Thoughts On Physician Assisted Suicide

A beloved patient of the skeptical cardiologist committed suicide two years ago.

Although 90 years in chronological age, Phyllis appeared and behaved as one much younger. She was full of life, energy and happiness when she came to my office for treatment of her atrial fibrillation and heart failure.
 
Her daughter and I discussed what happened and how it could have been prevented.  Her perspective follows:

My mother, Phyllis, was a complicated woman.  She was intelligent, charming, beautiful, spirited and fun with an inquisitive mind and many interests.  She could play competitive Bridge and win, even in her 90’s. She drove a little red convertible and had the top down whenever possible. She liked to dress stylishly and had excellent taste.  She had a lifelong habit of health and always exercised and ate carefully…except for chocolate.  She had a legendary addiction to chocolate and I think she will be remembered in our family for many generations to come by all of the wonderful chocolate stories. She was always working to improve herself and to that end almost never read fiction, preferring biography or autobiography. In her 40’s she took up synchronized swimming and water ballet.  She was very single minded in her goal to improve her skills, participated in the Sr. Olympics in Denmark in 1989 and won a silver medal!  At the age of 50 she decided to take up skiing and although she gave it up at 65, she did get good enough to ski the black slopes.  She was very happily married to my father, Jack, until his death at 69.  A few years later she married Earl and they had a solid union until his death.

She made the decision to end her life very soberly with much deliberation.  This had been on her mind for years before she actually accomplished it.  The prior Spring she had set a date and only due to much family intervention, involving lots of fun, did she cancel it.  She felt the odds of something happening to her, which would keep her bed or wheelchair bound or would take away her mental facilities, became greater and greater with each passing year. In her final year she could see differences with each passing month.  She never wanted to be dependent on anyone or anything. She was not depressed.  She had several falls in the last few months, nothing serious, just cuts or bruises, but she could see it was just a matter of time before a bad fall could take her out.  She no longer could eat chocolate or drink coffee or wine, all of which had been a great comfort to her. She had developed a heart problem, which she knew would only get worse as she aged. And she was very scared that her lifelong habit of heath would backfire on her.  That she would go on and on and on trapped in a bed or left with no mind.

She had discussed suicide with all her family at great length in the years leading up to her death. She didn’t like the idea anymore that we did but she was afraid that something would happen to her and she would no longer have the ability to make this decision if she felt it was necessary.

So in the early hours of February 19, 2016 she put a gun in her mouth and pulled the trigger.

How unfair that she had to do this gruesome and scary thing all by herself. She would still be alive if she knew that when the time came in which she no longer felt she had an acceptable quality of life she could have taken a pill or be given a shot and then died gently surrounded by all who loved her.

I think everyone needs to look at their own life and ask themselves – what do I want the final years of my life to look like?  Medical science has given us the ability to live much longer healthier lives.  But that comes at a cost.  Many people live on and on in nursing homes, just shells of humans because medical science can keep them alive almost indefinitely.  Is this what the average person wants?  Do most people think to themselves – I’m really looking forward to those years when I’m fed, bathroomed and bathed by strangers?

I think Physician Assisted Suicide can be a good answer for those people who do not want to live in this manner and have made their intentions very clear to family and doctors.

I miss my mom.  I miss our long talks and walks.  I miss lunches out with her. I even miss our disagreements.  And I know that if Physician Assisted Suicide had been legalized in Missouri, she would still be here, playing Bridge, laughing, talking about good books, enjoying family visits, shopping for pretty clothes and getting ready for all the parties of the Holiday season.

Physician-Assisted Suicide

Since this happened I have become an advocate of state laws allowing physician-assisted suicide (PAS).  These laws are intended  for patients with terminal disease, but I think if Phyllis had lived in a state where these existed she would not have felt compelled to do what she did.
Physicians are divided on the topic of PAS with 55-65% in state medical society surveys favoring allowing such laws.
Despite this, the American College of Physicians recently published a position paper stating its opposition to PAS:

It is problematic given the nature of the patient–physician relationship, affects trust in the relationship and in the profession, and fundamentally alters the medical profession’s role in society. Furthermore, the principles at stake in this debate also underlie medicine’s responsibilities regarding other issues and the physician’s duties to provide care based on clinical judgment, evidence, and ethics. Society’s focus at the end of life should be on efforts to address suffering and the needs of patients and families, including improving access to effective hospice and palliative care.

Stat news has two physician-authored pieces on this topic which are well worth reading. In the first article, Ira Byock, M.D., a palliative care physician, writes that “there are some things doctors must not do. Intentionally ending patients’ lives is chief among them.” He decries excessive pain and suffering at the end of life but thinks that “so much of that kind of suffering could have been avoided with good care.”
The second article was written by Roger Kligler a physician in his sixties who is dying of metastatic prostate cancer. He writes:

When my suffering becomes intolerable, I hope my doctors will permit me the option to end it peacefully with medical aid in dying — something I have been working to get explicitly authorized in Massachusetts, where I live. Medical aid in dying gives mentally capable, terminally ill adults with six months or less to live the option to request a prescription medication they can choose to take in order to end unbearable suffering by gently dying in their sleep.

For more information on this topic I recommend the website of Death with Dignity, the organization which authored the Oregon statute governing the prescribing of life-ending medications to eligible terminally ill people. About 100 patients a year have taken advantage of the Oregon Death With Dignity Statute. The website notes that “Overall, 1,545 patients obtained a lethal prescription from 1998 through 2015. On average, 64 percent took the drugs.  Almost all died but six people woke up and died later of natural causes.”
-ACP