THE CASE AGAINST ASSISTED SUICIDE

Assisted suicide—when a doctor prescribes a lethal overdose for a patient to intentionally end his or her own life—is currently legal in five states, and some advocates aim to legalize the practice in Minnesota. This effort should be rejected. Assisted suicide is unethical, dangerous, and unnecessary.

Assisted suicide violates human dignity and equality

 

Suicide is always tragic because every human life, without exception, is valuable—regardless of age, illness, disability, and dependency, and regardless of whether a person will live for another six months or another 60 years.

 

Our society seeks to prevent suicide in general, but assisted suicide laws carve out an exception. They designate a particular class of people (those who meet the law's criteria) for whom intentional killing is a valid option. Assisted suicide sends the harmful and discriminatory message that the lives of disabled, sick, and dependent people are less "dignified" and less worth protecting than the lives of everyone else. That's why many disability rights organizations strongly oppose the legalization of assisted suicide.

 

No one should be excluded from protection and care.

 

Assisted suicide threatens the vulnerable

 

Proponents of assisted suicide focus on sympathetic individual stories, but these can obscure the many dangers of legalization. People are harmed when assisted suicide is legal.

 

Coercion and abuse: Assisted suicide laws do not require that anyone witness the death—there are no safeguards at all once the lethal drug has been dispensed. In Oregon and Washington, where assisted suicide is legal, prescribing physicians generally are not present when the lethal dose is administered.

 

Legalizing assisted suicide also leads to other kinds of pressure and coercion. In Oregon, 48 percent of assisted suicide patients in 2015 expressed concern about being a "burden" on family and friends. In Washington, 52 percent in 2015 expressed the same worry. Moreover, public and private insurers have a financial incentive to steer patients toward suicide rather than life-extending treatment. Some Medicaid patients in Oregon have been denied expensive treatment and offered assisted suicide instead.

 

Neglect of the mentally ill: Assisted suicide laws do not require that a patient undergo psychiatric evaluation before receiving the lethal prescription. (The decision to refer for evaluation is left to the prescribing physician.) Yet as a study published in the American Journal of Psychiatry concluded, "The desire for death in terminally ill patients is closely associated with clinical depression—a potentially treatable condition—and can also decrease over time." 

 

In Oregon and Washington, only a tiny fraction of assisted suicide patients first receive counseling. A British Medical Journal study of patients in Oregon found that "the current practice of the Death with Dignity Act may fail to protect some patients whose choices are influenced by depression from receiving a prescription for a lethal drug." Suffering people deserve treatment and support, not killing.

 

Mistaken prognoses: Assisted suicide laws rely on correctly diagnosing that a patient has less than six months remaining. But such predictions are inexact and often mistaken. In both Oregon and Washington, patients receiving lethal prescriptions have lived more than 1,000 days before dying by suicide—that means they lived years beyond the (mistaken) six month prognosis. The "terminal illness" requirement has even been understood to include chronic conditions that would only cause death if left untreated.

 

Jeanette Hall, an Oregon cancer patient, received a terminal diagnosis in 2000. She wanted assisted suicide, but her doctor encouraged her to undergo treatment instead. Today her cancer is gone and she is very happy to be alive. "If my doctor had believed in assisted suicide, I would be dead," she says. Legalizing assisted suicide encourages patients who would live for months, years, or even decades to throw their lives away.

 

Suicide contagion: Research shows that the acceptance, legitimization, and publicity of suicide encourages additional suicides. That's why assisted suicide can increase the number of regular (non-assisted) suicides. Following Oregon's legalization of assisted suicide in 1997, for example, regular suicides in that state have increased significantly at a rate well above the national average. And a 2015 study in the Southern Medical Journal concluded that (controlling for various factors) "legalizing [physician-assisted suicide] was associated with a 6.3 percent increase in total suicides." Suicide is already among the leading causes of death. Legalizing assisted suicide can influence vulnerable people and make this devastating problem worse.

 

Assisted suicide is unnecessary

 

It is already legal for patients to decline unwanted medical treatment and allow the dying process to take its course. And everyone has the right to receive good palliative and hospice care. Assisted suicide is something very different—it is intentional killing. This practice, explains the American Medical Association, "is fundamentally incompatible with the physician's role as healer."

 

Advocacy groups claim that assisted suicide is necessary to prevent pain and suffering. Generally, though, pain can be controlled if proper care is made available. According to the National Hospice and Palliative Care Organization, "When symptoms or circumstances become intolerable to a patient, effective therapies are now available to assure relief from almost all forms of distress during the terminal phase of an illness." At the end of life, in the most extreme cases, palliative sedation can prevent suffering.

 

"As a palliative care physician I aid people in dying by treating their symptoms and supporting them through the difficult practical and emotional tasks of completing their lives," says Dr. Ira Byock, a Dartmouth professor and director of the Providence Institute for Human Caring. "In more than 35 years of practice I have never once had to kill a patient to alleviate the person's suffering."

 

In fact, concern about pain is not a major reason given by those who have assisted suicides in places where it is legal; in Oregon and Washington, it is not even among the top five reasons, according to official state reports. The top concerns patients cite are the loss of autonomy, the inability to do certain activities, the perceived loss of "dignity," and the feeling of being a "burden" on others. Legalizing assisted suicide, in practice, does not authorize the killing of those who are in great physical pain; it authorizes the killing of those who are disabled and dependent.

 

Of course, disease and disability involve real difficulties and fears. But the solution to these problems is not suicide. The solution is to provide the emotional support and medical care that patients need, including mental health care and palliative care. That's what genuine compassion requires.

 

All people deserve protection, care, and support


Most states that have considered assisted suicide have rejected it—and for good reason. Legalizing assisted suicide is a grave mistake. It jeopardizes the lives of vulnerable people, especially those who are sick, disabled, and disadvantaged. We should instead strive to ensure quality palliative and hospice care. Every human being—irrespective of age, illness, and disability—deserves protection and compassion under the law.

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