Is Physician-Assisted Suicide Viable?

Since California resident Brittany Maynard moved to Oregon late last year in order to undertake  a physician-assisted suicide and publicized her decision via the social media, the issue has gained significant force back in her home state. 

The proponents of physician-assisted suicide as an end-of-life option for California residents diagnosed with terminal illnesses are again advancing a bill, SB 128, through the state Legislature. 

The bill has been passed by a couple of Senate committees, but has not yet been subjected to a full floor vote in either chamber. The volatility over the issue makes it too soon to tell how that bill will eventually fare. Should the bill fail passage this time, its sponsors are prepared to ask voters to approve a ballot measure next year. 

Physician-assisted suicide has gained popular support in the United States – according to a recent Gallup poll, about 70% support it, compared to fewer than half in the early 1970s. However, that's still about five percentage points lower than it was in the mid-1990s. That was the heyday of Jack Kevorkian, M.D., but his conviction for murder of one of his patients – he wanted to die but could not perform the final act himself -- probably had more to do with progress stalling on this issue than anything else. Kevorkian pushed “60 Minutes” to televise his actions, and he was completely unrepentant during his trial, where he represented himself.

With each attempt, legislators and the public are becoming more knowledgeable and more approving of this form of aid in dying.   Either way, even its most ardent opponents agree that California is poised to become the fifth state in our nation to adopt medical treatment protocols to proactively end human life.

The good thing about SB 128 is that the protocols it prescribes have been vetted by all the experts in Oregon, Vermont, and Washington where similar laws have been enacted.  Montana is the fourth state that allows physician-assisted suicide, but the authorization came by way of a court ruling, as opposed to crafted law.  Similarly, a court ruling that is being appealed could add New Mexico to this list.

Religious leaders tend to be opposed to physician-assisted suicide, but it still has bipartisan support, as liberals and libertarians pretty much come down on the same side of this issue.

I believe that approval of this end-of-life option is long overdue; we as autonomous individuals should have the right to decide how our lives will end if confronted with a terminal illness.  I neither dismiss nor deny effective pain management, hospice and palliative acre, the Advance Health Care Directive, or Physician Orders for Life Sustaining Treatment (POLST) as worthy options, but these are all passive end-of-life choices.  Proactive choice should be allowed because persons are entitled to be self-determining without interference.  As Immanuel Kant and other philosophers argued from the earliest days of civilization, this is a fundamental human right.

SB 128 does, however, fall short in one key area; it fails to specify any special training requirements for physicians who want to counsel and advise patients on pursuing end-of-life options.  Not surprisingly, physicians would be squeamish about counseling their patients without having some specifics as to how to proceed.

As do the laws in the states that allow physicians to aid in proactively ending a person’s life, this bill would deny doctors their humanity.  That can be corrected by adding diversity training and a fellowship in end-of-life care requirement for participating physicians.

A plethora of studies can be found in medical literature to underscore the degree of influence that race, ethnicity, gender, socio-economic status and lifestyle choices have on physician-patient relationships and the medical treatment options prescribed by doctors. This serves to underscore the reality that doctors are no less flawed by their socialization than any of the rest of us.  But the rest of us are not given a license to kill. Neither should anyone with just a medical degree, especially in a state with so diverse a population as California.

Jim Lott is the principal consultant with Lott Advantage, LLC. He is a member of the Payers & Providers editorial board.