autonomy

By Peggy Battin
TEDMED 2014
Originally published October 29, 2014

Philosopher and bioethicist Peggy Battin tells us the moving story of how and why her husband chose to die.  She addresses death, end of life issues, and individual choices in the process.  She shares her emotional reactions to the process.

The Last Right: Why America Is Moving Slowly on Assisted Suicide

By Ross Douthat
The New York Times Sunday Review
Originally posted on October 11, 2014

Here is an excerpt:

The tragedy here is almost deep enough to drown the political debate. But that debate’s continued existence is still a striking fact. Why, in a society where individualism seems to be carrying the day, is the right that Maynard intends to exercise still confined to just a handful of states? Why has assisted suicide’s advance been slow, when on other social issues the landscape has shifted dramatically in a libertarian direction?

Twenty years ago, a much more rapid advance seemed likely. Some sort of right to suicide seemed like a potential extension of “the right to define one’s own concept of existence” that the Supreme Court had invoked while upholding a woman’s constitutional right to abortion. Polls in the 1990s consistently showed more support — majority support, depending on the framing — for physician-assisted suicide than for what then seemed like the eccentric cause of same-sex marriage.

The entire article is here.

Suicide tourism: a pilot study on the Swiss phenomenon

By S. Gauthier, J. Mausbach, T. Reisch, and C. Bartsch
J Med Ethics doi:10.1136/medethics-2014-102091

Abstract

While assisted suicide (AS) is strictly restricted in many countries, it is not clearly regulated by law in Switzerland. This imbalance leads to an influx of people—‘suicide tourists’—coming to Switzerland, mainly to the Canton of Zurich, for the sole purpose of committing suicide. Political debate regarding ‘suicide tourism’ is taking place in many countries. Swiss medicolegal experts are confronted with these cases almost daily, which prompted our scientific investigation of the phenomenon. The present study has three aims: (1) to determine selected details about AS in the study group (age, gender and country of residence of the suicide tourists, the organisation involved, the ingested substance leading to death and any diseases that were the main reason for AS); (2) to find out the countries from which suicide tourists come and to review existing laws in the top three in order to test the hypothesis that suicide tourism leads to the amendment of existing regulations in foreign countries; and (3) to compare our results with those of earlier studies in Zurich. We did a retrospective data analysis of the Zurich Institute of Legal Medicine database on AS of non-Swiss residents in the last 5 years (2008–2012), and internet research for current legislation and political debate in the three foreign countries most concerned. We analysed 611 cases from 31 countries all over the world. Non-terminal conditions such as neurological and rheumatic diseases are increasing among suicide tourists. The unique phenomenon of suicide tourism in Switzerland may indeed result in the amendment or supplementary guidelines to existing regulations in foreign countries.

The entire story is here.

The Role of and Challenges for Psychologists in Physician Assisted Suicide

Shara M. Johnson, Robert J. Cramer, Mary Alice Conroy, and Brett O. Gardner
Death Studies, 38: 582–588, 2014
Copyright © Taylor & Francis Group, LLC
ISSN: 0748-1187 print/1091-7683 online
DOI: 10.1080/07481187.2013.820228

Abstract

Physician assisted suicide (PAS) poses complex legal and ethical dilemmas for practicing psychologists. Since the passage of the Oregon Death with Dignity Act in 1997, Montana and Washington have passed similar legislation. Despite the law requiring competence evaluations by medical and psychological professionals, existing psycholegal literature inadequately addresses the role of psychologists in the PAS process. This article reviews legal statutes and analyzes ethical dilemmas psychologists may face if involved. We consider competence both generally and in the context of PAS. Suggestions are made for psychologists completing competence assessments and future directions to improve competence assessments for PAS are provided.

The entire article is here.

Quebec passes landmark end-of-life-care bill

Act respecting end-of-life care, Bill 52, allows terminally ill patients to choose death

By CBC News
Originally posted June 5, 2014

Terminally ill patients in Quebec now have the right to choose to die.

The non-partisan Bill 52, also known as an act respecting end-of-life care, passed Thursday afternoon in a free vote at the National Assembly in Quebec City.

The entire story is here.

Bill 52 is here.

Judge rules patients in New Mexico have fundamental right to get aid in dying

By Susan Montoya Bryan
Associated Press
Originally posted January 13, 2014

ALBUQUERQUE, N.M. -- A New Mexico judge has ruled some patients can choose a physician's aid in getting prescription medications to peacefully end their lives.

Second Judicial District Judge Nan Nash ruled Monday that the ability of competent, terminally ill patients to choose aid in dying is a fundamental right under the state constitution.

The entire article is here.

Vermont Legalizes Assisted Suicide

By Wilson Ring
The Associated Press
Originally published May 20, 2013

After years of debate, Vermont became the fourth state in the country Monday to allow doctors to prescribe lethal doses of medicine to terminally ill patients seeking to end their lives.

Gov. Peter Shumlin signed the bill into law at a Statehouse ceremony even as opponents vowed to push for its repeal.

The End of Life Choices law was effective immediately, although it could be weeks before the state Health Department develops regulations in accordance with the new measure.

Vermont Health Commissioner Dr. Harry Chen said he expects doctors to write between 10 and 20 lethal prescriptions a year, with a smaller number of patients actually using the drugs.

He based his figures on the experience in Oregon, the first state to legalize assisted suicide in 1997. Washington state and Montana followed later, with Montana's coming by way of a court order.

The entire story is here.

Physician-Assisted Suicide Program Wins Praise

By John Gever
Medscape News
Originally published April 10, 2013

Patients, their families, and physicians have been satisfied with a "death with dignity" physician-assisted suicide program made available to terminal cancer patients at a Seattle clinic, clinicians there reported.

Among 114 patients who asked about the program at the Seattle Cancer Care Alliance, the outpatient clinic for the city's major cancer treatment centers, 40 passed screening examinations and ultimately received lethal prescriptions for secobarbital, although only 24 actually took the drug, according to Elizabeth Trice Loggers, MD, PhD, and colleagues at the clinic and its affiliated centers.

"Patients, caregivers, and family members have frequently expressed gratitude after the patient obtained the prescription, regardless of whether it was ever filled or ingested, typically referencing an important sense of control in an uncertain situation," the authors wrote in the April 11 issue of the New England Journal of Medicine.

The entire story is here.

The primary source is here.

Physician-Assisted Suicide Program Rarely Used, Study Finds

By Serena Gordon
HealthDay Reporter
Originally published April 10, 2013
Physician-assisted suicide laws can raise controversy and concern with their passage, but a new study from Washington state suggests many of those fears may be unfounded.


Washington's Death With Dignity Act hasn't lead to scores of terminally ill people seeking lethal prescriptions, the researchers report: Almost three years after the law was enacted, just 255 people had obtained a lethal prescription from a physician.

Of those 255 prescriptions, 40 were written for terminal cancer patients at the Seattle Cancer Care Alliance. And, in the new study, doctors there found that only 60 percent (24 people) of their patients chose to use their prescription to hasten their death.

"Most Americans say that they want to die at home with family members around, not in pain and with their mental faculties as in tact as possible. But, not everyone is achieving that kind of good death. For the rare number of people using the Death With Dignity program, we are reassured by the high numbers of people who use palliative or hospice care and who talk with their families about this decision," said study author Dr. Elizabeth Trice Loggers, medical director of palliative care at the Seattle Cancer Care Alliance.

The entire story is here.

A Texas Senate Bill Would Revise the State’s End-of-Life Procedure

By Becca Aaronson
The Texas Tribune/The New York Times
Originally published March 31, 2013

Texas lawmakers have grappled year after year over whether families or medical professionals should decide when to end a terminally ill patient’s life-sustaining care. This year, they seem closer to a compromise.

“If we were only making decisions based on medical facts, everything would be straightforward,” said Dr. Leigh Fredholm, the medical director of Seton palliative care at the University Medical Center Brackenridge in Austin. “But that’s not how we make decisions.” (Seton is a corporate sponsor of The Texas Tribune.)

State law allows physicians to discontinue treatment they deem medically futile. If a physician’s decision to end treatment contradicts the patient’s advance directive or the judgment of the patient’s surrogates, state law gives patients or their families 10 days to find another provider and appeal the doctor’s decision to a hospital ethics committee.

Advocacy groups that identify as “pro-life” say existing law does not go far enough to protect the interests of patients or their families. But they are divided on how legislators should change it. While support in the Legislature’s upper chamber seems to be coalescing around Senate Bill 303, which would tweak the process, some support bills that would bar doctors or hospital ethics committees from making the final decision to end treatment.

The entire story is here.

Rational suicide: Why Beverley Broadbent chose to die

By Julie Medew
The Age
Originally published April 2, 2013

Beverley Broadbent was not dying of a terminal illness, nor was she depressed or unhappy. But at 83, she wanted to die.

After living a rich and satisfying life, the Brighton East woman said the ageing process had come to feel like a disease that was robbing her of her physical and mental fitness. In February, she said she had had enough.

''I look well and I walk well so people think I'm fine. But I have so many things wrong with me,'' she said. ''The balance is gone. It's taking so much time for me to keep fit to enjoy myself that there's not enough time to enjoy myself.''

In several interviews with Fairfax Media, Ms Broadbent said she planned to take her own life so she could have a peaceful, dignified death. She said she did not want her health to deteriorate to the point where she had dementia or found herself in a nursing home with no way out.



The entire story is here.

Thanks to Gary Schoener for this story.

Do We Need 'Thanaticians' for the Terminally Ill?

By Ronald W. Pies
Medscape - Ethics in Psychiatry
Originally published September 26, 2012

My 89-year-old mother had been losing ground for some years, experiencing what geriatricians sometimes call "the dwindles." Toward the end of her life, she was beset by a deteriorating heart; an inability to walk; and occasional, severe gastrointestinal pain. My family got her the best medical treatment available -- eventually including home hospice care -- and she generally maintained a positive attitude throughout her long downhill slide.

But one day, as I sat beside her bed, she seemed unusually subdued. "Honey," she said, "How do I get out of this mess?" I had a pretty good idea of what she was really asking me, but I deflected her question with another question: "Ma, what 'mess' do you mean?" I asked. "It's all right," she replied, smiling sadly, "I'll manage."

My mother was doing what she had always done: sparing her children from pain. In this case, it was the pain of dealing with the waning days of her life and the frustration of knowing there was no easy escape from the burdens of dying slowly. "Ma, I'll always make sure you are getting enough treatment for your pain," I added, taking her hand -- knowing that the prospect of unremitting pain is often an underlying fear of terminally ill persons.

Yet, unspoken in my mother's question was the issue of so-called physician-assisted dying, sometimes called "physician-assisted suicide" -- an enormously heated controversy both outside and within the medical profession. In my home state, Massachusetts, the issue has come to the fore, owing to a November ballot initiative for a measure that would allow terminally ill patients to be prescribed lethal drugs. A closely related bill (H.3884) has also come before the Massachusetts Legislature's Joint Committee on the Judiciary.

The entire ethical dilemma is here.

Vermont Senate approves amended death with dignity bill

By Dave Gram
The Associated Press
Originally published February 13, 2013

The Vermont Senate on Wednesday gave preliminary approval to an amended bill allowing doctors to prescribe a lethal dose of medication to terminally ill patients.

But even some backers of the measure, which passed 21-9, called the amended version a travesty. And other long-time backers of what they call ‘‘death with dignity’’ or ‘‘end-of-life choices,’’ along with opponents of physician-assisted suicide, were so angry about the amendment that they voted against it.

‘‘I will be voting yes for this bill, as much as I detest it,’’ said Sen. Claire Ayer, D-Addison and chairwoman of the Senate Health and Welfare Committee.

She said she hoped much of the original language — which mirrored Oregon’s first-in-the-nation Death With Dignity Act — would be restored when the measure moves to the House.

‘‘I want to be on that conference committee,’’ Ayer said, referring to the six-member panel of lawmakers who work out the differences between the House and Senate bills after they have cleared both chambers.

The entire story is here.

Backers of Mass. assisted suicide measure concede

ASSOCIATED PRESS  
Originally published NOVEMBER 07, 2012


Supporters of a ballot question legalizing physician-assisted suicide for the terminally ill in Massachusetts have conceded defeat, even though the vote is too close to call.

A spokesman for the Death With Dignity Act campaign said in a statement early Wednesday that ‘‘regrettably, we fell short.’’

The entire story is here.

Suicide by Choice? Not So Fast

By Ben Mattlin
The New York Times - Opinion Pages
Originally published October 31, 2012

NEXT week, voters in Massachusetts will decide whether to adopt an assisted-suicide law. As a good pro-choice liberal, I ought to support the effort. But as a lifelong disabled person, I cannot.

There are solid arguments in favor. No one will be coerced into taking a poison pill, supporters insist. The “right to die” will apply only to those with six months to live or less. Doctors will take into account the possibility of depression. There is no slippery slope.

Fair enough, but I remain skeptical. There’s been scant evidence of abuse so far in Oregon, Washington and Montana, the three states where physician-assisted death is already legal, but abuse — whether spousal, child or elder — is notoriously underreported, and evidence is difficult to come by. What’s more, Massachusetts registered nearly 20,000 cases of elder abuse in 2010 alone.

The entire article is here.

May Doctors Help You to Die?

By Marcia Angell
The New York Review of Books
Published on October 11, 2012


On November 6, Massachusetts voters will decide whether a physician may provide a dying patient with medication to bring about a faster, easier death if the patient chooses. On the ballot will be a Death with Dignity Act that reads:

It is hereby declared that the public welfare requires a defined and safeguarded process by which an adult Massachusetts resident who has the capacity to make health care decisions and who has been determined by his or her attending and consulting physicians to be suffering from a terminal disease that will cause death within six months may obtain medication that the patient may self administer to end his or her life in a humane and dignified manner. It is further declared that the public welfare requires that such a process be entirely voluntary on the part of all participants, including the patient, his or her physicians, and any other health care provider or facility providing services or care to the patient.

If this ballot initiative passes, it will be binding, and Massachusetts will join Oregon, which implemented a virtually identical statute in 1998, and Washington, which did the same in 2009, as the only states where voters approved this form of physician-assisted dying, sometimes called aid-in-dying. (These terms are favored by proponents over the older term, physician-assisted suicide, because they distinguish it from the typical suicide in which someone with a normal life expectancy chooses death over life. Here the patient is near death from natural causes anyway, and chooses the timing and manner of an inevitable death.) Montana, through a 2009 decision by its Supreme Court, not a voter referendum, also permits physician-assisted dying.

The entire review is here.

Merciful Assistance or Physician-Assisted Killing?

By Ronald Pies, M.D.
psychcentral.com blog

Here are some excerpts:


From the standpoint of medical ethics, I see no fundamental moral difference in a doctor’s assisting a patient to jump off a bridge — without, of course, pushing him off — and a doctor’s prescribing a lethal dose of medication to “assist” in the patient’s suicide. The main difference is that, whereas anybody can assist a suicidal patient in climbing over a bridge railing, only physicians and a few other health care professionals are authorized by law to prescribe medication — and, in Oregon and Washington state, to prescribe lethal medication for “physician-assisted suicide” (PAS).

Of course, there are important procedural differences between my bridge scenario and the way PAS is handled in these states. There are numerous procedural safeguards in place to ensure that dying patients are thoroughly evaluated, and not pressured or coerced into requesting lethal medication — though the evidence is mixed as to how effective these safeguards have been. One study of physician-assisted suicide in Oregon and the Netherlands found no evidence that disadvantaged groups (such as the elderly or disabled) are being disproportionately affected by the laws (Battin et al). On the other hand, another study (Finlay and George) concluded that, “…there is reason to believe that some terminally ill patients in Oregon are taking their own lives with lethal drugs supplied by doctors despite having had depression at the time when they were assessed and cleared for PAS.”

From a strictly ethical perspective, I believe physicians have no more business helping patients kill themselves with lethal drugs than they do helping patients jump off bridges — regardless of how “voluntary” the patient’s decision may be. Clearly, neither action is compatible with the traditional role of the physician as healer. Indeed, psychiatrist and ethicist Dr. Thomas Szasz has argued that “physician-assisted suicide” is merely a euphemism for “medical killing.” For these reasons, I am opposed to the November ballot initiative in Massachusetts for a measure that would allow terminally ill patients to be prescribed lethal drugs.

The entire blog post is here.

In Ill Doctor, a Surprise Reflection of Who Picks Assisted Suicide

by Katie Hafner
The New York Times
Originally published on August 11, 2012

Dr. Richard Wesley has amyotrophic lateral sclerosis, the incurable disease that lays waste to muscles while leaving the mind intact. He lives with the knowledge that an untimely death is chasing him down, but takes solace in knowing that he can decide exactly when, where and how he will die.

Under Washington State’s Death With Dignity Act, his physician has given him a prescription for a lethal dose of barbiturates. He would prefer to die naturally, but if dying becomes protracted and difficult, he plans to take the drugs and die peacefully within minutes.

“It’s like the definition of pornography,” Dr. Wesley, 67, said at his home here in Seattle, with Mount Rainier in the distance. “I’ll know it’s time to go when I see it.”

Washington followed Oregon in allowing terminally ill patients to get a prescription for drugs that will hasten death. Critics of such laws feared that poor people would be pressured to kill themselves because they or their families could not afford end-of-life care. But the demographics of patients who have gotten the prescriptions are surprisingly different than expected, according to data collected by Oregon and Washington through 2011.

Dr. Wesley is emblematic of those who have taken advantage of the law. They are overwhelmingly white, well educated and financially comfortable. And they are making the choice not because they are in pain but because they want to have the same control over their deaths that they have had over their lives.

(cut)

Dr. Linda Ganzini, a professor of psychiatry at Oregon Health and Science University, published a study in 2009 of 56 Oregonians who were in the process of requesting physician-aided dying.
      

“Everybody thought this was going to be about pain,” Dr. Ganzini said. “It turns out pain is kind of irrelevant.”

By far the most common reasons, Dr. Ganzini’s study found, were the desire to be in control, to remain autonomous and to die at home. “It turns out that for this group of people, dying is less about physical symptoms than personal values,” she said.

The entire story is here.