The Ninth and Second Circuits (whose decisions were heard by the U.S.
Supreme Court last year) both dismissed the risks associated with
legalizing physician-assisted suicide as insubstantial, and claimed
that, to the extent risks exist, they can effectively be eliminated
through state law or regulation. Our concerns about the risks of
legalizing assisted suicide are set forth in detail in “When Death is
Sought,” and will not be restated in depth here. We take this
opportunity, however, to outline briefly the primary risks associated
with legalization:
Undiagnosed or untreated mental illness.
Many individuals who contemplate suicide — including those who are
terminally ill — suffer from treatable mental disorders, most
commonly depression. Yet physicians routinely fail to diagnose and
treat these disorders, particularly among patients at the end of
life... If assisted suicide is legalized, many requests based on
mental illness are likely to be granted, even though they do not
reflect a competent, settled decision to die.
Improperly managed physical symptoms.
Requests for assisted suicide are also highly correlated with
unrelieved pain and other discomfort associated with physical
illness. Despite significant advances in palliative care, the pain
and discomfort that accompany many physical illnesses are often
grossly under treated in current clinical practice. If assisted
suicide is legalized, physicians are likely to grant requests for
assisted suicide from patients in pain before all available options
to relieve the patient's pain have thoroughly been explored.
Insufficient attention to the suffering
and fears of dying patients. For some individuals with
terminal or incurable diseases, suicide may appear to be the only
solution to profound existential suffering, feelings of abandonment,
or fears about the process of dying. While the provision of
psychological, spiritual, and social supports — particularly,
comprehensive hospice services — can often address these concerns,
many individuals do not receive these interventions. If
physician-assisted suicide is legalized, many individuals are likely
to seek the option because their suffering and fears have not
adequately been addressed.
Vulnerability of socially marginalized
groups. No matter how carefully any guidelines for
physician-assisted suicide are framed, the practice will be
implemented through the prism of social inequality and bias that
characterizes the delivery of services in all segments of our
society, including health care. The practices will pose the greatest
risks to those who are poor, elderly, isolated, members of a
minority group, or who lack access to good medical care.
Devaluation of the lives of the
disabled. A physician's reaction to a patient's
request for suicide assistance is likely to depend heavily on the
physician's perception of the patient's quality of life. Physicians,
like the rest of society, may often devalue the quality of life of
individuals with disabilities, and may therefore be particularly
inclined to grant requests for suicide assistance from disabled
patients.
Sense of obligation. The
legalization of assisted suicide would itself send a message that
suicide is a socially acceptable response to terminal or incurable
disease. Some patients are likely to feel pressured to take this
option, particularly those who feel obligated to relieve their loved
ones of the burden of care. Those patients who do not want to commit
suicide may feel obligated to justify their decision to continue
living.
Patient deference to physician
recommendations. Physicians typically make
recommendations about treatment options, and patients generally do
what physicians recommend. Once a physician states or implies that
assisted suicide would he “medically appropriate,” some patients
will feel that they have few, if any, alternatives but to accept the
recommendation.
Increasing financial incentives to limit
care. Physician-assisted suicide is far less expensive
than palliative and supportive care at the end of life. As medical
care shifts to a system of capitation, financial incentives to limit
treatment may influence the way that the option of
physician-assisted suicide is presented to patients, as well as the
range of alternatives patients are able to obtain.
Arbitrariness of proposed limits.
Once society authorizes physician-assisted suicide for
competent, terminally ill patients experiencing unrelievable
suffering, it will be difficult, if not impossible, to contain the
option to such a limited group. Individuals who are not competent,
who are not terminally ill, or who cannot self-administer lethal
drugs will also seek the option of physician-assisted death, and no
principled basis will exist to deny them this right.
Impossibility of developing effective
regulation. The clinical safeguards that have been
proposed to prevent abuse and errors are unlikely to be realized in
everyday medical practice. Moreover, the private nature of these
decisions would undermine efforts to monitor physicians behavior to
prevent mistakes and abuse.
New York State Task Force on Life and the Law. “Life, Law, and
Suicide.” First Things 85 (August/September 1998): 45-46.
New York State Task Force on Life and the Law.
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