The dark side of a DC bill that no one wants to talk about

Washington D.C., Oct 18, 2016 / 16:15 pm

Treatable depression, financial gain from a patient's death, doctors who can write a fatal prescription with little knowledge of the person it's for – all things that supporters of physician assisted suicide in the District of Columbia would perhaps prefer not to discuss.

But as the city council in the nation's capital may soon legalize the procedure, both the Church and local citizens have taken up arms to label it as prejudiced against the "most vulnerable."

The bill is immoral, unethical, and unjust, said Dr. Lucia Silecchia, a law professor at the Catholic University of America's Columbus School of Law, and a D.C. citizen.

"Thus, while the Catholic and Christian understanding of the dignity of human persons, made in the image and likeness of God undergirds the moral critique of such statutes, the medical opposition long predates Christ, and the legal objections should compel anyone who observes how easily disregard for the life of one spreads," she stated to CNA.

On Oct. 18, the city council for the District of Columbia voted to put legalization of physician-assisted suicide on their legislative agenda. The bill was introduced in January 2015 by council member Mary Cheh.

In the summer of 2015, citizens of the city showed up in large numbers to support or oppose the bill; a public hearing went on for hours as many advocates, one after another, insisted that the city not legalize the measure.

Cardinal Donald Wuerl of Washington has been outspoken against the measure, and other assisted suicide measures that have been introduced in states around the country in what he called "a concerted aggressive campaign…which plays on people's darkest fears and exploits their vulnerabilities to advance ideas and practices that have long been understood to be grave infamies opposed to human dignity and which poison human society."

What is at stake is nothing less than how society views human life, he maintained.

"We are facing a seismic shift in how we, as a society, will look at life in the future and, even more frightening, what powers the state will have to determine who lives and who dies," he said.

"We are all responsible for working to protect all human life until it ends naturally, until the time that God alone appoints for our departure. It is not for us to decide the hour, we are not the arbiters of life and death."

The D.C. bill is flawed for a number of reasons, Silecchia explained to CNA.

For one, any two physicians could write a prescription for a fatal drug overdose request, no matter how little they know the patient. Also, if patients are refused their request by their primary care physician, they could just seek out another doctor who may not know them well, but will write them a prescription.

"This undermines the dignity of those who suffer by suggesting to them – while they are most vulnerable – that their lives no longer have value," she said.

Witnesses of the patient's consent could be an "interested party" – someone who could benefit financially or personally from the patient's death – Silecchia noted, raising even more ethical challenges to the proposal.  

Also, the measure may apply disproportionately to the "most vulnerable," like low-income or elderly persons who feel they may be a "burden" to friends and family as they become sicker, and those suffering from mental illness like depression or anxiety, she explained.

Herbert Hendin, M.D. has written on the psychological issues surrounding patients with terminal diagnoses. In his book Seduced by Death, he explained how many of these patients, when they fear a terminal diagnosis, desire to end their lives – but many of them are suffering from a curable mental illness that can be treated.

It's not the fear of death that exacerbates their psychological condition, but rather the fear of dying, he explained, when "patients displace anxieties about death onto the circumstances of dying: dependence, loss of dignity, and the unpleasant side effects of medical treatments."

The advocacy group "Not Dead Yet" has also claimed that such fears drive a patient's desire to die, noting that "among the top five reasons given" for a fatal prescription request "are feelings of being a 'burden on others' (41%) or feeling a 'loss of autonomy' (92%) or 'loss of dignity' (78%)."

"These are not about pain from a terminal disease, but are psychological and social issues that cry out for meaningful supports and genuine care," the group continued.

"Yet the assisted suicide law does not even require disclosures about consumer controlled home care options to address feelings of loss of autonomy or feelings of being a burden on family, much less require that those services be provided."

"When these fears are dealt with by a caring and knowledgeable physician, the request for death usually disappears," he added.

In his experience treating these patients, Hendin found that when a patient chose treatment over a fatal prescription and resolved his fears – as well as unresolved conflicts he may have had with friends or family – he greatly appreciated his final months to do so, even if he experienced physical suffering in that time.

And, some warn, the legalization of assisted suicide actually opens the door for the normalization of other dark practices like euthanasia.

When a patient expresses a desire to die but chooses to wait until they are further along in their sickness to take the prescription, the ethical lines can become blurry as to whether that action was their own decision made with a clear mind, or was the decision of their friends and family who pressured them, while under extreme duress, into taking the medication.

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The state of New York Governor Mario Cuomo's own task force pointed to the possibility of this scenario in their 1994 guidelines "When Death Is Sought," updated in 2011.

"Even if the law is never changed to sanction involuntary euthanasia, the potential for abuse would be profound," they wrote. This is because "once euthanasia is established as a 'therapeutic' alternative, the line between patients competent to consent and those who are not will seem arbitrary to some doctors," including in some cases of patients who are "incapacitated" where their doctors will deem it therapeutic to give them a fatal dose of medication.

Leon Kass, who chaired President Bush's Council on Bioethics from 2001-05, explained this from a doctor's perspective in his work "Why Doctors Must Not Kill" – cited in the task force report.

"How easily will they be able to care for patients when it is always possible to think of killing them as a 'therapeutic' option?" he asked. "Physicians get tired of treating patients who are on their way down - 'gorks,' 'gomers,' and 'vegetables' -  are only some of the less than affectionate names they receive from house officers."

And an assisted suicide law could also disproportionately target minorities and the poor, the New York task force report argued, because everyday prejudices – from which physicians, however well-intentioned, "are not exempt" – will affect how doctors choose to treat patients – with their very lives at stake.

"Finally, it must be recognized that assisted suicide and euthanasia will be practiced through the prism of social inequality and prejudice that characterizes the delivery of services in all segments of society, including health care," the report stated. "Those who will be most vulnerable to abuse, error, or indifference are the poor, minorities, and those who are least educated and least empowered."

For example, the disproportionate number of minorities and poor persons who are executed by the state shows how policies like the death penalty are not immune from prejudice, the task force claimed. That injustice would not disappear under physician-assisted suicide, they added.

Someone who faces a terminal diagnosis is in a tough situation, Cardinal Wuerl acknowledged in a recent blog post on assisted suicide.

Yet the merciful response is not to give them a fatal dose of medication, he insisted.

"It cannot be denied that there are hardships in life, some of which seem to overwhelm us," he wrote. "Whether experienced late in life, in a physical illness of a bout of mental depression, or in a crisis pregnancy, the human condition is for us all beset with trials and tribulations. In particular, the losses and changes associated with the progression of a terminal illness often contribute to psychological distress and feelings of worthlessness and despair."

"A truly compassionate and merciful response to the sick and vulnerable is not to confirm these impulses by offering them a lethal drug," he added, but rather "our response should be to draw them away from the edge, to help the vulnerable among us – regardless of their condition or circumstances – with genuine compassion and give them hope."