Physician-assisted Suicide Laws: Real Safeguards? No. Discrimination? Yes!

By Nancy Valko

notdeadyetlivereMany years ago before the first physician-assisted suicide law was passed in Oregon, I was asked to see a patient I will call “Eleanor” who was on the oncology (cancer) unit where I worked.

Eleanor was larger than life even when she became ill with cancer in her 50s. Spirited and feisty with a wicked sense of humor, Eleanor regaled us doctors and nurses with her tales about her event-filled life. But over some months when her cancer treatments failed to cure her, Eleanor’s mood darkened and she told me of her plans to commit suicide either with a “doctor” like Jack Kevorkian or by her own hand.

She was insistent that she die before she became mentally diminished or physically dependent on others. I notified the doctor and spent time talking with her.

With treatment and especially by addressing her fears and the ramifications of a suicide decision, I was elated when Eleanor changed not only her mind but also her attitude. Once she decided against suicide, she embraced life fully and with gusto. She eventually died comfortably and naturally.

However, after Eleanor changed her mind about suicide and mentioned me, her friends tracked me down and threatened to get me fired because I was unjustly “interfering with her right to die.” Instead of being happy or relieved for Eleanor, these friends were instead outraged that we took the usual measures we would take with anyone to prevent a suicide.

I was shocked then but I am not now, especially after physician-assisted suicide was legalized in some states and one of its victims, the late Brittany Maynard, became a celebrity.

HOW ASSISTED SUICIDE LAWS DISCRIMINATE IN TREATMENT FOR SUICIDAL PATIENTS

When a patient expresses thoughts of suicide, this is considered an emergency. As health care providers, we notify the doctors and an evaluation is done.

As the American Family Physician website states in “Evaluation and Treatment of the Suicidal Patient“:

“Important elements of the history that permit evaluation of the seriousness of suicidal ideation include the intent, plan, and means; the availability of social support; previous suicide attempts; and the presence of comorbid [simultaneous presence of] psychiatric illness or substance abuse. After intent has been established, inpatient and outpatient management should include ensuring patient safety and medical stabilization; activating support networks; and initiating therapy for psychiatric diseases. Care plans for patients with chronic suicidal ideation include these same steps, as well as referral for specialty care.” (Emphasis added)

However, physician-assisted suicide laws like Washington State’s “Death with Dignity Act” only requires doctors to

(e) Refer the patient for counseling if appropriate under RCW 70.245.060

and

If, in the opinion of the attending physician or the consulting physician, a patient may be suffering from a psychiatric or psychological disorder or depression causing impaired judgment, either physician shall refer the patient for counseling.” (Emphasis added)

Not surprisingly, very few people are referred for counseling since assisted suicide activists and some others consider such suicides “rational”.

HOW PHYSICIAN-ASSISTED SUICIDE LAWS DISCRIMINATE EVEN IN DEATH CERTIFICATES

While it can be painful to the family (as I personally know), when suicide is determined to be the cause of death, it must be reported as such on the person’s death certificate.

However, the Washington State assisted suicide law actually forbids doctors from listing assisted suicide as the cause of death: “(2) The attending physician may sign the patient’s death certificate which shall list the underlying terminal disease as the cause of death.“

There are even detailed “Instructions for Physicians and Other Medical Certifiers for Death Certificates: Compliance with the Death with Dignity Act” [www.doh.wa.gov/portals/1/Documents/5300/DWDAMedCertifier.pdf]:

“If you know the decedent used the Death with Dignity Act, you must comply with the strict requirements of the law when completing the death record:

1. The underlying terminal disease must be listed as the cause of death.
2. The manner of death must be marked as “Natural.”
3. The cause of death section may not contain any language that indicates that the Death with Dignity Act was used, such as:
4. Suicide
5. Assisted suicide
6. Physician-assisted suicide
7. Death with Dignity
8. I-1000
9. Mercy killing
10. Euthanasia
11. Secobarbital or Seconal
12. Pentobarbital or Nembutal

The Washington State Registrar will reject any death certificate that does not properly adhere to the requirements of the Death with Dignity Act.1 If a death certificate contains any reference to actions that might indicate use of the act, the Local Registrar and Funeral Director will be instructed, under RCW 70.58.030, to obtain a correction from the medical certifier before a permit to proceed with disposition will be issued.”(Emphasis added)

This flies in the face of the 2003 CDC’s Medical Examiners’ and Coroners’ Handbook on Death Registration and Fetal Death Reporting that states:

“The death certificate is the source for State and national mortality statistics (figures 1–3) and is used to determine which medical conditions receive research and development funding, to set public health goals, and to measure health status at local, State, national, and international levels.” (Emphasis added)

The Handbook also gives the distinctions between manners of deaths:

Natural—‘‘due solely or nearly totally to disease and/or the aging process.’’

Suicide—‘‘results from an injury or poisoning as a result of an intentional, self-inflicted act committed to do self-harm or cause the death of one’s self.’’

Why were the activists and lawyers who wrote this law not challenged when it was written to actually require doctors to lie on a legal document and add yet another layer of secrecy?

Again, as I wrote in my previous blog “Why Should Physician-Assisted Suicide Laws Grant Special Privileges?,” legislatures and the public need to know and challenge these outrageous provisions as well as being informed about the personal and societal dangers of assisted suicide itself. We must demand truth, transparency and accountability, especially when life and death are at stake.

Editor’s note. This appeared on Nancy’s blog.