Sunday, April 15, 2012

Physician-Assisted Suicide in the US: Don't Compare it To Europe

Earlier this week the New York Times held a "Room For Debate" roundtable on Physician-Assisted Suicide that left me mostly frustrated. Each of the eight participants took no more than about four paragraphs to share their viewpoint, which is far too brief to introduce laypeople to some of the minefields associated with the practice. The topic is just too complicated for that kind of brevity by my reckoning. None of the authors gave more than a glancing nod to issues surrounding palliative care, a huge omission since it's at least possible, if not likely, that many people who support PAS do so out of a largely erroneous belief that people with terminal diseases, especially cancer, often die horribly painful deaths that modern medicine simply could not prevent. I'm assuming that these writers, several of whom are renowned experts in this field, eschewed writing about palliative care not by choice but by length limitations imposed by the editors, but that's just a guess. Hey Times--give 'em eight grafs! I promise your readers will read it!

We at the Billy Rubin Blog are strongly opposed to PAS--a topic that we have briefly touched on in our discussion of the profound media misrepresentation of Jack Kevorkian, as cold-blooded a murderer as has ever walked the earth and who got away with over 100 butcheries by cloaking himself in self-righteousness and preying on the public's abject fear of (mostly) cancer. There are more judicious docs who support the practice, such as Timothy Quill, who proposed a "constitutional right to suicide" that the US Supreme Court didn't come close to buying (it was rejected 9-0). While I respect guys like Quill and don't think they need to be stripped of their licenses (unlike Kevorkian), I do believe it is unethical to participate in suicides, even if some Northwestern States give it their legal imprimatur.

Too-abbreviated a discussion or not, one excellent point kept cropping up by the PAS opponents. PAS supporters are fond of invoking the situation in the Netherlands, where the practice has existed for decades and doesn't appear to be highly controversial today, nor does it appear to have become a back door for euthanasia as many in the US fear it will. But this is most definitely not an apples-to-apples comparison, since US health care mostly functions as a free-market phenomenon, where secondary incentives can play a role in motivating patients, families, and insurance companies to nudge people along the path. As this article notes, at least one such scenario like this has already played out in PAS-legal Oregon.

We'd prefer the Dutch abandoned the practice altogether, but either way we heed this observation from Dr. Petra de Jong, the head of Right to Die Netherlands: "Euthanasia and assisted suicide can only be legalized in a country with optimum health care, including palliative care. But most of all, with citizens having access to good health care, regardless of their income." Yep.


  1. really interesting post. i generally support people's right to die, but i do have concerns about pas and think that physician's have a moral obligation that works counter to the idea of pas. but i had really never really considered the implications of the us health care system in regards to pas. super interesting point of view, and quite valid. scary stuff.

  2. Thanks Sharon. I distinguish between a "right to die", which I'd define as a patient's right to be free to refuse any and all (i.e. including life-sustaining) medical treatments offered by docs, and PAS, which constitutes a pact between doc and patient to aggressively terminate a life. I support the former but not the latter.

    To use a practical example, I see nothing wrong with patients asking docs to turn off an implanted cardiac assist device, which keeps people alive by administering electroshocks to the heart when one's heart goes into the life-threatenting rhythm of ventricular fibrillation. I've seen this happen, and invariably the patients die of V-fib arrest within weeks or months. I have no problem with turning the device off as that's a passive action (the withdrawal of life-sustaining medicine). I see a big difference between that an actively administering medications whose specific functions are to bring about death. For what it's worth, I think that view is shared by the large majority of my professional colleagues. For once I'm not so far out on a limb with radical ideas, which is comforting. Best, Billy