As a physician with a background in bioethics, I have a particular interest in the so-called “Death with Dignity” initiative. The bill itself contains various flaws that make it not only unacceptable but dangerous. First, this bill does not require that the mental state of the patient be assessed by a psychiatrist. We know that the top reasons for terminally ill patients to request suicide are that they feel life is no longer enjoyable, have lost autonomy, or believe their lives to be burdensome or without dignity (and NOT as a result of pain). And although these reported symptoms may be similar to those expressed by depressed patients without an underlying terminal illness, no counseling nor psychiatric assessment is mandated under the bill. Psychotherapy and psychopharmacology may provide great relief for any patient suffering from depression. As physicians, we routinely hospitalize depressed patients who are contemplating suicide — for the purpose of treating the depression and getting the patient to a healthier mental state to deal with life. Shouldn’t we require that a thorough psychiatric assessment be done for those struggling to come to terms with their own mortality?
Secondly, the requirement that the patient has “six months to live” in order to request these lethal medications is generally understood by those within medicine to be an unreliable prediction. All health care providers have experienced the desperately ill patient who somehow survives against all odds and the relatively well patient who dies shortly after a diagnosis. In addition, the bill does not stipulate whether the six months is with or without treatment for disease. Although the prediction of six months to live is often required to receive hospice care, the result of miscalculation (i.e., one is discharged from the hospice) is a much more benign outcome than ingesting lethal drugs based on flawed forecasting.