Re: He Walked the Walk

Doctor-assisted suicide isn't an issue that I've spent much time with. From where I sit, right now, suffering from nothing more burdensome than a week-long sore throat brought on (I'd guess) by the change in the weather and post-nasal drip, I'd be extremely hesitant to tell somebody with excruciating pain that they must endure it.

However, commenting to Patrick's recent post on the issue, Jon raises the worthwhile point that "death with dignity" becomes quite a bit more insidious when healthcare moves into the hands of a government necessarily keeping an eye on top-down control of costs. Insurance companies can serve the same ends, by increasing the incentive to end life rather than to manage disease.

Even beyond that concern, though, there is the broader problem that these sorts of policies tend to expand once the culture accepts them. The barriers keeping the practice rare and targeted to extreme cases tend to erode, and cultural ideas about life tend to shift.

It's all well and good to make broad pronouncements about averting suffering and to assert that "a physician who does not believe in this action will not be forced to perform it" (which Patrick is surprisingly blithe in doing, given recent debates). But if our society does move in the direction of accepting the practice, it's critical that we do so with more clarity than appears common.

Even look at the statistics available in Oregon, from the page to which Patrick links. Since the practice was legalized in 1998, only 596 people have officially availed themselves of the opportunity, which is (thankfully) not a large number comparatively.

However, only 40 of them were "referred for psychiatric evaluation." The median length of the patient's relationship with the prescribing physician was 12 weeks (that's 84 days or roughly three months). That means that for every patient who'd been seeing the prescribing doctor for their entire lives (maxing out at 1,905 weeks), there was one who'd known him or her for less than 12. The median length of time between the first request for medication and death was 46 days, or almost seven weeks.

Now, of course, it's possible that family physicians might be squeamish about killing long-term patients, or that their moral objections led their patients to other doctors. But such are the numbers that ought to constitute the core of any real debate about the issue, especially given the fact that only 6.7% of them appear to have gone through even a pro forma psychiatric evaluation.

Of far more concern, however, is the fact that only 134 of the patients cited "inadequate pain control or concern about it." Be sure, advocates, that you have a clear definition of what you consider to be suffering. Most of the patients cited "losing autonomy" and "less able to engage in activities making life enjoyable." A couple hundred less cited "loss of dignity" and "losing control of bodily functions."

If this is a path that people want our society go down, we have to take profuse care to ensure that "death with dignity" doesn't morph into plain ol' suicide, and from there, to a cost saving measure toward which the healthcare infrastructure (however it finally develops) creates incentive.