SalemNews.com, Salem, MA

October 30, 2012

Column: A physician's perspective on Question 2

Kerry Pound
The Salem News

---- — 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.

Furthermore, although proponents claim the bill offers a compassionate option, it is actually constructed in such a way to make the act of suicide incredibly isolating. The bill does not require any family members or next of kin be notified of a patient’s decision to kill herself. A spouse or relative struggling with the knowledge of a loved one’s diagnosis could be left further dealing with a suicide. But perhaps the most disturbing element in the proposed legislation is that no one (no witnesses, no medical personnel) need be present at the time of ingestion of this lethal dose of barbiturates. The lack of oversight opens the door to abuse of the sick, elderly, poor and disabled, not to mention myriad other concerns if the drugs get into the wrong hands.

The real fallacy of this bill is that it presents suicide as simply one option among many as patients navigate through the choices surrounding a terminal diagnosis. However, the idea that prescribing lethal medications for our sickest patients to kill themselves alone is just another option is certainly not the understanding of the vast majority of physicians who take an oath to “Do no harm.” Most of us realize that in enabling a patient’s suicide, we are corrupting the very foundation of medicine and changing the way physicians and patients understand each other’s roles. (The Massachusetts Medical Society and American Medical Association both oppose physician-assisted suicide.)

The practice of medicine involves meeting patients at their most vulnerable times — they often feel stripped of their dignity and come to us physically and spiritually naked, scared, and sometimes alone. As physicians, we recognize their trepidation, embarrassment and sadness, but acknowledge their humanness as they sit before us. We deal with their bodily fluids, foul smells, physical wasting, raw anguish, and yet we recognize the person in front of us. We meet them where they are and try to offer them some treatment or care that re-establishes their dignity — perhaps in an entirely new way. Palliative care, the branch of medicine that offers care to those with chronic or terminal illnesses, seeks to treat the whole person. It attempts to heal spiritual, mental and, where possible, physical processes that cause the patient suffering. Those within palliative care support the whole person and often guide them toward a peaceful end at the time of natural death. This bill does not require a palliative care referral to discuss options of care.

Compassion literally means to “suffer with” and, indeed, doctors are called to be compassionate — to suffer with our patients — not to desert them by enabling them to kill themselves alone. Shouldn’t we demand that our physicians in particular be with us in our time of greatest need? Shouldn’t we train our medical students in compassionate care? If we support this bill, we as a society are ushering in a new and corrupt culture of medicine — one in which the very underpinning of medicine to “do no harm” is eradicated. I ask you to vote NO and send a message to physicians that more compassion, not less, is needed.

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Kerry Pound is a physician working at Salem Hospital in the pediatric ER.