JAMA “viewpoint” offers same old rationale for Physician-Assisted Suicide

By Dave Andrusko

JAMAarticle4I don’t know Anna E. Roberts at all but I do know enough about Lawrence O. Gostin to anticipate that their joint “Viewpoint” in the Journal of the American Medical Association (JAMA) would be an apologetic for Physician-Assisted Dying.

And, sure enough, “Physician-Assisted Dying: A Turning Point?” was just that.

Their strategy was straightforward. Lead with their heaviest artillery–Brittany Maynard–end with her “final words” as Brittany “took the final step in her life’s journey” and in-between politely dismiss all the objections to PAD. (They note that in the United States euthanasia–physicians lethally administering drugs to a patient –is not legal while Physician-Assisted Suicide–where the physician prescribes the lethal medicines which the patient takes herself–is legal in a few states.)

To be fair, Gostin and Roberts do hit on many of the objections, if only to brush them aside: Incompatibility With Medical Practice; Devaluing Human Life; Opening the Floodgate; Disproportionate Access for the Poor; and Abuse of PAD.

Let’s take just one example that shows how superficial their analysis is.

“Most patients who request PAD are well educated, insured, and in hospice care, rather than being poor and in public hospitals. It is unknown whether the Affordable Care Act might increase patient preferences for hospice and other palliative care services over PAD. Universal health coverage that includes high-quality end-of-life care would be the most effective way of ensuring that the poor and vulnerable are not drawn to PAD for financial reasons.” Let’s see if we can cut through the fog. The reasons the more affluent are far more likely to request physician “assistance” in dying than the poor are many. But they begin with a truth which Gostin and Roberts imply is more or less limited to Europe: they want “help” because they are “tired of life,” or because they are lonely after the death of a spouse, or because they anticipate a time when they may have Alzheimer’s.

In other words, hardly any cite the rationale that has operated as the camel’s nose under the tent: the adult who is terminally ill and in intractable pain.

And we are not safe from what is taking place in Europe just because there is an ocean in between. As Dr. Rene Leiva wrote in the Canadian Medical Association Journal blogs on November 24, 2015

In Belgium, hastened death has become part of the culture: despite having initially focused on the competent adult who is terminally ill, it has quickly moved into euthanasia for mental suffering and dementia, and for those tired of living, as well as children; it is commonly practiced by other health professionals such as nurses despite this being illegal. Medically assisted deaths have risen by 640% in Belgium since the law was adopted in 2002 and there are a significant number of deaths without consent as well as under reporting.

Gostin and Roberts happily (my characterization) cite the decision by the California Medical Association to move from opposed to neutral when that state passed the “End of Life Option Act.” That is part of what they describe [hope?] is a “turning point,” which also includes the many bills that were introduced in state legislatures in 2015 and supportive public opinion polls.

No one, including me, would dismiss their prophecy out of hand. But I would remind us that we just defeated still another physician-assisted bill in New Jersey and have thwarted dozens of similar proposals throughout the nation.

The opposition coalition that includes almost the entirety of the disability rights movement, healthcare workers , civil rights advocates, patient advocacy organizations, many medical organizations, hospice workers, and what bioethicist Wesley J. Smith describes as “egalitarian liberals” along with the leaders of faith communities stands stronger than ever.