Psychologist: Why suicide and medical aid in dying are truly different
As a board-certified clinical psychologist for the last four decades who has counseled both patients who were dying and those who wanted to end their life prematurely via suicide, I can tell you unequivocally that there is no comparison between the two. But don’t just take my word for it.
The American Association of Suicidology, a suicide prevention, medical research association whose membership includes mental health and public health professionals, issued a position statement in 2017 concluding:
“[S]uicide and physician aid in dying are conceptually, medically, and legally different phenomena … including intention, absence of physical self-violence, the physician’s assessment that the patient’s choice is not distorted by mental illness, a personal view of self-preservation versus self-destruction, and by the fact that the person who has requested aid in dying does not typically die alone and in despair, but, most frequently, where they wish, at home, with the comfort of his or her family. In fact, we believe that the term ‘physician-assisted suicide’ in itself constitutes a critical reason why these distinct death categories are so often conflated, and should be deleted from use. Such deaths should not be considered to be cases of suicide.”
The American Academy of Hospice and Palliative Medicine, American College of Legal Medicine, American Medical Women’s Association, and American Public Health Association have adopted policies opposing the use of suicide and assisted suicide to describe medical aid in dying.
The Journal of Palliative Medicine has published peer-reviewed, clinical criteria for physician aid in dying, not physician-assisted suicide.
If a terminally ill person utilizes medical aid in dying, the death certificate does not say the cause is “suicide.” It says the cause is the underlying, terminal disease. By the same reasoning, death certificates of people who die on the operating table to remove a tumor, by voluntarily stopping eating and drinking with palliative support, or from palliative sedation (in which the patient is medicated into a coma until they die of dehydration or the underlying, terminal disease), indicate the cause of death also is the underlying, terminal disease.
As the past chair of the American College of Physicians Board of Regents, Yul Ejnes, MD, explains: “The [death certificate] information…helps policymakers set public health goals and research funding priorities…For the cause of death, it’s important that physicians list a disease and not a mechanism.”
In addition, a Purple Insights poll in Connecticut showed 66 percent of state voters overall and 65 percent of voters with disabilities support medical aid in dying. This strong support among people with disabilities is not surprising to me because my patients with disabilities want the same autonomy to make their own end-of-life care decisions as my other patients and there is no evidence that medical aid-in-dying laws put people with disabilities at risk.
In fact, the executive director of Disability Rights Oregon (DRO), which has federal authority to act as a watchdog for people with disabilities and request confidential records, confirmed in a 2019 letter that:
“In the years since passage of the  Oregon Death with Dignity Act (the Act)…DRO has never to my knowledge received a complaint that a person with disabilities was coerced or being coerced to make use of the Act.”
Sadly since the introduction of the first medical aid-in-dying bill in Connecticut in 1994, opponents have made the same baseless claims disproven by more than 40 years of public data in eight states and Washington, D.C. that have authorized this end-of-life care option to gently end unbearable suffering.
Fortunately, these claims failed to intimidate the Connecticut Public Health Committee because its members approved medical aid-in-dying legislation (HB 6425) in a bipartisan vote of 24-9 for the first time ever earlier this month.
Now I urge our state lawmakers to pass this compassionate legislation as soon as possible, so no more terminally ill Connecticut residents have to suffer needlessly at life’s inevitable end.
Jeff Gardere is a board-certified clinical psychologist and an ordained minister who lives in Weston.
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