“You matter because of who you are. You matter to the last moment of your life, and we will do all we can , not only to help you die peacefully, but also to live until you die.”
– Dame Cicely Saunders, Physician, nurse, social worker, and founder of the modern hospice
As a physician watching assisted suicide go from public policy to “medical” practice here in California, I see my own patients with chronic, life threatening illnesses as, perhaps inadvertent, but vulnerable targets of this dangerous legislation. The experience of depression in the context of terminal illness is everywhere. I am grateful to our own Congressman here in Orange, Lou Correa, for standing up for those who end up with less choice under the law by cosponsoring bipartisan legislation in D.C. that outlines these dangers. This is in gratitude to the 12 cosponsors of this bill, 6 Democrats and 6 Republicans, coming together to do something right.
On such a nuanced, deeply personal, and human issue, I resist the stop-at-nothing political campaign to legalize physician-assisted suicide precisely because the basis of palliative care medicine within the hospice context is to help you live until you die naturally. As the American Cancer Society states: “The hospice philosophy accepts death as the final stage of life: it affirms life and neither hastens nor postpones death.” In 2017, there are means to address and alleviate physical, emotional and existential pain. As a palliative care physician at the forefront of the field, I can assure you, many patients even here in Orange County, do not have access to these resources. It is a travesty that we put suicide on the table as “medical treatment” paid for by state Medicaid dollars, helping vulnerable people kill themselves, forcing them to choose between death, care, pain, and debt. Some might say that the majority of those choosing doctor assisted suicide are on hospice or palliative care, therefore, it cannot be sufficient for the needs of the dying. Please be advised: not all hospices or palliative programs are the same. There is a vast difference in philosophy and care among over 100 hospice providers in Orange County. And of the palliative services provided, they are not standardized! As a palliative care physician, for proponents to suggest that we must erase the sufferers to erase their suffering seems more like a political scare tactic than sound medicine. We should be utilizing our energy and resources instead on improving the quality of care for those at the end of life.
I feel deeply for the suffering and the dying and their families – I have dedicated my professional life to their care. As my patients navigate a complex medical system, family and finances, facing tough diagnoses, they are vulnerable and afraid of mortality. To suggest they have a “human right’’ to assisted suicide is both preposterous and tremendously irresponsible. As the Oregon data shows, people are not really choosing assisted suicide due to pain or the fear of it. Rather, as the federal legislation points out, their motivations are emotional and existential fears, mostly fearing newfound disability. Is that truly an autonomous choice in a profit-driven healthcare system?
In light of these glaring concerns, I say first things first. As dangerous as it can be to my patients, assisted suicide cannot be a priority for end-of-life policy. Kudos Lou, to you and the others for fighting for the vulnerable!
Dr. Vincent Nguyen, MD, head of St. Joseph Hoag Health’s palliative care program.