Op-Ed: Legislating Death with Dignity needs Debate with Dignity by Michael Collins

The introduction again of legislation that would allow people with terminal illnesses to obtain lethal doses of drugs with which to kill themselves has reignited the debate about assisted suicide in Maryland.

The attraction of the “Richard E. Israel and Roger “Pip” Moyer Death End-of-Life Option Act,” HB370 and SB354, is understandable. Who has seen people in the last stages of a terminal illness and not thought, “What can we do to ease their suffering?” Whose heart has not gone out to families whose loved ones endure often intense pain as they die?

I’m sure many people have thought, “If I am ever in that condition, I don’t know how long I’d want to hang on.”

These laws’ advocates often use intensely personal tales, such as that of former Annapolis Alderman Dick Israel, who succumbed to Parkinson’s disease, and, Brittany Maynard, a 29-year-old California woman with terminal brain cancer, who moved to Oregon to take advantage of that state’s assisted-suicide law.

Yet, that the passage of these laws relies so heavily on their raw emotional appeal should make us pause. We need to ask some hard questions about these issues and think just as hard about their potentially ugly answers.

Have we exhausted all options related to palliative care? If there are laws and regulations that onerously restrict physicians from prescribing the painkillers that can alleviate a terminal patient’s suffering, shouldn’t we change them first?

If enacted, this law will establish the principle that people in Maryland have a right to “death with dignity,” as the legislation was called when first introduced two years ago. With that accomplished, what is there to prevent the law from expanding to allow physician-administered suicide?

Slippery slope

In the Netherlands, where euthanasia has been legal since 2002, physicians are helping people with treatable mental illnesses—like depression—commit suicide. And, numerous doctors have become “angels of death,” euthanizing terminally ill patients without their consent.

A 2012 paper by J. Pereira in Current Oncology, found that despite safeguards built into so-called “death with dignity” laws, most safeguards are ignored.

For example, in 2005, more than 540 people in Holland were euthanized without providing explicit consent. In the Flemish part of Belgium, 208 people were euthanized without consent because they were in a coma.

Pereira’s study concluded that in 30 years, the Netherlands has slowly moved from euthanasia for terminal illnesses to euthanasia for psychological distress. That point was driven home last year in a widely reported case where a woman in her 20s—who did not have a terminal illness—was euthanized in Holland. She had been a victim of sexual trauma and her psychiatrist determined that she had untreatable Posttraumatic Stress Disorder.

Lawsuits

Proponents of so-called “death with dignity” argue a patient should have the right to self-administer a lethal dose of prescription drugs. But what about people with disabilities? Such a law is one lawsuit from being an Americans With Disabilities Act (ADA) violation for those who cannot self-administer.

Opponents of capital punishment point to the Hippocratic Oath to keep doctors from assisting in legal executions. They have also attacked drug companies for providing the lethal cocktails for executions. And they have pointed to botched executions as reason to end all executions.

Would doctors who prescribe lethal doses of drugs be violating their Hippocratic Oath? Could they be subject to professional sanctions?
Will drug companies have an incentive to create more powerful poisons so a patient does not have to swallow 100 capsules?
If even medically supervised executions can be botched, what can we assume about patient suicide? If not supervised, what happens? Could a patient be in a permanent vegetative state requiring life support? If supervised, would more active measures be required?
Proponents of such abortion-inducing drugs as Plan-B have sued pharmacists who refuse to dispense abortificients because it violates their conscience. Will pharmacists be liable to lawsuits if they refuse to prescribe life-ending drugs?

Conscience

The introduction of euthanasia will place Maryland’s health-care professionals on a collision course with numerous ethical and moral dilemmas. Anti-capital punishment activists argue that the Hippocratic Oath prohibits doctors from assisting with legal executions. Can it be made to square with euthanasia?

What about those with religious objections? Will a Muslim doctor be able to refuse to write a prescription for lethal drugs based on his religious beliefs? Will a pharmacist who is an evangelical Protestant be able to refuse to fill such a prescription on the same grounds?

Grim efficiency?

In 2008, Barbara Wagner and Randy Stroop were denied further cancer treatments by Oregon’s state-run Medicaid program because their cancers were in advanced stages. They were informed, however, that it would pay for their assisted suicide drugs.

Opponents of Oregon’s assisted suicide have noted potential conflicts of interest between doctors who approve assisted suicide and their employment with health maintenance organizations (HMOs).

Will Maryland’s Medicaid provide suicide drugs? What about insurance policies purchased through Maryland’s health exchange? Will we create a two-tier system where the wealthy with private insurance get their expensive cancer treatment while the poor on Medicaid get offered suicide drugs?

I fear that many of the people now holding out the promise of “death with dignity” are exploiting our compassion, anxieties, and fears in order to move us—incrementally, at first—toward a truly nightmarish future in which human life will be easily and callously disposed of in service to some amorphous “greater good.” Will we soon have ambulatory “dignity” clinics, like the dystopian future presented in the 1970s film “Soylent Green?” Recall how the Edward G. Robinson character “went home,” a euphemism for assisted suicide.

Before we pass the “End-of-Life Option Act” law, we need a debate with dignity, that strips away the euphemisms, asks the hard questions and gets the unvarnished answers.

Michael Collins can be reached at [email protected].