Legislative proposals for physician-assisted suicide degrade the trusting relationship patients have with their providers, provide an illusion of autonomy, and harm the most vulnerable among us. We need to advocate instead for equality of care — a health care principle that aspires to offer the same access to care and health services to all people regardless of their health condition.
Every person has the right to receive health care and control their illnesses. ("Bodily autonomy should apply at life's end, too," Opinion Exchange, Jan. 25).
As a professor of medical oncology and internal medicine for over 40 years, as well as the first Mayo Clinic physician board-certified in hospice and palliative care, I see physician-assisted suicide as a personal issue for me. I have a unique lens through which to address principled end-of-life care and what constitutes real patient autonomy, having been at the bedsides of more than 30,000 terminally ill patients.
One patient experience, in particular, has riveted my soul. As a consulting hospice and palliative care physician, I was asked to see a patient for a goals-of-care consultation. I carefully reviewed the patient's history to understand his primary symptom management issues. He was terminally ill with metastatic non-small-cell lung cancer, in pain, short of breath and could not sleep.
When I first visited him and introduced myself, he said, "I know what you do. You are here to put me down. To end my miserable existence. Right?"
I explained that my specialty focused on improving patient care, creating better pain and symptom management, and supporting his overall well-being — not acting with the primary intention of ending his life.
I also explained that each of his symptoms was treatable. After thoughtful review, he decided to carry on with my prescribed treatment. With his care plan in place, his condition and pain management significantly improved.
If physician-assisted suicide were legalized, the "standard of care" mandated by the assisted-suicide legislation would require that I counsel such a patient on how to end his life, while at the same time giving medical advice about how to improve his condition. In my medical judgment, this would constitute malpractice, be incompatible with ethical health care and should not be allowed.
In almost all clinical studies, symptom management for pain results in an enhanced quality of life for the overwhelming majority of patients. For the remaining patients, extraordinary measures such as conscious sedation are well-established options that, in my experience, have consistently met the pain management needs of high pain- or suffering-threshold patients.
I shudder to think what might have transpired with the patient I cared for if physician-assisted suicide were legal in Minnesota. It will actually reduce patient autonomy by restricting real health care choices. Even more troubling, these laws reinforce the unspoken maxim that not all lives matter (especially the lives of people with disabilities) and, consequently, those at the end of life will have a moral duty to end their lives or be blamed for continuing to live.
My medical experience has taught me that patients who are suffering at the end-of-life are in need of more compassion and care than being sent home with a bottle of pills to end their lives because we have communicated to them that they are a burden.
Instead of legalizing assisted suicide, we need to encourage more access to palliative (pain management) care and hospice care, which is now incorporated into the litany of comfort measures at end-of-life. There remains much work to be done to improve provider training for illness specific palliative/hospice interventions and, even more importantly, to increase patient access to these critical end-of-life supports.
Rather than pain and suffering, the main reason that patients identify for choosing assisted suicide is a "fear of being a burden to others." Pain or suffering does not even make the top five reasons. So, again, instead of legalizing assisted suicide, we need to create better policies addressing the underlying social, emotional and spiritual dimensions of end-of-life care that might lead someone to think their life is not worth living.
If physician-assisted suicide is legalized in Minnesota, we will also see an increase in ableism, greater health care disparities among historically marginalized peoples, and more trauma to individuals on the margins who do not have the agency to speak for themselves and would be coerced into unethical treatments to limit the financial burdens of end-of-life care.
If we as healers do not advocate for every patient, if we get in the business of offering death as an option, we will lose trust — that sacred bond.
Health care, by definition, is either preventative or restorative. Physician-assisted suicide is neither. Physicians are healers, not accomplices in the killing of our patients. We take an oath to treat the patient and, by intervening with the primary purpose of ending a patient's life, we would dishonor that patient and radically alter the foundation of the patient-doctor relationship.
Protecting the choices of a few by legalizing physician-assisted suicide will endanger health care for all of us.
Edward T. Creagan is emeritus professor of medical oncology and internal medicine at Mayo Clinic and past president of the Mayo Clinic Faculty. He is a member of the Minnesota Alliance for Ethical Healthcare. The views represented here are solely his own.