Much of what people think they know about physician-assisted death (also called physician-assisted dying or PAD) is false information. Despite PAD becoming legal in more and more states, there is still much controversy and stigma attached to it. Having this stigma slows the progress of making legal changes to allow PAD, giving patients the right to die peacefully on their own terms. Here are seven of the most common misconceptions regarding PAD and explain why they are wrong.
The term physician-assisted suicide is a blatant attempt for those opposed to PAD to attach a negative connotation to it through word choice. The language used is important. The proper terms are physician-assisted dying, physician-assisted death, and medical aid in dying. A judge in Washington refused to allow the biased term “assisted suicide” on Washington State’s Death with Dignity Act ballot measure. According to Jack Newbold, “I’m not committing suicide, and I don’t want to die. I was upset by media reports that I intend to ‘kill’ myself. I’m not killing myself; bone cancer is taking care of that. I may take the option of shortening the agony of my final hours.”
Opponents of PAD are simply trying to attach negative language to the term to help sway public opinion in their favor. These people are not committing suicide. To attach the term suicide is inaccurate, inappropriate, and disrespectful. The patients are already dying and only want to have the legal choice to do so peacefully on their terms. Those that use the term suicide are misleading the public and perpetuating this myth.
This common criticism is simply not true. The expectation of individual liberty is coded in law. The right to bodily autonomy is included under article 8, the right to privacy, of the European Convention on Human Rights (ECHR) and later The Human Rights Act. The ECHR, underpins the rights of individuals to “inherent dignity”. Therefore, if someone feels that dignity is no longer attainable due to the progression of a terminal illness, then assisted dying should be a legitimate legal choice for people.
The physician is not doing anything unethical if PAD is legal. Furthermore, the patient is already dying and simply wanting to make their impending death more peaceful. The physician is helping them avoid further suffering from continued deterioration and giving them the freedom to quicken their impending death in a peaceful manner.
There is also the doctrine of double effect to consider. This legal judgement states that a doctor is entitled to do all that is proper and necessary to relieve pain even if the measures he takes may incidentally shorten life. This document allows physicians to give their terminally ill patients more pain medications even though they may suppress the patient’s breathing which can lead to the patient’s death. There are many ethical arguments for physician-assisted death.
A common myth meant to villainize PAD, claims that vulnerable people such as the elderly and uninsured will be pressured to choose physician assisted-dying as it is less expensive than months of care. These are baseless claims that have no truth behind them at all. There are extremely strict eligibility requirements in states where PAD is legal that prevent vulnerable patients from being endangered or coerced.
Oregon’s death with dignity act annual report for 2018 completely contradicts the claim as 99.3% of patients who received a prescription for PAD had health insurance. The annual report also confirms that these patients have terminal progressive diseases and a life expectancy of less than 6-months as 90.5% were already on hospice care. These patients simply do not want to die slowly while deteriorating more and more. They want to have control over how and when they die. Between the requirements and the statistics, it is clear that the vulnerable are not being endangered in any way.p.
This claim is nothing more than an attempt to villainize physicians. In Oregon, where PAD is legal, physicians are recommending hospice care more since the law went into effect. In states where PAD is legal, physicians are also more willing to prescribe larger doses of morphine and other narcotics for end of life pain management.
PAD is a multi-step process that requires numerous conversations between the doctor and the patient. It also requires a second, independent physician to verify the diagnosis, prognosis, and to again go through all other options available to the patient. Throughout the process and numerous conversations, about why the patient is choosing assisted dying, the doctor and patient cannot avoid forming a stronger relationship.
PAD helps facilitates a better dying experience whether the patient qualifies for it or not by simply forcing the conversation. There is clear evidence that shows that it reduces the number of people who die in hospitals and actually increases the use of palliative care and hospice. If anything, the doctor/patient relationship is stronger.
Critics are quick to use this accusation. They claim that physicians are either not knowledgeable enough about other means of helping their patients or simply not taking the time to thoroughly explore all other options with their patients. This claim is easy to discredit since as part of the requirements, the attending physician cannot help but offer person-centered care.
Attending physicians are required by law to thoroughly discuss all other options with the patient as part of the eligibility requirements. In fact, the independent physician that the patient must see, is also required to go over all other options available.
Client support services are available to all patients considering PAD free of charge. These services help patients consider all end of life options, prepare advance directives, and understand hospice care. During this entire process, the patient may change his or her mind at any time. If anything, the process of physician-assisted dying provides much more one on one care with the physician and with all the safeguards and stipulations in place, it provides the patient with high-quality and compassionate end of life care.
With this claim, critics claim that patients will be at risk of being pressured or coerced into the decision by their doctor, family, or insurance company. This accusation is simply not true. To qualify for physician-assisted dying, the patient must meet strict eligibility requirements including two written requests that are at least 15-days apart, a written request, and second independent physician must confirm the patient’s diagnosis, prognosis, and that all other options have been explained and made available to the patient. Most importantly, the patient can also change his mind at any time.
With all these stipulations and the safeguards that are in place, the patient is making the choice based on what he believes is best for himself, is fully aware of all other options, and has ample opportunity to change his mind. PAD gives patients more autonomy not less by allowing the patients the legal right to choose to die peacefully at home.
The patients are already dying slow deaths and will continue to deteriorate until their death. One important principle is a respect for the autonomy and self-determination of individuals, including the autonomy of patients at the end of life. PAD allows patients the freedom to simply shorten that process and eliminate further deterioration.
This damaging claim may at first seem to have some merit. However, the legal definition of murder is the killing a human being by another sane person, with intent, malice aforethought (prior intention to kill the particular victim or anyone who gets in the way) and with no legal excuse or authority. At first, the definition appears to match this myth since the physician does intend to end the patient’s life. However, there are a couple of important aspects of this subject to make note of.
First, the patient must request and self-administer the medication, and second, the physician’s intention is to compassionately allow the patient to die on his or her own terms rather than continue to suffer and deteriorate from a progressive terminal illness that the patient is already dying from. In addition, the physician would be legally excusable and have authority if PAD were legal in that state.
PAD is giving terminally ill patients the ability to choose to have a good death, a death free from the continued decline in health, pain and suffering. The patient is making the choice to die peacefully. PAD is not murder, it is compassion.
The bottom line is that physician-assisted dying gets a lot of bad publicity because critics, often conservative groups, use these faux facts to sway public opinion. If these false claims are not discredited, they will continue to slow progress of changing laws to allow PAD, and cause people to suffer and deteriorate in their final weeks of life. To alleviate their concerns, the public must be educated about PAD and all the requirements of both the patient and the physicians. Overall, PAD is a helpful and compassionate measure that helps terminally ill patients avoid needless suffering and to die peacefully in their homes on their terms.
Hyperlinks
- https://endoflifewa.org/medical/
- https://www.dispatch.com/news/20180417/dont-call-it-physician-assisted-suicide-bill-sponsor-insists
- https://peh-med.biomedcentral.com/articles/10.1186/1747-5341-9-3
- https://jme.bmj.com/content/31/4/235
- https://peh-med.biomedcentral.com/articles/10.1186/1747-5341-9-3
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4779271/
- https://www.deathwithdignity.org/oregon-death-with-dignity-act-annual-reports/
- https://www.chicagotribune.com/news/ct-xpm-1998-06-06-9806130001-story.html
- https://www.nolo.com/legal-encyclopedia/death-with-dignity-colorado.html
- https://www.vox.com/first-person/2017/9/21/16335534/aid-in-dying-california-legal-end-of-life
- https://www.mariecurie.org.uk/professionals/palliative-care-knowledge-zone/proving-good-quality-care/what-does-high-quality-end-of-life-care-look-like
- https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162AB15
- https://endoflifewa.org/dwd/
- https://coalitionccc.org/tools-resources/end-of-life-option-act/
- https://bpr.berkeley.edu/2015/04/01/physician-assisted-death-a-patients-last-plea-for-autonomy/
- https://impactethics.ca/2014/01/21/the-ethical-bases-of-medical-aid-in-dying-2/
- https://dictionary.law.com/Default.aspx?selected=1303
- https://www.statnews.com/2018/01/31/medical-aid-in-dying-doctor/
- https://www.huffingtonpost.ca/toula-foscolos/bill-52-quebec-euthanasia_b_5379940.html
