The assisted suicide debate ultimately distracts medical professionals like me from pursuing dignified health care options at the end of life. I wholeheartedly believe Minnesota can become the hub of innovative palliative care and hospice care. Granting the “right” of patients to receive pills that kill misses the mark (“I have ALS, and I hope for a dignified death,” Sept. 24).
I recently testified before the Minnesota House Health and Human Services Policy Committee’s public hearing on a bill to legalize assisted suicide — the so-called “End-of-Life Options Act” (HF 2152). I was heartened to see the diverse group of individuals, both locally and nationally, who care so deeply about providing excellent comfort and support to those living with disabilities, or terminal and chronic illness. These individuals stood in opposition to this dangerous bill that undermines quality ethical health care for all Minnesotans.
This legislation is important to me and countless colleagues — physicians, nurse practitioners, clinical nurse specialists, hospice nurses, social workers, spiritual care and integrative health and healing practitioners. We wake up every day with passion to provide patients excellent symptom support and comfort. Together, we achieve peace by optimizing patients’ five domains of pain — physical, emotional, social, spiritual and familial. This is the medical standard that health care professionals are currently held to in Minnesota.
I do not live with ALS, Parkinson’s disease, metastatic cancer, advanced congestive heart failure, chronic obstructive pulmonary disease or any other terminal illness. But every day I compassionately accompany those heroically living with disabilities, and chronic or terminal illnesses.
I am frequently asked by patients and families, “Are you trying to kill me?” when I recommend initiating low-dose morphine and/or lorazepam for physical and emotional pain and breathlessness (this is appropriate medication-prescribing that can achieve real comfort while not hastening death).
If HF 2152 becomes law, the new medical standard will mandate that all physicians and nonphysicians who deal with potentially terminal illnesses advise patients about the “treatment option” of ending their life.
This imposition on the practice of health care will create further distrust between patients and provider who would hold the prescribing or referring power over a patient’s life and death instead of their care. Patients will no longer ask, “Are you trying to kill me?” Instead, they would be justified in emphatically accusing the provider, “You are trying to kill me!”
This is undignified and cruel to patients and their families while also being coercive to physicians and nonphysicians.
I know first-hand, it takes no great skill or time to write a prescription for pills that kill. In contrast, it takes consummate clinical and diagnostic skill and significant time and effort to scientifically and artfully prescribe comfort. We must do better to excel in teaching medical professionals to prescribe dignified care, not pills that kill.
It is true that people living with neurologic conditions, such as ALS, experience a highly variable disease progression, can become very disabled, and may experience a high symptom burden. Making use of palliative care from diagnosis to end of life can help respond to their unique needs. Unfortunately, many physicians and nonphysicians (even many neurologists) lack the education and expertise in palliative care and fewer than 2% of palliative care clinicians are neurologists. The “problem of suffering” is really a systemic failure of health care. Not surprisingly, this has contributed to the underutilization of palliative care for patients living with such diverse neurological conditions.
I applauded the establishment of the Palliative Care Advisory Council (created by MN Statute 144.059). This suggests Minnesota’s legislators desire to strongly support and fund efforts to eliminate suffering — not eliminating the patient who is suffering.
We must do better to excel at quality and ethical health care to uphold the true dignity of every patient and provide them and their families peace at the end of life’s journey.
Neal C. Buddensiek is chief medical officer at Benedictine Health System.