In a recent Spy op-ed, Michael Collins suggested that we need to debate this issue because the proponents of the bill provide personal stories (he calls them tales) that rely on raw emotion to promote these acts and should make us pause before enacting them. In his article he then goes on an emotional journey of his own by using loaded words suicide, killing, and euthanasia to describe this bill and with his own tales of abuse in the Netherlands.
His first sentence in an attempt to explain this act contains the following “….to obtain lethal doses of drugs with which to kill themselves”. A person in this position is not killing themselves they are already going to die very soon. They are choosing to end their lives when, where, and with whom they love. Throughout his article he continuously refers to death with dignity as suicide and even euthanasia.
Medical aid in dying is fundamentally different from suicide:
A person seeking medical aid in dying wants to live but not with the physical or emotional pain that living would require. The person considering suicide has no terminal illness buts want to die.
A person seeking medical aid in dying, is suffering life-ending illness and understand that further treatment is inappropriate and there is no hope for a better outcome. Those considering suicide see no hope but do not recognize their problems are treatable.
People seeking medical aid in dying are deliberate in their request and will often include family in their discussions with their physicians. The act of suicide is secretive and often impulsive without involvement of family, friends, and healthcare professionals.
Equating medical aid in dying with euthanasia is hypocritical. Euthanasia is commonly a lethal injection given by a third party. It is frequently done without the consent or approval of the patient. The bill in the Maryland General Assembly does not allow euthanasia.
Mr. Collins also talks about Doctors violating the Hippocratic Oath. I assume he means the often quoted “do no harm”. Are Doctors doing no harm when they make decisions about treatment based on their expertise alone followed by pushing patients into dangerous treatments that have no hope of improving a person’s life or even prolonging their life? I believe doctors need to obtain a sense of the patients own priorities before discussing treatment options.
Doctors should not be the final arbitrator in this decision it should be up to the person to make that choice.
One of the major components of this bill is that before a Doctor can prescribe a lethal dose of medicine the Doctor must provide the patient with a complete picture of all their end of life options including pain and symptom management, hospice, Voluntarily stopping eating and drinking, declining or stopping life-sustaining treatment, palliative sedation, as well as medical aid in dying.
I don’t disagree with Mr. Collins in that the end of life medical treatment provided in this country needs to be fully debated and thought about. This includes reexamining what medical professionals are taught in medical school.
Mr. Collins should look at Oregon and not the Netherlands for understanding how this law works. This law has been in effect in Oregon since 1997 and in that time End-Of-Life care has improved due in large due to the dialogue encouraged by the law between people and their doctors. Hospice use is high as is other use of palliative care. Some hospice programs reported a 20% increase in referrals since the law went into effect. The in-hospital death rates are the lowest in the nation, in-home death rates are the highest, and violent suicide among hospice patients has virtually disappeared.