What Does Coercion Look Like?

“You hold her down and I’ll give her the drink.”

“Your condition is not worth treating. Let’s start the Medical Aid in Dying process.”

This may be what people think coercion is like, but really it is far more subtle and powerful.

The popular news media is full of “good death” stories often originating from Compassion and Choices or the Kaiser Family Foundation.  The state reports where physician-assisted suicide is legal all seem to show how safe it is.  They try to convince us that it is a safe and rare procedure–does that sound familiar? It does to those who remember how America was groomed to legalize abortion.

Coercion looks like Sarah’s Story in Vermont:

Coercion looks like 85 year old widow Kate Chaney in Oregon:

She and her daughter Erika asked for a lethal prescription, but her doctor denied the request.  They asked for another opinion, and the second doctor sent her for a psychiatric evaluation.  The psychiatrist noted:

  • She was not pushing explicitly for suicide
  • She lacked the capacity to make that decision
  • Her daughter Erika became angry when told the results

When Erika complained, the health organization recommended and paid for a second psychiatric evaluation.  Do you think any approving doctor or health organization would do that if the family insisted their relative not receive a lethal prescription? Do health organizations have a conflict of interest given they will save money if a patient commits suicide?

The second psychiatrist thought Erika was “somewhat coercive” but granted the request.

An executive at that same health organization contacted 800 physicians encouraging them to act as the assisted suicide attending physician for their own patients and be willing to do it for other patients as well.

Coercion looks like young Candice Lewis in Canada:

Candice is one of many people subjected to coercion by the medical community documented in the film Fatal FlawsThe instances are far worse where euthanasia is legal.

Compassion and Choices frequently sends volunteers when patients have scheduled their suicides.  They prepare the lethal drink by opening the 100 Seconal capsules and dumping them into water for the patient to drink.  It is harder to change you mind when someone has made a special trip to be there and helped get things ready, especially when they remind you that this was what you wanted.

Mass General Hospital has used a protocol it created allowing doctors to impose a Do Not Resuscitate (DNR) order against a patient’s will if the doctor decides resuscitation would do more harm than good. No second opinion nor ethics consult is required.

How difficult would it be for a family to demoralize a patient with subtle comments about the strain care giving is causing them or frequent suggestions to opt for assisted suicide?  Patients and their families are rely on doctors for their medical expertise; how options are framed have an enormous impact on patient decision making.

Recently, a physician assistant student in my office described an incident during his intensive care rotation.  The medical team met just before meeting with the family to coordinate their strategies to convince the patient and family to end further care.

Here in Massachusetts, social workers are sometimes told by clinician to see a patient to “get the DNR signed.” What is asked of social workers in states where PAS is legal?  The role of a palliative care clinician is to discuss with patients “diagnosis awareness” and “goals of care,” but one must be very careful that their biases not be brought in to these conversations. They are conversations that too easily can become coercion.

Medical Aid in Dying is a “designer law” that gives autonomy to a select few who are determined to have it regardless of how it impacts the medical system or others in society.  Coercion is a real problem that minimal details and physician self-reports in state summaries do not reveal. 

We don’t need a designer law that protects physicians from all liability for those so desperate for control can have it while putting so many vulnerable people at risk.  We cannot possibly legalize such a dangerous practice. 

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