Wednesday, March 29, 2017

Assisted Suicide Wrong RX

William Toffler, MD

I am a professor emeritus of family medicine at Oregon Health & Science University in Portland, Ore. I have lived and practiced medicine in Oregon for almost 37 years.
There has been a profound shift in attitude in my state since the voters of Oregon narrowly embraced assisted suicide 20 years ago. This shift has been detrimental to our patients, degraded the quality of medical care and compromised the integrity of my profession.

Proponents claim our law is working well. This is not true. Doctors engaging in this practice do not accurately report the cause of death on the death certificate. Instead, they are required by state law to fabricate the cause of death, stating that the cause is “natural.” Just before assisted suicide was to be implemented, the legislature implemented a system of two different death certificates (one that is public with no medical information, and a private one). Thus, review and tracking by anyone outside of the Oregon Health Division is impossible.
Doctors who self-report data to OHD are rarely present when a patient takes the overdose. Thus, all “reassuring” reports from Oregon are biased by the conflict of interest of participants who are themselves promoters of assisted suicide. The information is never independently verified for accuracy.
Many individuals who have been labeled “terminal” and given overdoses by their doctors were actually found to be depressed, yet the doctor who prescribed their lethal dose had not recognized the depression. In fact, 25 percent of all requestors met the criteria for major depressive disorder and 23 percent met the criteria for anxiety disorder. Rather than being treated, these patients were given an overdose. In 2015, only 5 out of 218 individuals had a referral for psychiatric/psychological evaluation.
One of my first encounters with a request for suicide assistance came from a patient with progressive multiple sclerosis. He was a general contractor and quite productive. He acknowledged that MS was a major challenge and told me that, if he got much worse, he might want to “just end it.”
“It sounds like you are telling me this because you might ultimately want assistance with your own suicide if things got worse,” I said. He nodded affirmatively and seemed relieved that I understood.
I told him that I understood his fear and even his belief that physician-assisted suicide might be a good option for him. I told him that, if he became sicker, I would give him the best care available. I told him that, no matter how debilitated he might become, his life would always be inherently valuable and I did not recommend his suicide. He simply said “Thank you.”
William Toffler, MD