Last session, legislation for assisted suicide failed to move forward in the General Assembly’s Judiciary Committee. The death of this bill in the committee will allow for continued protection of the state’s most vulnerable people. As physicians who have vowed to protect patients in our care and are aware of the dangers of assisted suicide, we praise the Judiciary Committee for its inaction on this bill.
Connecticut’s assisted suicide bill was designed with purported safeguards, including: that the patient must have a terminal disease which will lead to death within six months, that they must make two oral and one written request to their attending physician, that the written request be witnessed by two individuals, that the witnesses attest that the patient is of sound mind and has not been coerced, that the patient be referred to another physician to verify the attending physician’s diagnosis of a terminal illness, that the patient be offered an opportunity to rescind their request, and that the patient be given the opportunity to obtain palliative care. Additionally, if the patient is deemed to have an underlying psychiatric or psychological condition, including depression, that is causing impaired judgement, the patient must be referred for evaluation to determine the patient’s capacity to request termination of their life. However, these so-called “safeguards” fail to protect patients.
Common reasons for a request for an end to life include: concern regarding intractable pain, loss of dignity or self-control, or that activities of daily living are not enjoyable. As we listened to the public testimony before the Public Health Committee, we were deeply saddened to hear people tell personal stories of loved ones who suffered discomfort and loss of independence at the end of their life. Cases like these should cause us to redouble our efforts to improve palliative care for all. They do not call us to actively end the lives of our patients. As physicians with a combined 67 years of clinical experience, our concerns with the bill were five-fold.
First, our ability as physicians to determine the timing of death in the setting of illness is imperfect. Both of us have cared for patients diagnosed with “terminal illnesses” by multiple specialists who entered and eventually left inpatient hospice units to live many fulfilling years with their families.
Second, safeguards are ineffective. If we look at the long-standing Dutch example, which allows access to both assisted suicide and euthanasia, in nearly 20 percent of cases, available palliative care measures were declined by the patient, 60 percent of cases were not reported truthfully to public health authorities and 50 percent did not have the required consultations. A recent medical paper even described 53 cases in the Netherlands where patients were requesting euthanasia and physician-assisted suicide for non-life threatening conditions including visual impairment, hearing loss, chronic fatigue, incontinence, or recurrent falls. In Oregon, less than 5 percent of assisted suicide cases were referred for psychiatric evaluation.
Third, medical care has improved dramatically. With advances in expert diagnosis, palliative, psychiatric, and hospice care both in the hospital and at home, we simply do not see patients who die in intractable pain or without dignity when given the appropriate medical and supportive care.
Fourth, the qualifications of a responsible attending physician are not clearly specified in the bill. This is concerning as physicians with limited experience in the practice of medicine would be able to give patients access to life-ending medication.
Fifth, physicians are obligated to care for their patients under all circumstances. In 1927, Francis Peabody, a noted Boston physician, wrote, “one of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.” Our work, as physicians, is to walk with our patients and their families, both when the patient is well and when they are ill, not to give them medications for the sole purpose of ending their lives. With regards to our responsibility to families, a Swiss study showed that 20 percent of patient relatives who died following assisted suicide in that country demonstrated full or partial post-traumatic stress disorder and 16 percent had symptoms of depression for up to 2 years following their loss, rates higher than in the general population who had suffered a natural loss. What our patients and families need is, in the words of Dr. Diane Meier a geriatrician and palliative care specialist, a, “meaningful and committed human connection-not 2 grams of secobarbital” at the end of life.
We urge other states legislatures to follow Connecticut’s lead and defeat bills to legalize assisted suicide. The practice is simply the wrong first step in a perilous direction and will make patients suspicious of our intentions at the exact time that they need us most.
Andre N. Sofair, MD, MPH, is a Professor of Medicine, Epidemiology, and Public Health at Yale University School of Medicine. Barry J. Wu, MD, is a Professor of Clinical Medicine at Yale University School of Medicine.