Aid in dying is not assisted suicide
The January 20 op-ed “Separating myth and reality in aid in dying” is very misleading in numerous ways. First, assisted suicide terminology is repeatedly used. Terminally ill patients who consume life ending medicines are not suicidal. Stark differences exist.
Suicides are committed by those who can continue to live, but choose not to; are done in isolation, often impulsively and violently; and they are tragic. To the contrary, medical aid in dying is available only to terminally ill patients who will soon die; the process usually takes at least several weeks; it occurs after consultation with two physicians and almost always with family support; and it is empowering.
The term “assisted suicide” is rejected by the American Public Health Association, American Academy of Hospice and Palliative Medicine, American Medical Women’s Association, the American Psychological Association, American Academy of Family Physicians, among others, and in the state laws which permit medical aid in dying. And, in 2017 the American Association of Suicidology issued this statement: “Suicide is not the same as physician aid in dying.”
Second, while concern is expressed about those who access medical aid in dying and hospice, in fact, those who die by medical aid in dying are far more often receiving hospice care at their deaths than others who die, over 90% on average in Oregon which has had a medical aid in dying law for over 20 years. And, Oregon does have a very high rate of hospice use compared to other states.
Third, while legitimate concerns are expressed about patients not getting appropriate medical care and health disparities, these concerns have no connection to medical aid in dying. There is no evidence that patients who access it have been deprived of quality end-of -life care, and, as mentioned above, most patients are enrolled in hospice when they die by medical aid in dying, receiving the gold standard of end of life care.
Additionally, the concern expressed about why people choose medical aid in dying, which is not usually because of uncontrollable pain, is not valid. People suffer in different ways at the end of their lives. All who are dying and have decision-making capacity should be able to decide if and when, if ever, that their suffering has become intolerable, whether because of pain or other reasons.
The concern expressed about “erroneous or vague medical predictions” is also not valid. If anything, doctors more often predict that patients will live longer than they actually do. And, patients who choose the option of medical aid in dying almost always wait until they are in fact quite close to death, the process usually taking some seven weeks from the time the first request is made until the drugs are taken, if ever (about one third of patients never take them).
Clearly, patients should be able to make decisions on medical aid in dying, based on the prognostications of two doctors, just as they can make similar decisions to hasten their deaths by stopping or never starting life sustaining treatments.
Finally, the concerns about “coercion, trickery, or worse” would be understandable if there were not over 50 years of experience with medical aid in dying in the nine states which authorize the practice, without any substantiated court or administrative cases proving coercion or any other abuses. While an occasional abuse is possible, that is not a sufficient reason to prevent dying patients from accessing medical aid in dying.
Medical aid in dying has been consistently proven to be a safe, ethical and effective medical practice that benefits patients by providing a peaceful death, and causes no harm to anyone. It is time for the Connecticut legislature to act.
David C. Leven is Executive Director Emeritus and Senior Consultant End of Life Choices New York
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