The body language of assisted suicide

What the verbal request fails to reveal

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Laws that allow assisted suicide restrict the provision of “aid-in-dying” drugs to patients whose mental status is not impaired and who are capable of sound judgment.

Medscape recently featured a video interview of Timothy Quill, the palliative care specialist and long-term assisted suicide activist.  He is interviewed by the ethicist Arthur Caplan, and the two discuss the psychological evaluation of terminally ill patients who request physician-assisted suicide (PAS).

Several points made by Quill caught my attention.

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Should assisted suicide be legal in a free society?

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Abigail Hall Blanco, a research fellow at the Independent Institute, recently wrote a piece entitled “Assisted suicide is a personal choice” in which she defends the position that assisted suicide should be legal in a free society.

Before discussing this piece, it is important to clarify what Blanco probably means when she asserts that assisted suicide is a “personal choice.”  After all, the statement may seem like a triviality: all humans are persons, and therefore all human choices are personal choices.

I suspect that what Blanco means to say is that assisted suicide should be legal because it is a free choice that only affects the person making it.  In that sense, the subject and object of the choice are both the same person: The choice begins with the person and the effect ends in the same person.

Having made that clarification, let’s examine the three arguments Blanco makes to support her position.  These arguments are counterpoints to claims allegedly made by opponents of assisted suicide.

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On the deactivation of implantable devices

Tough ethical questions

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There is an interesting thread on Twitter generated by a BBC article relating the case of a British patient who was granted the right to have her pacemaker deactivated.  Dr. Wes Fisher was interviewed in the article.

The question posed is whether this constitutes assisted suicide or not.  Dr. John Mandrola pointed to the position document of the Heart Rhythm Society regarding such cases and seems firm that pacemaker deactivation is not euthanasia.

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Taking stock of our existence

Gawande versus Frankl on the meaningful life

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My last post was prompted by a reader’s comment where Victor Frankl’s Man’s Search for Meaning and Atul Gawande’s Being Mortal were juxtaposed.  Since receiving that message, I have had occasion to notice that others also associate these two books.

For example, both are mentioned positively in this moving article by Dr. Clare Luz about a friend’s suicide, and in these tweets from Dr. Paddy Barrett’s podcast program:

Friends and patients of mine have likewise mentioned these two works to me, expressing praise and testifying to the deep impact the books have had on them.

I suspect that many readers of this blog will at least be familiar with these two books.  If not, summaries are here (Frankl) and here (Gawande).

I read the books in succession and found the difference between the two striking.  Frankl and Gawande seem to be at polar opposites on the question of life and death.  In this post, I will explore this difference, starting with Gawande’s point of departure.

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Is assisted suicide “medically necessary?”

Canada may soon debate the question

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André Picard, one of Canada’s foremost healthcare journalists, published an article today in which he analyzes the funding rationale for his country’s healthcare system.

Canada has the most singularly bizarre health-funding model in the world. It is, to use the technical term, bifurcated – meaning there are two distinct categories.

“Medically necessary” care, defined as hospital and physician services, is paid 100 per cent from the public purse. Selling these services privately is, with few exceptions, illegal or subject to punishing penalties…

The rest of health care is, by default, not deemed medically necessary, but still gets varying degrees of public funding. Only about 6 per cent of dental care is paid publicly, as are almost half of prescription drug costs, and about two-thirds of long-term care costs.

Given Canada’s perennial healthcare budget deficits and notorious waiting lines for medical care,  Picard adds:

Getting the mix of public and private care right means ensuring everyone has access to essential care in a cost-effective manner, and still allowing patients a modicum of choice, and the ability to supplement their publicly funded care with other services.

At some point, we have to make some clear, coherent decisions to ensure that happens. Doing so begins with asking, and answering, the question: What is really “medically necessary”?

The final question Picard asks couldn’t come at a more opportune time.

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The suicide Robin Williams was denied

The double standard of assisted dying laws

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The autopsy performed after Robin Williams committed suicide showed that the actor had widespread Lewy body disease.  His widow Susan just revealed that information and told reporters that depression was only a small part of the myriad of frightening and incomprehensible symptoms that beset him for more than a year before he took his life.  As the disease progressed, he suffered from impaired movement, anxiety, paranoid thoughts, and depression.

Last month, Governor Jerry Brown signed into law a bill that allows doctors to prescribe a lethal medication to terminally ill patients who wish to end their lives.  In the letter he issued as he signed the bill, he wrote: “I do not know what I would do if I were dying in prolonged and excruciating pain.  I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn’t deny that right to others.”

But apparently, Jerry Brown and those who support the law would deny “that right” to people who, like Robin Williams, suffer from Lewy body disease.

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At the tribunal of Jerry Brown’s conscience

Assisted suicide and our peace of mind

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When California Governor Edmund Gerald “Jerry” Brown, Jr. signed into law ABx2 15, legalizing assisted suicide in the state, he issued the following statement explaining the reasoning behind his decision:

ABX2_15_Signing_Message cropped

In his 1993, John Paul II had this to say about the kind of examination of conscience through which Governor Brown would become “certain” about the comfort that the law would provide him and others:

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A deadly choice for the medical profession

"Physician-assisted dying" is a mutual suicide

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As part of the debate on physician-assisted suicide, the San Francisco Medical Society kindly invited me to write an article taking the “contra” position.  Below is the text of the article.  You can find the print version along with the article taking the “pro” position here

When a terminally ill but mentally competent patient wishes to die, should a physician be allowed to bring about such wish?  The California legislature is considering that question, and physicians will soon be asked to weigh in on it.  Until recently, so-called “physician-assisted dying” (PAD) garnered little support among doctors.  Currently, however, enthusiasm in its favor is growing.  What are the reasons given to justify this emerging practice?  Do they truly warrant legal sanction?  And do they justify an about-face from the medical profession’s long-held stance on this matter?

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