I had already finished my weekly blog post discussing the comparison of sick and well care health care systems. However, I read through the article in The Week, listened to a segment on 60 Minutes TV show and had listened to numerous news pieces regarding Brittany Maynard, a “beautiful newlywed” who was diagnosed with a malignant brain tumor in January. She was told in April that she had only six months to live.
She took an interesting approach to her disease and after discussions with her family, moved with her husband to Oregon, one of the only five states in the U.S. that allow doctor-assisted suicide. This is where a physician can prescribe a lethal medication that the patient, in this case Maynard, can plan to ingest in their own bed, home, etc. with her husband, family and her/their side.
Ms. Maynard, in the last few weeks, has become “ a remarkably effective” campaigner for assisted suicide to be legalized nationwide. “I do not want to die,” said Brittany Maynard in CNN.com. “But I do not want to live into the end stage of this illness, when the fast growing tumor would eat deeply into my brain, changing my personality, stealing all motor and cognitive control, and inflicting pain even morphine couldn’t mask. All that I and people like me ask is that we be allowed to exert what little control we still have over our destinies, by choosing a death with dignity. Who has the right to tell me that I don’t deserve this choice?”
I have thoroughly examined my thoughts and feelings on this matter and have questioned what I would do in the same situation. However, as I visited a friend a few days ago, slowing dying of a metastatic/spreading cancer, I asked my friend what I could do for him as a courtesy. He begged me to please let him die. I also remember my own mother begging me to let her die after a number of strokes and her worsening Parkinson’s disease as well as her Alzheimer’s disease. The panic and misery in both their eyes as well as the same situations that I have seen many times in my practice where patients have no treatment options in light of their growing, spreading cancers has convinced me that the choice to end life can be a choice. Notice that I said CAN. Why not should? This, as many have mentioned, is a slippery slope.
I think that Oregon and the other states that allow physician assisted suicide require two doctors to certify that the patient has less than six months to live. The patient must then pass a battery of tests to prove that he or she isn’t depressed, acting impulsively, or being coerced. If the patient “passes” all the evaluating tests and still chooses to proceed with the doctor-assisted suicide, they must administer the medication their selves. Other states have looked into Oregon’s model because since the law went into effect in 1997, only 750 Oregonians have ended their lives with a physician’s assistance, all meeting the proper criteria.
As Michael Gerson stated in his commentary in The Washington Post, “All of us can imagine horrible circumstances in which we’d want the same choice as Maynard’s. But establish the “right” of sick individuals to kill themselves and the right “begins to look more and more like an expectation.” And truly, that isn’t a society we want to live or die in. Look at the European countries that have assisted suicides. The lines and criteria seem to have become blurry and in my eye worrisome. The question that I bring up is in the environment of the Affordable Care Act where we are already seeing restriction of care and possibly the “death panels,” will assisted suicide in terminally ill patients be a way of controlling costs? Remember, the last two years of our health care lives are the most expensive. Therefore if the governing forces of health care could change these criteria so that regulations now not only allow doctor assisted suicides but also start to require it for certain diagnoses.
Sounds far out doesn’t it? However, think about some of the long waiting times for operative procedures in England. Waiting times of six to 18 months for a procedure seems without knowledgeable or ethical basis. But if you think carefully the prolonged waiting times allow the patients with higher co-morbidities to die before their appointed surgeries. This way the surgical procedures have a lower complication rate, eliminate many admissions to the intensive care unit and also readmissions. This saves the health care system millions of dollars.
So, maybe the idea of death panels and the use of “assisted suicides” are not so “far out” to control costs in an environment of sustainable costs basis for the ACA.
I still believe that physician assisted suicides have some value for the terminally ill in pain, with no hope of survival. We just have to be very, very careful about the criteria and laws that establish the criteria, not allowing any leeway for anything other than criteria as set up by states like Oregon. We need to be careful of the slippery slope and who is enforcing the criteria and testing.
I also need to ask the question that has been bothering me. In this Ebola “crisis” where is the Surgeon General or the nominated Surgeon General? Why do we need to have the President name an Ebola Czar, which is unconstitutional, when we have or should have a Surgeon General? Also, as I have mentioned, why is it always we the U.S. that always come to the aid of others, especially when it puts all our citizens in jeopardy? Do we need to send 3,900 troops to help “combat” the Ebola crisis in Wets Africa?