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We Cannot Let Patients Kill Themselves

This article appears in the February 1, 2019 edition of the Catholic Free Press

The Massachusetts legislature has once again introduced a bill to legalize physician-assisted suicide (PAS). Deemed the “End of Life Options Act”, it seeks to make killing oneself just another end-of-life option to be provided by a doctor. It is a further expansion of the culture of death, a description famously given to Western society by Pope Saint John Paul II in his 1995 encyclical, Evangelium Vitae.

Despite vigorous public testimony regarding the dangers of assisted suicide, legislators and advocates continue to press for legalization.  Advocates will talk about how “safe” the law is because no incidents have been reported. The reality is that no current law legalizing PAS contains any regulatory oversight since doctors that participates are completely immune from any criminal, civil, or professional liability.

Furthermore, no researchers have examined the practice. Scholars are quoting 20-year-old data collected just prior to Oregon’s legalization. The physician self-reports compiled by these states contain grouped statistics without details. Research is made more difficult by falsely listing the cause of death as the underlying illness. It is easy to say the laws are safe when no one is really checking.

They point out the carefully-crafted safeguards, but where PAS is legal, advocates decry them as barriers that must be removed. Death within six months and the mental health exclusion are the two most sought after “barriers”. What is portrayed as “dignity” for the suffering eventually becomes PAS for anyone who asks. Euthanasia is not far behind that.

You will hear stories of people claiming unbearable suffering at the end of their lives. You will not hear that around 80% of people request PAS not because they have any physical pain, but because they can no longer do what they want (decreasing ability to participate in activities that make life enjoyable, loss of autonomy, loss of dignity). They want the medicine because they feel better just knowing they have it. Why? So on a bad day, they can impulsively take it?  Reducing physical suffering is the proper role of medicine, not helping patients die.

The bill has written into it the same inherent conflict of interests placed in all the other bills. It gives an illusion of safety by allowing only one of the witnesses to be a relative or someone who financially benefits from the patient’s death—yet a son and his girlfriend eager to gain an inheritance qualifies. Neither the patient’s physician nor anyone connected to a facility caring for a patient can be a witness, yet if a patient is in a long-term care facility then the facility must designate one of the witnesses. Why do all these assisted suicide laws have this strange clause that is such an obvious conflict of interest?

Most alarming is the history of Massachusetts case law in Brophy v. New England Sinai Hospital. The state Supreme Court allowed the wife of Paul Brophy, a man in a “persistent vegetative state”, to remove his feeding tube for the expressed purpose of causing his death. The court characterized his condition as “helpless” so not worthy of equal protection. Even though the PAS bill prohibits it from anyone with a guardian, or solely because of age or disability, the Brophy precedent make this “barrier” an easy one to take down. A guardian could then request PAS without the patient’s consent leading to death-by-proxy.

We cannot allow patients to kill themselves nor let doctors prescribe lethal doses of medication, especially without oversight or liability. We cannot legalize PAS here where it can so easily turn into death-by-proxy. Tell your legislators you oppose PAS.

Not So Subtle Coercion

The Guardian newspaper recently published an extensive and informative article on euthanasia and assisted suicide, Death on demand: has euthanasia gone too far?

I have written about how coercion is a subtle yet powerful thing–here and now in the United States. This vignette from the article demonstrates how all subtlety is lost after legalization and cultural acceptance.

For all the safeguards that have been put in place against the manipulation of applicants for euthanasia, in cases where patients do include relatives in their decision-making, it can never be entirely foreclosed, as I discovered in a GP’s surgery in Wallonia, the French-speaking part of Belgium.

The GP in question – we’ll call her Marie-Louise – is a self-confessed idealist who sees it as her mission to “care, care, care”. In 2017, one of her patients, a man in late middle-age, was diagnosed with dementia and signed a directive asking for euthanasia when his condition worsened. As his mind faltered, however, so did his resolve – which did not please his wife, who became an evangelist for her husband’s death. “He must have changed his mind 20 times,” Marie-Louise said. “I saw the pressure she was applying.”

In order to illustrate one of the woman’s outbursts, Marie-Louise rose from her desk, walked over to the filing cabinet and, adopting the persona of the infuriated wife, slammed down her fist, exclaiming, “If only he had the courage! Coward!”

Most medical ethicists would approve of Marie-Louise’s refusal to euthanise a patient who had been pressured. By the time she went away on holiday last summer, she believed she had won from her patient an undertaking not to press for euthanasia. But she had not reckoned with her own colleague in the practice, a doctor who takes a favourable line towards euthanasia, and when Marie-Louise returned from holidays she found out that this colleague had euthanised her patient.

When I visited Marie-Louise several months after the event, she remained bewildered by what had happened. As with Marc, guilt was a factor; if she hadn’t gone away, would her patient still be alive? Now she was making plans to leave the practice, but hadn’t yet made an announcement for fear of unsettling her other patients. “How can I stay here?” she said. “I am a doctor and yet I can’t guarantee the safety of my most vulnerable patients.”

We have come a long way philosophically since the introduction of hospice and through the Quinlan and Cruzan cases in refusing or stopping medical care that is burdensome. This has led not only to a deeper affirmation of the dignity of life and the reality of death but also the hope in eternal life.

We crossed the line when we began the push for advance directives in 1991. No longer do we decide what is burdensome in the present, but what we fear in the future. This leads to an inherent prejudice against the disabled by allowing people to declare states worse than death. This echoes the 1920 German eugenics essay The Announcement for the Destruction of Life Unworthy of Living that evolved into the Nazi T4 program.

Eugenicists made the mistake of declaring others unworthy of life by legalizing things like forced sterilization and abortion. Today euthanasia advocates have begun by playing on people’s fears and prejudices through advance directives, leading them to declare themselves unworthy of life should they become disabled. Once the barriers to PAS are removed, euthanasia will quickly follow. Those advance directives filled out to refuse care under certain conditions will then be used by physicians and courts to actively euthanize people.

The vignette above is the proof of it.

Witness For Life and Changes to the PAS Bill

Public testimony provided by Kris Correira, PA-C addressed an issue changed in the legislation filed in 2019. It eliminated the attack on religious freedom.

In both 2017 and 2018, I publicly testified before the legislature regarding the dangers of the assisted suicide bill. In particular, I alone focused on the attack on religious freedom not part of any other PAS legislation. Those of you hearing me speak at the Fatal Flaws showing talk about this point.

In both bills, the problem comes in Section 15. The problematic wording is as follows:

15(4)(a) Health care providers shall maintain and disclose to consumers upon request their written policies outlining the extent to which they refuse to participate in providing to a qualified patient any medication pursuant to this act.

(b) The required consumer disclosure shall at minimum:

(vi) inform consumers that the cost of such transfer will be borne by the transferring provider; [emphasis added]

In my 2017 testimony, I wrote:

The Act states that a health care provider like myself, “is not under duty…to participate in providing a qualified patient with the medication.” But then it goes on to mandates that I provide patients with a referral specifically to someone who is willing to participate, and even to pay for the transfer.  So, if I am not willing to kill my patients then I must pay to send them to someone who will?  I will not do this, nor will any Catholic hospital.  Again, I ask you, is it your intention to shut down all the Catholic hospitals, and to drive out all the Catholic health care providers, putting thousands of vulnerable patients at risk, for a handful of people who demand that doctors must help them kill themselves?

From 2017 to 2018, the bill changed by adding in a 15 day waiting period, but the language restricting religious freedom remained. In my 2018 testimony, besides discussing other problems with the bill, I reiterated:

H 1991 forces us to act directly against our consciences by mandating that we refer patients to those who will assist in their suicides. It makes us pay even more by forcing us to incur the cost to transfer patients to another provider.

Now, this year’s bill eliminates the mandate to cooperate with evil. It now reads:

(vi) inform consumers that the cost of transferring records will be borne by the transferring provider [emphasis added]

Prescribed suicide is wrong for many reason even without the restrictions on religious freedom. We are not free to do whatever we want with our bodies as if we created them ourselves. With every body there is a soul together made by God for God whether we believe it or not. We have a duty to one another to regard the inherent dignity of every human life, and that includes prohibiting the intentional hastening of anyone’s death.

Autonomy, Except for Religious Reasons

In Australia, a judge has ordered that a pregnant teenage who is a Jehovah’s Witness receive a blood transfusion should she need one when being induced to deliver her baby.

Why? “The court heard from experts who said that while the teenager had been very clear and consistent in her wishes she was influenced by a willingness to please her family and the community she was dependent on.” One expert testified that, “the girl could have been trying to seek approval from those around her after committing the ‘transgression’ of falling pregnant out of wedlock.”

Refusing a transfusion, as a medical expert testified, risked only the mother’s health, not the baby’s. She said that to receive a blood transfusion would be as psychologically distressful as someone raping her or committing some other act of violence to her.

Refusing treatment is an established right.  What if she refused a treatment for a reason other than her religious belief? No judge would be involved.

How about abortion? How many abortions are done to hide a “dumb mistake?” With Oprah and the rest of the culture “shouting” their abortions, how many teens are looking to please friends saying she would be stupid not to have an abortion? And then there are the boyfriends and parents demanding teens dependent on them get abortions. No judge would be involved for any pregnant woman wanting to kill her child.

But opposing abortion is labeled as a religious issue. Remember mindless slogans like, “Get your rosaries off my ovaries?”

How about assisted suicide? Patients with serious illness become increasingly dependent on their medical teams and families as caregivers, far more so than a pregnant teenager.  No judge would be involved for any sick person wanting to kill themselves.

But opposing “aid in dying” is labeled a religious issue.

This tactic has been used ever since the eugenics movement began 100 years ago that morphed into Planned Parenthood and The Hemlock Society in the 1960’s. Their quest for “autonomy” has always meant being free from whatever the Church has taught to be fundamentally wrong.

Some day, the Culture of Death will realize the Church teaches those things because God knows what will lead us all to thrive as human beings living in society, caring for one another.

AMA 2016 Code of Ethics

ama

The AMA is in the process of updating its Code of Ethics.  The preliminary documents are available online, including Chapter 5: Opinions on Caring for Patients at the End of Life.

Based on this preliminary document, it looks as if the AMA will continue to stand against physician-assisted suicide and euthanasia. In both cases, the document states that “permitting physicians to engage” in either of them “would ultimately cause more harm than good.”  Both are “fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.”

Although the AMA remains against active killing, it very much encourages passive dying. Of eight sections, three are dedicated to insisting that patients be left to die, sometimes even when they don’t want to.

The first two sections are about Advance Care Planning and Advance Directives.  These are new concepts that medicine has not needed before the era of cost containment because the assumption has always been that if a person comes to a medical professional, it is because he or she wants care.  Now we must ask patients again and again if they are sure they want treatment because certainly some, even many, will refuse.

We know most patients refuse certain treatments before they even need them out of fear and pride–the “I would rather die than live like that” effect.  (See Rubin EB, Buehler AE, Halpern SD. States Worse Than Death Among Hospitalized Patients With Serious Illnesses. JAMA Intern Med. Published online August 01, 2016.)  When actually confronted with these conditions, patients willingly to adapt to them and go on living.

states-worse-than-death

The next three sections are all scenarios in which the AMA insists that doctors let patients die.

5.3 Withholding or Withdrawing Life-Sustaining Treatment: “When an intervention no longer helps to achieve the patient’s goal for care or desired quality of life, it is ethically appropriate for physicans to withdraw it.”  This opinion does contain hope, however.  I advise patients not to refuse any treatment in an advance directive before they are faced with that choice because even after starting a treatment it always can be stopped if it is not effective.  In other words, don’t make a decision before you actually have to make it.

5.4 Orders Not to Attempt Resuscitation: “Whether a patient declines or accepts medically appropriate resuscitative interventions, physicians should not permit their personal value judgements to obstruct implementation of the patient’s decision.”  Compare this statement to what is found in the next section.

5.5 Medically Ineffective Interventions: “At times patients (or their surrogates) request interventions that the physician judges not to be medically appropriate.”  It goes on to say, “Respecting patient autonomy does not mean that patients should receive specific interventions simply because they (or their surrogates) request them.”

So physicians should not let their “personal value judgements” get in the way of treating someone but must insist on their judgements regarding what is “futile”?  The section states, “The meaning of the term ‘futile’ depends on the values and goals of a particular patient in specific clinical circumstances.”  While patient autonomy is the overruling factor in refusing treatment, it can be ignored when a doctor’s opinion is that something is futile.  And how often will physicians deem a treatment futile not based on the merit of the treatment, but on the arbitrary value they place on someone’s life becasue of a patient’s age or condition?