Thursday, October 25, 2012

Massachusetts' Assisted Suicide Proposal: Concerns on Question 2 ...

Con?cerns on Ques?tion?2

by Jacque?line Har?vey, Ph.D. | Boston, MA | | 10/24/12 1:47?PM

The 2012 ?Act Rel?a?tive to Death with Dig?nity? goes before Mass?a?chu?setts vot?ers on Novem?ber 6. Ques?tion 2 asks vot?ers directly whether to legal?ize physician-assisted sui?cide (PAS) or uphold exist?ing state statutes. If vot?ers affirm Ques?tion 2, Mass?a?chu?setts would join Ore?gon, Wash?ing?ton and Mon?tana as the only states in the U.S. to allow this prac?tice. Recent stud?ies on PAS in these states paint a reveal?ing por?trait of what would tran?spire in Mass?a?chu?setts if vot?ers approve Ques?tion 2. How?ever, unlike cit?i?zens of Ore?gon who passed the first ?Death with Dig?nity Act? in 1997, vot?ers in Mass?a?chu?setts have the ben?e?fit of learn?ing the actual out?comes of such leg?is?la?tion in other states. Vot?ers now have access to numer?ous stud?ies that both vin?di?cate oppo?nents? pre?dic?tions about PAS and present even more concerns.

Con?cern 1: Denial of Pal?lia?tive Care Coverage

Ore?gon and Wash?ing?ton impose report?ing require?ments for PAS, and while there are only three years of data from Wash?ing?ton (Washington?s ?Death with Dig?nity? Act took effect in 2009), objec?tive stud?ies done in both states sup?port many of the fears listed by oppo?nents of Mass?a?chu?setts? ?Death with Dig?nity? Ini?tia?tive. Oppo?nents pre?dicted in 1997 that states that legal?ize PAS may coax and coerce unwill?ing patients toward end?ing their lives by lim?it?ing or deny?ing pal?lia?tive care. While PAS pro?po?nents have since cited increased spend?ing on pal?lia?tive care as evi?dence that oppo?nents were incor?rect, other reports con?firm oppo?nents? fears, par?tic?u?larly inci?dents where ter?mi?nally ill cit?i?zens were told by state med?ical plan author?i?ties that they would not pay the cost of pain-control, but would cover the cost of their sui?cides. Another study indi?cated that 24 per?cent of patients who chose PAS reported that they did not have ade?quate finances to cover expen?di?tures for med?ical care and equip?ment, in spite of the fact that 98 per?cent of respon?dents had health insur?ance. Fears that PAS may not be freely cho?sen by patients but instead rep?re?sent a last act of des?per?a?tion are sup?ported by this evidence.

Con?cern 2: Inher?i?tance and Other Finan?cial Incentives

PAS pro?po?nents attempt to refute oppo?nents? claim that PAS would dis?pro?por?tion?ately tar?get the vul?ner?a?ble, cit?ing the fact that peo?ple who have taken their own lives are bet?ter edu?cated and more finan?cially sta?ble than the gen?eral pop?u?la?tion. Oppo?nents reply that this high?lights another grave con?cern, finan?cial abuse of the elderly, sug?gest?ing that those patients who have a sig?nif?i?cant estate may feel com?pelled to die in order to leave their prop?erty to their heirs. A recent study of patients receiv?ing PAS in Ore?gon and Wash?ing?ton demon?strates that PAS may not be used to ben?e?fit the patient, but the patient?s fam?ily. One study employed a ?Qual?ity of Death and Dying Ques?tion?naire? that exam?ined patient pain and other symp?toms as well as readi?ness for death, anx?i?ety and mood[1]. The study indi?cated that patients choos?ing PAS did not report a higher qual?ity of death than those dying nat?u?rally, but rather that the patient?s fam?ily mem?bers did indi?cate a higher qual?ity of death on some items. Addi?tional research also found that care?givers of patients in both Ore?gon and Wash?ing?ton who ended their lives by PAS were them?selves suf?fer?ing from sub?stan?tial finan?cial and health-related harms: 37 per?cent had lost income because of care?giv?ing (18 per?cent had had to quit their pay?ing jobs), 12 per?cent had become ill them?selves while care?giv?ing, 29 per?cent had delayed plans for them?selves or their fam?i?lies, 23 per?cent stated that their social lives suf?fered fre?quently, 20 per?cent com?plained that they often did not have enough time for them?selves, 33 per?cent fre?quently felt stressed because of care?giv?ing, and 24 per?cent were clin?i?cally depressed. Although respon?dents claim that none of these fac?tors was asso?ci?ated with the deci?sion to end the patient?s life, Wash?ing?ton State reported in 2011 that over half of respon?dents choos?ing PAS men?tioned ?con?cerns about being a bur?den? as a rea?son for choos?ing to take their own lives. This evi?dence over?whelm?ingly sug?gests that oppo?nents? fears of patient coer?cion are well-founded and that patients may not choose PAS in their best inter?est, but rather in the per?ceived best inter?est of oth?ers???many of whom stand to gain from a patient?s ear?lier demise.

Con?cern 3: Adverse Impact on the Disabled

Addi?tion?ally, an exhaus?tive analy?sis of 11 years of reports on Oregon?s statute failed to quiet the ongo?ing out?cry regard?ing the pos?si?bil?ity that PAS unduly tar?gets per?sons with dis?abil?i?ties. This panel of schol?ars exam?ined all avail?able lit?er?a?ture on Oregon?s Death with Dig?nity Act and ulti?mately deter?mined that physi?cians may bias their assess?ments of the qual?ity or wor?thi?ness of life with a dis?abil?ity and influ?ence the rec?om?men?da?tion regard?ing life-sustaining treat?ment options. The authors agree with many oppo?nents of PAS who note the poten?tial for abuse due to the lack of over?sight of or penal?ties for rogue physi?cians who choose not to report assisted sui?cides to the proper authorities.

Con?cern 4: Mis?taken Diag?noses and Life Expectancy

Along with a lack of over?sight and account?abil?ity for physi?cians, a review of stud?ies also deter?mined that physi?cians? med?ical diag?noses were often incor?rect, both in declar?ing a patient to have a ter?mi?nal con?di?tion and esti?mat?ing their life expectancy at six months or fewer. A prog?no?sis of only six months equals 180 days max?i?mum, and yet Oregon?s report indi?cates the num?ber of days between writ?ing the lethal pre?scrip?tion and the patient?s actual death ranged from zero to 698 days (nearly two years). Another study of physi?cians who were will?ing to pre?scribe the lethal dose found that 27 per?cent were not con?fi?dent that they could deter?mine if a patient only had six months or fewer to live. One report dis?cusses a PAS oppo?nent from Ore?gon who was told that she had only six months to one year to live; today, over 11 years later, she is still alive. Addi?tion?ally, since many peo?ple sur?vive in spite of ter?mi?nal prog?no?sis, and since the median num?ber of days between the writ?ing of a lethal pre?scrip?tion and the patient?s death is seven, it is unknown how many of these patients would have actu?ally died within the six-month time?frame or any?thing close to it. There is also the report that many patients opt?ing to end their lives suf?fer from treat?able depres?sion and physi?cians report that patients for whom inter?ven?tions were made (like treat?ing depres?sion) were more likely to change their minds about want?ing to end their lives. One ana?lyst, after exam?in?ing Oregon?s most recent annual report, found that physi?cians who pre?scribe the lethal med?ica?tions are fail?ing to refer for nec?es?sary psy?chi?atric eval?u?a?tions of patients, many of whom might recon?sider sui?cide if prop?erly treated. This prompts the ques?tion of how many peo?ple freely choose PAS or are pres?sured into the deci?sion by neg?a?tive cir?cum?stances, espe?cially cir?cum?stances for which there is some or com?plete relief.

Con?cern 5: Medico-Professional Oppo?si?tion to?PAS

Despite media por?tray?als of oppo?si?tion to PAS as based pri?mar?ily on moral or reli?gious grounds, data reaf?firms that the most endur?ing oppo?nents of PAS are physi?cians. The Amer?i?can Med?ical Asso?ci?a?tion has not wavered in its oppo?si?tion to PAS and states, ?Physician-assisted sui?cide is fun?da?men?tally incom?pat?i?ble with the physician?s role as healer, would be dif?fi?cult or impos?si?ble to con?trol, and would pose seri?ous soci?etal risks.? The med?ical community?s staunch oppo?si?tion to PAS is regarded as a major rea?son why no state leg?is?la?ture has legal?ized PAS despite more than 120 attempts, as over?whelm?ing expert tes?ti?mony against this prac?tice has suc?ceeded in per?suad?ing leg?is?la?tors across party lines of its demon?strated dan?gers. Leg?isla?tive attempts failed in Mon?tana in 2009, where PAS was only legal?ized by court decree. Indeed, bal?lot ini?tia?tives were approved in Ore?gon (1994) and Wash?ing?ton (2008), fol?low?ing years of failed leg?isla?tive attempts. Like?wise, pro?posed bills failed in the Mass?a?chu?setts leg?is?la?ture in 1995, 1997, 2009 and, most recently, 2011 and 2012. Hav?ing failed to con?vince leg?is?la?tors, PAS pro?po?nents in Mass?a?chu?setts hope to legal?ize PAS by appeal?ing to a pop?u?lace that is largely unfa?mil?iar with the con?se?quences in states with this deadly law on the other side of the nation. There is over?whelm?ing sci?en?tific evi?dence and human expe?ri?ence val?i?dat?ing the dan?gers of PAS, and Mass?a?chu?setts vot?ers have a respon?si?bil?ity to access as much of this crit?i?cal infor?ma?tion as pos?si?ble before they go the polls. This includes knowl?edge of the text of the pro?posed statute which, like Ore?gon and Washington?s, oppo?nents note fails to impose over?sight of physi?cians in order to pre?vent abuses.


PAS has never been legal?ized when sub?jected to the legal and sci?en?tific scrutiny of a leg?is?la?ture with the abil?ity to exam?ine years of research that has estab?lished the dam?age these statutes have caused. More?over, no stud?ies have been com?pleted that sug?gest any ben?e?fits of PAS, let alone ben?e?fits that would jus?tify coax?ing or coerc?ing vul?ner?a?ble patients to kill them?selves for the ben?e?fit of oth?ers, tak?ing the lives of those with?out ter?mi?nal ill?nesses, and killing peo?ple who may have years left to live. No research exists to demon?strate that patients are ben?e?fit?ted by PAS. Rather, stud?ies to date have uncov?ered addi?tional neg?a?tive con?se?quences beyond those most rou?tinely cited in oppo?si?tion to this prac?tice. Mass?a?chu?setts vot?ers should make every effort to obtain the evi?dence and weigh it for them?selves as they go to the polls and ren?der their judg?ment on Ques?tion 2 this Novem?ber?6.

*See also pre?vi?ous CLI blog on Oregon?s 2012 Annual PAS Report.

Life?News Note: Jacque?line Har?vey, Ph.D.
is a bioethi?cist and pub?lic pol?icy scholar whose research pri?mar?ily focuses on end-of-life leg?is?la?tion, par?tic?u?larly state poli?cies that allow the forced removal of life-sustaining med?ical treat?ment against patient wishes. Her train?ing includes a Ph.D. in Pub?lic Admin?is?tra?tion and an M.S. in Social Work. Dr. Har?vey cur?rently works in Texas as a pol?icy ana?lyst and inde?pen?dent eval?u?a?tor, ana?lyz?ing the effec?tive?ness of gov?ern?ment social wel?fare grants and human ser?vice pro?grams for non-profit organizations.


[1] Smith, KA, Goy, ER, Havath, TA, Ganzini, L. Qual?ity of death and dying in patients who request physician-assisted death. Jour?nal of Pal?lia?tive Med?i?cine. 14,4.?2011.

Arti?cle source:

Tags: Assisted Suicide, Political, Prolife


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