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END-OF-LIFE
ISSUES
olina, Utah and Wyoming do not address the issue at all. Montana ‘A WAY OUT’ HELPS
and Bernalillo County in New Mexico have court rulings support- More than one survey has shown that patients take a great deal
ing the practice but no experience. Three states, Oregon, Washing-
ton and more recently Vermont, explicitly permit physician-assisted of relief in knowing that there is a way to stop the endless pain if
suicide, and it is worth looking at the requirements and experiences they must, with much of the hopelessness of one’s final days being
in those states should Texans ever wish to consider this. due to the fear that the pain and assault to dignity is just going to
go on indefinitely. The knowledge that there is “a way out” is some-
In states where it is allowed, to qualify for the program, a patient times comfort enough to patients with incurable disease. Nation-
must be at least 18 years old, sane, and have a prognosis that gives wide, however, surveys of professionals and laypeople show about
them less than six months to live (confirmed by two physicians). two-thirds still oppose liberalization of assisted-suicide laws in their
They must make a written request in the presence of two witnesses states or the country as a whole.
and, when the time comes, must make two oral requests to the in-
volved physician at least 15 days apart. Physician-assisted suicide is legal in a few other countries
(Switzerland, Belgium, Netherlands and Luxembourg) and while
It is difficult for many to accept the concept espoused by assisted- illegal or unaddressed in others, physician prosecution is uncom-
suicide proponents that “freedom to end hopeless suffering” might mon unless they take a more active role in directly ending a life.
be as important as “freedom to live.” The concern is that somehow Assisted suicide per se is illegal in Germany but physicians are al-
the right to end a hopeless and painful life will evolve into the duty lowed to administer dangerous sedatives to a dying patient at their
to end a resource-consuming life, the concern that “free will’ will request. In countries where it is allowed, there are similar findings
become “manipulated will.” Rational discussion of this valid con- of more people qualifying and registering for an assisted-suicide
cern is probably impossible in the current social and political envi- program than actually using it.
ronment. The hysterical reaction to imaginary “death panels” that
some still believe are hidden somewhere in the Affordable Care Act The Hippocratic Oath is considered out of date enough that
(Obamacare) suggests that many Americans are not ready to have many medical schools now use alternative affirmations upon grad-
this discussion yet. Concerned citizens think of the roving euthana- uation. How do modern medical oaths deal with the reality of
sia vans that crisscrossed Germany in the mid-1930s eliminating physician-assisted suicide? Dr. Lasagna’s oath is used by many and
the weak, the hopelessly infirm and the “mentally feeble.” Profes- includes the following phrase: “Most especially must I treat with
sionals and laypeople alike are afraid that this is an inevitable end care in matters of life and death. If it is given to save a life, all
point although it is hard to imagine a culture that values individual thanks. But it may also be within my power to take a life; this awe-
freedoms as much as ours allowing such a thing. That being said, some responsibility must be faced with great humbleness and
Dr. Jack Kevorkian even lost the support of many “death with dig- awareness of my own frailty.” The Model Oath for the New Physi-
nity” groups when he broadened the indications for his rogue eu- cian developed by the American Medical Student Association does
thanasia program from pre-terminal patients to some with not address this topic directly but does have the more general state-
nonlethal chronic pain syndromes and severe depression. ment, “I dedicate my career to the compassionate service of hu-
manity — caring for the sick, promoting health, preventing disease,
So what is the actual experience in places that allow physician-as- and alleviating pain and suffering.” Perhaps the best way to look
sisted suicide? It may be surprising that many patients who qualify ahead to hard choices and tough changes is to distill the discussion
and register for the state-sanctioned program do not ultimately go to the basics: If it were me or mine, what would I want?
through the plan, dying instead of their disease. Since it became legal
in Oregon in 1997, prescriptions were written for just under 1,200 Jeffrey J. Meffert, MD, is an associate professor of der-
patients, with only 750 making use of them. Washington’s experience matology and cutaneous surgery at the University of Texas
since 2009 shows a closer parity with 525 of the 549 prescriptions Health Science Center at San Antonio and a member of
being used, although many more patients initiated registration. the BCMS Communications/Publications Committee.
visit us at www.bcms.org 11
