Prescriptions for Social Ill

On June 9, 1998 the Governor's Blue Ribbon Panel on Living & Dying with Dignity issued its final report urging Hawaii lawmakers to legalize both physician-assisted suicide and physician-assisted death (PASD). It is a recommendation fraught with adverse consequences for the people of Hawaii, particularly for Hawaii's most vulnerable poor, sick, elderly, and disabled populations. While many PASD proponents are motivated by a positive desire to remedy the very serious problem of chronic end of life pain and suffering, their proposed solution is an unfortunate and short sighted prescription for social ill.

Clarifying the Essentials

Contrary to conventional wisdom, the contemporary debate in this area is not about a mentally competent adult's legal right to refuse medical treatment. That legal right currently exists. The debate is about one's right to either directly or indirectly end the life of another.

Physician-assisted suicide and physician-assisted death (or euthanasia) are often used synonymously. However, there are important distinctions. Physician-assisted suicide is when a physician intentionally provides a patient with the means to commit suicide. In physician-assisted death, the physician actively participates in the administration of a lethal agent with the intent to cause the death of the patient.

Physician assisted death can be: (1) Voluntary-at the patient's request; (2) Nonvoluntary-without the consent of the patient because the patient is not competent to consent. Usually approval is obtained from a family member or court order; and, (3) Involuntary-against the will of the patient.

Legal Update -There is No Constitutional Right to Physician-Assisted Suicide

On June 26, 1997, the United States Supreme Court ruled unanimously in Vacco v. Quill and Washington v. Glucksberg that there is no constitutional right to physician-assisted suicide. In these rulings, the U.S. Supreme Court overturned two federal appeals courts, including Hawaii's own 9th Circuit, which had declared unconstitutional state laws in Washington and New York prohibiting physician-assisted suicide. As a result, battles over physician-assisted suicide will continue at the state legislative level, including here in Hawaii. Only Oregon has legalized physician-assisted suicide.

The Slippery Slope-From Right to Duty? The Netherlands Experience

Research on these topics examines both PAS and PAD practices in the Netherlands. Research from the "Remmelink Report" conducted in 1990 and 1995 found that physicians in the Netherlands are involved in both euthanasia and physician-assisted suicide. The study also uncovered the frightening fact that euthanasia is 10 times more common than physician-assisted suicide. Among the euthanasia deaths studied, ¼ of the patients killed had not given explicit consent. Commenting on the Netherlands experience, Former Surgeon General of the United States C. Everett Koop, M. D. has written "in a few short years, second opinions about the need for euthanasia have been abandoned. Where a euthanasia death is reported, investigations are few and far between. Many euthanasia deaths are not reported, even on a death certificate. All evidence in these matters is under the control of the physician, and patients have been killed without having requested death. It could happen here." This is the same slippery slope that could turn the right to physician-assisted suicide into a responsibility to die, leaving the elderly, sick and disabled populations vulnerable to coercion.

Compassionate Alternatives

Many of the patients seeking PASD are in tremendous, but needless, pain. In today's health care delivery system, proper pain management can alleviate most all forms of pain for the terminally and chronically ill. Many assisted-suicide seekers are also suffering from depression. These valuable people need their physicians to deliver care and treatment for their depression, not to deliver tools of death. The Hippocratic Oath states in part "I will use treatment to help the sick according to my ability and judgment, but I will never use it to injure or wrong them."

Government should not transform the role of physician from one who heals to one who take's life. We would all do well to heed the words of C. Everett Koop, M.D. "Let those who seek death with dignity beware, lest they lose life with dignity in the process."