Physician-assisted suicide law rewrite deserves a death without dignity
Washington state lawmakers are considering altering current law to allow non-physicians to determine eligibility for and write lethal prescriptions for terminally ill patients with a six-month prognosis.
House Bill 1141 would shorten the waiting period to receive lethal drugs from 15 days to 72 hours and eliminate it when life expectancy is less than 72 hours.
A recent News Tribune editorial was rightly reluctant to endorse the waiting time reduction. However, that reluctance should extend to all provisions of this bill, since it reflects a misunderstanding of dying physiology and palliative care capabilities while allowing injustice, especially for those with mental illness and disabilities.
Two professionals perform the initial evaluation, but under this bill only one provider, even a non-physician, would need to make the complex determination that a patient has 72 hours to live. It would allow the participation of advanced registered nurse practitioners, physician assistants and osteopathic physician assistants.
Physicians, much less those with less experience, cannot reliably make a 72-hour or a six-month prediction. A 72-hour prognosis indicates a person is in the dying process with failing organs and questionable cognitive capacity to make life-ending decisions. Lethal overdoses are unnecessary and ill-advised.
Palliative care offers many diverse treatments, such that pain should never be a reason to seek lethal drugs. Patients’ access to palliative care should not be taken as a given, as minorities and those in disadvantaged communities may encounter barriers to receiving palliative care.
It would be a tragedy for this population if removal of safeguards made lethal drugs more accessible than palliative care.
Patients requesting a hastened death usually do not cite concerns about pain but about loss of abilities or autonomy — issues experienced by everyone at some point. The disability community knows “new normals” can be embraced when given sufficient time and support.
A physician’s role is to value patients’ inherent dignity, regardless of their condition. This benevolent responsibility turns malevolent when physicians offer lethal drugs to terminally ill patients — who may be in reversible, temporary despair —within a short time frame of 72 hours.
This fails to allow time for palliative care and mental health interventions, after which many patients change their minds and choose not to hasten death.
Physicians’ lethal prescriptions imply agreement that patients’ loss of function makes their lives expendable and not worth even attempting treatment. This condemns the disabled and despondent, violating their right to change their mind, and leaves them dying hopeless with their dignity disregarded.
Depression is expected in 25 to 40 percent of those desiring to hasten death, yet less than 5 percent are referred for mental health counseling in Washington.
Physicians are likely missing the diagnosis of depression, and patients are inappropriately receiving lethal prescriptions. Yet this bill proposes lowering evaluators’ qualifications?
Increasing awareness may not change the “stark education and equity gap” in lethal prescription use that was identified in the TNT editorial, because the choice to hasten death could reflect differences in patients’ sources of meaning, support or other deeper issues that transcend superficial data.
HB 1141 should be rejected. Better options include improving the deficient oversight of the current law and ensuring good palliative care.
Dr. Sharon Quick of Bonney Lake is Washington state director for the American Academy of Medical Ethics. She is a pediatric anesthesiologist/critical care physician with expertise in pain management and care for dying patients. Reach her by email at mission4kids@comcast.net