First, Do Harm . . .
A betrayal of the hospice movement.
Mar 19, 2007, Vol. 12, No. 26 • By WESLEY J. SMITH
The American Academy of Hospice and Palliative Medicine has just released a position statement on the issue of physician-assisted suicide, in which it abdicates its core professional responsibility. On the impropriety of permitting doctors to help kill their patients, the association has assumed a position of "studied neutrality."
One of the AAHPM's stated missions is to engage in "public policy advocacy" for hospice and palliative care. Assuming a neutral stance on what may be the most important public policy controversy of our day involving dying people is both a cowardly act and a backdoor repudiation of the long-established philosophy of hospice care, which promises to respect the intrinsic value of each patient's life and to care for dying patients until their natural deaths.
In its "Position Statement on Physician Assisted Death" (PAD is the reigning euphemism for physician-assisted suicide, allowing doctors to pretend they are not participating in the intentional killing of patients), the AAHPM approaches the entire topic with willful naiveté. For example, it states:
But Oregon's experiment with state-sanctioned assisted suicide has demonstrated that "severe suffering" is not the cause for most requests for assisted suicide. Rather, patients usually ask for lethal prescriptions due to loss of autonomy, fear over being a burden to their families, losing the ability to engage in enjoyable activities, and losing dignity. These are all important issues, and it is incumbent upon doctors to help patients overcome them. But they do not reflect the severe physical suffering the AAHPM presumes would cause their patients to request assisted suicide.
The association's naiveté is further on display in its proposed "guidelines" to prevent abuses in assisted suicides. It advises physicians practicing in regions where assisted suicide is legal to use "great caution" before helping kill their patients. Such caution should "include assurance" that
Here's the thing: Few of these "assurances" are legally required in Oregon, where assisted suicide is already legal. Nor will they be required if pending legislation in California and Vermont to allow physician-assisted suicide becomes law. For example, none requires that suicidal patients actually receive the best possible palliative care before ending their lives. Nor are any meaningful steps required to ensure that the patient is not under "coercive influences from family or financial pressure."
To see how ephemeral such "assurances" really are, consider the 1999 assisted suicide of Oregon Alz heimer's and cancer patient Kate Cheney. (See my "Suicide Unlimited in Oregon," in the November 8, 1999, WEEKLY STANDARD.) Because Cheney was demented, the doctor from whom she requested poison pills sent her to a psychiatrist for evaluation, who determined that Cheney did not possess the "very high capacity required to weigh options about assisted suicide." Moreover, she found that Cheney "does not seem to be explicitly pushing for this" and that Cheney's daughter was the primary advocate for the proposed suicide. Accordingly, the psychiatrist recommended against issuing a lethal prescription.
As has happened in other cases in Oregon, a doctor disapproving of an assisted suicide proved a mere bump in the road. Cheney's daughter simply asked another doctor for a different opinion. The psychologist to which Cheney's HMO then sent her also expressed worries that the request "may be influenced by her family's wishes," but nevertheless recommended in favor of the assisted suicide. In the end, it didn't matter that two independent mental health professionals found familial pressure was being exerted on Cheney; she received the lethal prescription.
The AAHPM properly urges that "medical practitioners carefully scrutinize the sources of fear and suffering leading to the request" for assisted suicide "with the goal of addressing these sources without hastening death," along with practice guidelines for accomplishing these important goals. But this promotion of good medical practice rings hollow given the association's explicit neutrality on assisted suicide, which in effect grants member doctors permission to help kill their patients without threatening their good standing with the association.
Wesley J. Smith is a senior fellow at the Discovery Institute, an attorney for the International Task Force on Euthanasia and Assisted Suicide, and a special consultant to the Center for Bioethics and Culture.