Physician-assisted suicide is back on California's political agenda. Indeed, anyone who read the newspaper or watched TV coverage when the End of Life Option Act (SB 128) was introduced Jan. 21 might think it's a done deal, though the bill hasn't even cleared committee. The message from supporters and the media is clear: Like women's rights, voting rights, gay marriage and hikes to the minimum wage, it's only a of time before physician-assisted suicide becomes legal because, after all, it is the right thing to do. If this bill fails, supporters promise a ballot initiative in 2016.
As someone who supports all those other liberal causes, yet opposes physician-assisted suicide, I'd ask my fellow progressives to shine a cold hard light on this issue. We have been the target of a decades-long branding campaign that paints hastening death as an extension of personal freedoms. We should bring the same skepticism to physician-assisted suicide that we do to fracking and genetically modified food.
Groups such as Compassion and Choices, the nonprofit advocacy organization spearheading SB 128 and similar bills elsewhere, masterfully employ Orwellian propaganda techniques: Redefine words to mean what you want them to mean. Repeat key points until they acquire an unquestioned air of truth.
“Suicide” is distasteful, so they promote “physician aid-in-dying,” “death with dignity” and the “right to die.” And yet all of these mean taking action to end one's own life. The news media have largely adopted the assisted suicide movement's terminology, so these euphemisms are worth unpacking here.
“Physician aid-in-dying” makes it sound like giving someone a lethal drug is an extension of hospice and palliative care. It is not. As a palliative care physician I aid people in dying by treating their symptoms and supporting them through the difficult practical and emotional tasks of completing their lives. In more than 35 years of practice I have never once had to kill a patient to alleviate the person's suffering.
“Death with dignity” implies that frail or physically dependent people aren't already dignified. But they are. People who are disabled or facing life's end can be cared for in ways that allow them to feel respected, worthy and valued.
The phrase “right to die” is brilliant branding. You will not, however, find any such right within the U.N.'s Universal Declaration of Human Rights or U.S. Constitution. Americans have a constitutional right to refuse life-prolonging treatments. But there's a big difference between being allowed to die of your disease and having a doctor intentionally end your life.
Supporters of bills such as California's repeatedly assert that legalizing physician-assisted suicide is not a slippery slope. Evidence, however, shows that criteria and safeguards for dispensing life-ending drugs are being relaxed.
In the 1990s, proponents in Oregon campaigned to legalize physician-assisted suicide in cases of unrelievable physical suffering. Oregon Health Authority research, however, shows that more than 75% of those who took that option didn't cite pain as a concern. Their issues were emotional or existential: feeling a burden to family, loss of autonomy or inability to do things they enjoy.
To glimpse the future, one need only look at the Netherlands, where euthanasia — a lethal injection by a doctor, not simply a prescription to be self-administered — has been available for several decades. There, people have been euthanized at their request for pain, tinnitus or blindness in non-terminal cases. More than 4,800 people were euthanized in 2013, more than 40 of them for psychiatric illness, according to the Dutch Euthanasia Review Committees.
Think it couldn't happen in the U.S.? The mission of Final Exit Network, one of the key groups supporting SB 128, is to enable all competent adults to end their lives whenever they deem their physical quality of life is unacceptable. The movement is also pushing to expand the means of hastening death to include lethal injections delivered by physicians. Dr. Marcia Angell, who testifies for Compassion and Choices in court cases and legislative hearings, recently wrote in the New York Review of Books: “After my husband's death, I have come to favor euthanasia as well, for home hospice patients in the final, agonal stage of dying, who can no longer ingest medication orally.” This is the practice in the Netherlands that the American assisted-suicide groups still claim won't happen here.
I share the sense of anger, urgency and frustration over the sorry state of end-of-life care. A legitimate fear of dying badly fuels this movement. Last fall's Institute of Medicine report, “Dying in America,” detailed deficiencies in medical training and practice that contribute to needless suffering. It also lays out steps that healthcare and long-term care systems, insurers, medical schools and policymakers can take to reliably resolve this crisis. SB 128 addresses none of those; it merely gives doctors legal authority to end patients' lives.
I do not question the good intentions of SB 128's proponents. However, I believe that deliberately ending the lives of ill people represents a socially erosive response to basic human needs. If we can stay civil and (even relatively) calm, we can debate physician-assisted suicide while also substantially improving end-of-life care.
At the least, progressive voters should demand two important amendments to SB 128. First, medical schools must increase required curriculum in palliative care (at minimum, it should match the study of obstetrics and neonatology) and test students on managing pain and conducting conversations about serious illness before giving them a degree. Second, the Medical Board of California must also test pain management, communication and shared decision-making skills before licensing a physician. Supporters will worry about encumbering their bill. Many of us worry about the effects of their social engineering. If the Legislature decides to grant doctors authority to write lethal prescriptions, how could lawmakers do any less?
Ira Byock, M.D., directs the Institute for Human Caring of Providence Health & Services in Los Angeles. He is a professor of medicine at Dartmouth's Geisel School of Medicine and author of The Best Care Possible.