Coalition Voices: There is No Care or Dignity in Physician-Assisted Suicide

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Our new blog forum, Coalition Voices, features thoughts and personal stories from members of the Maryland Against Physician Assisted Suicide Coalition. In this week’s installment, Christine
Sybert, PharmD, Clinical Pharmacist at St. Agnes Hospital in Baltimore, shares just how dangerous physician-assisted suicide drugs are and how terminally-ill patients can be better helped mentally and physically.

Please join Christine Sybert and the growing list of other healthcare professionals against physician-assisted suicide by signing up for the new coalition Care Without Harm: Maryland Healthcare Professionals Against PAS.

By Christine Sybert

As a pharmacist, I took an oath and promised to consider the welfare of humanity and relief of suffering as my primary concerns.  People suffering from terminal illness certainly do suffer, as do their families.  I have seen this in my 20 years as a clinical pharmacist.  However, legalizing physician-assisted suicide is not acceptable medical care.  It leaves the door open for abuse and coercion, especially with the risk of labeling those who are elderly and disabled as lacking dignity and functionality, and hence eligible for government-sanctioned physician-assisted suicide.

Medicine is an art, a practice, not an exact science.  Often, patients who are given a 6-month life expectancy go on to survive several years.  Many of them also continue to live with an acceptable quality of life.  However, we must be careful not to equate functionality and quality of life with dignity.

Oregon’s latest report on the “Death with Dignity” Act lists the top five concerns patients have with end-of-life issues.  All five concerns are based on fear:

  • Less able to engage in activities making life enjoyable (96.2%)
  • Loss of autonomy (92.4%)
  • Loss of dignity (75.4%)
  • Burden of family, friends/caregivers (48.1%)
  • Losing control of bodily functions (35.7%).

What I found noteworthy was that inadequate pain control ranked low on the list of concerns, with only 28.7% of respondents identifying that as an issue. Therefore, it appears the driving force behind seeking physician assisted suicide is fear and fear of what life may bring. But shouldn’t we do a better job on managing patients’ fears?  Shouldn’t we be offering better palliative and supportive care?  We can all help each other face the natural event that is death and not instill fear and despair.

Physician-assisted suicide is not a “natural cause” of death, and it is dishonest to consider naming it as such.  We have an innate desire to survive, to fight to live.  While it is natural to die, it is unnatural to want to die.  Anyone who wants to die, and seeks sanctioning from the state to permit them to do so, is suffering from a mental disorder of depression or hopelessness.  The terminally ill population is already psychologically vulnerable, as evidenced in a prospective study of 92 terminally ill cancer patients at Memorial Sloan-Kettering Cancer Center.   We should focus on providing better hospice, palliative, and supportive care for those who suffer with a terminal illness.  Proponents of the failed legislation in Maryland would say they are simply trying to provide “autonomy” and end-of-life “options” for those who are suffering.  And while under the proposed legislation the patient would “self-administer” the drugs, it’s a slippery slope towards government-sanctioned euthanasia for the terminally ill.

The barbituates secobarbital and pentobarbital are the top two drugs prescribed for lethal overdoses. Both are DEA schedule C-II medications.  These are given in 9 gram or 10 gram doses, respectively, which are 90-100 times the recommended dosages of 100mg at bedtime to aid in sleeping.  Nausea and vomiting are common with these overdoses. In addition, the contents of 90 capsules of secobarbital must be opened up before being taken, as the patient may pass out before consuming the full overdose.  Both medications have to be mixed with juice to mask the bitter taste.  Death occurs by respiratory arrest.  While the intention is to die, what happens if the patient doesn’t die right away? The legislation in Maryland does not require a healthcare professional to be present at the time of ingestion, so a patient may potentially be in irreversible agony for hours.

In the healthcare insurance industry, a dead patient is the most cost-effective patient of all.  Will insurance companies notify patients once they are diagnosed as terminally ill that physician-assisted suicide is an option for them?  Yes. It happened to a woman in California. After initially approving her chemotherapy treatments (which happened to be within one week of California’s legislature  passing assisted suicide legislation into law), Stephanie Packer, a 32-year old wife and mother of four, received a letter from her insurance company denying her chemotherapy coverage; however, it did include a notice that they would pay $1.20 for her end-of-life prescription.  “As soon as this law was passed, patients fighting for a longer life end up getting denied treatment, because this will always be the cheapest option… it’s hard to financially fight,” Packer said.

Physician-assisted suicide legislation will serve to increase the suicide rate which is already on the rise.  The latest CDC data indicates that there were 606 suicides in Maryland in 2014, for an age-adjusted rate of 9.8 per 100,000. While this is less than the national average, shouldn’t our efforts be to reduce the number of suicides even further, not promote it?  If you doubt that passage of these bills will encourage non-assisted suicides, consider what Dr. Jones and Dr. Paton found when they evaluated the rates of suicide in the first four states that legalized physician-assisted suicide compared to twenty-five states with suicide data that have not.  They found a significant (6.3%) increase in total suicides and no reduction in the rates of non-assisted suicides. If the proposed legislation in Maryland had not been defeated, the anticipated increase in suicides of 6.3% would have resulted in an additional 39 all-cause suicides (including assisted) will occur with a new total of 644 suicides. This pushes our suicide rate to 10.4 per 100,000.  Is this really the “medical care” we want to provide to the people of Maryland?

Physician-assisted suicide is dangerous and should not be legalized. We must do a better job of caring for our patients through every stage of their lives, and treat them with true dignity when they are nearing death. 

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