Doctors Should Not Do the Politicians’ Dirty Work
Refusing Treatment is Preferable to Physician-Assisted Suicide
Every Connecticut legislative session, there is a strong push to legalize physician-assisted suicide. Euphemistically referred to as “The Aid-In-Dying Bill,” this bill failed to make its way out of the judiciary committee and will no longer be discussed this legislative term. But it will return.
In the good old days, people simply got sick and died. But medical technology has enabled us to endure slow and prolonged deaths, causing the demand for physician-assisted suicide. It is legal in much of Europe and several states allow it - Oregon, Washington, Montana, Vermont, California, Colorado, Hawaii, New Jersey, Maine, New Mexico and the District of Columbia.
Oregon was among the first to legalize physician-assisted suicide, in 1997. The apocalyptic warnings of opponents have not come to fruition with only 135 suicides in 2016. But the trend is accelerating.
Physicians are as perplexed by the issue as the general public. Like abortion, many physicians favor physician-assisted suicide but few are willing to assist in it. But the Hippocratic Oath is quite clear:
“I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.”
I come down on the same side as Hippocrates. It is not our job to kill our patients. If society deems through democratic discourse that painless suicide should be sanctioned by the government, then so be it - although I oppose this too. But Switzerland had approved the use of Sacro pods, although at the time of this writing, they have not been used yet. These are miniature gas chambers that suddenly decrease the amount of oxygen while maintaining carbon dioxide levels allowing for a rapid but peaceful death, sort of like Edward G. Robinson’s death scene in the movie Soylent Green.
Sarco Pod
If our political class wants to allow painless suicide, then legalize the Sarco pods. Don’t ask physicians to do your dirty work.
On the abortion issue, this is actually happening in the Connecticut. The Assembly recently passed a law that allows physician assistants and nurse practitioners to perform surgical suction abortions. Normally, when the political class proposes legislation that allows non-physicians to perform any surgical procedure, the medical societies strenuously object – what is termed by the political class as “turf wars.” But not this time. In fact, American College of Obstetricians and Gynecologists enthusiastically supports this law. The response of the medical profession to the nurse practitioners and physicians assistants has been “If you want to do abortions, be our guest.”
As a young physician doing a volunteer year in Haiti in 1984, I became intimately acquainted with dying patients suffering hideous deaths, especially from tuberculosis, AIDS (there was no cure then) and disfiguring and painful tropical diseases. I saw to it that they never suffered.
I would start an IV (intravenous line) in the patient and add morphine to the saline solution that the patient was receiving. Then I would ask the patient if the morphine dose was adequate to relieve them from their pain. If not, I would increase the dose until the patient was pain free. While the morphine could hasten death by a few hours, this was not my intention. It was simply to allow the patient a comfortable death.
This is routinely done in the United States in hospice care. But the issue is more complex than my simplified situation in Haiti because a significant number of patients are suffering slow painless deaths from horrible diseases such as Alzheimer’s, Parkinson’s, inclusion body myositis (made famous by the recent movie Father Stu), Amyotrophic Lateral Sclerosis (ALS or Lou Gering’s Disease) among others. These patients may reasonably not wish to suffer ignominious, degrading deaths characterized by dementia, paralysis and incontinence.
But there is a solution to their problem too – refusing treatment.
The past several decades has seen an explosion of highly effective antibiotics that can conquer what the Father of Internal Medicine, Sir William Osler, in 1892 called the “old man’s friend” – pneumonia. But a patient with slowly debilitating disease will almost surely succumb from pneumonia, as anyone who has witnessed death bed scenes in movies that depict a time period before the advent of antibiotics. Refusing antibiotic treatment along with administering intravenous morphine treatments for pain will allow the vast majority of patients peaceful deaths.
Yes, there will be hardship cases that do not fit neatly into the above characterizations. But allowing physicians to end the life of their patients demeans our profession and should our economy go into a severe depression, the right to die could quickly become the duty to die.