Assisted suicide advocates, when they are not striving to word engineer through use of the gooey euphemism “physician assisted death (PAD)”—which, alas, has been picked up by some professional journal authors—use scare tactics about unrelievable pain to sell the agenda. Well a new study has come out about what family members of those who died by assisted suicide in Oregon say the reasons were for their loved ones’ hastening their deaths. As previous studies have shown, it has very little to do with pain and almost everything to do with fear about future suffering. From the study in the Journal of General Internal Medicine 23(2):154–7 (no link):Family members describe loved ones who pursue PAD as individuals for whom being independent and in control is important, who anticipate the negative aspects of dying, and who believe that the impending loss of self, abilities, and quality of life will be intolerable. They fear being a burden to others, yet want to die at home. Concerns about what may be experienced in the future, including physical symptoms, were substantially more powerful reasons than what they experienced at the time of the request. Overall, the reasons reported are similar to those reported by hospice workers in Oregon who have cared for patients pursuing PAD2,5 and in a separate qualitative study of family members of patients who pursued assisted suicide outside the law in Washington and Oregon.
This is why assisted suicide constitutes often unintentional abandonment. When someone asks for the pills and their doctor’s response is to write the prescription, he or she is confirming their patient’s worst fears about being a burden or being less lovable, or dying without dignity. As Kubler Ross noted, people go through a difficult process when they learn they are dying. The very real fears and existential agony often—not always, but often—are transcended. Other studies show that people who wanted to die today are glad one month later they hung around. Hospice professionals will tell you of dying persons claiming that the end phase was one of the best times of their lives that they wouldn’t have missed for anything. I have seen that phenomenon myself during my time as a hospice volunteer.
The authors suggest that a good response to a request for assisted suicide is assurance:
To which I would add, say no to the request—as most doctors in Oregon apparently do. Otherwise, the physician is lending the weight of his or her authority to the burdens felt by the patient. How tragic that people in Oregon who decided on assisted suicide may have cheated themselves out of a time that, for all their fears, they might have ultimatelyu found to be well worth the living.Our data suggest that when talking with a patient requesting PAD,clinicians should focus on eliciting and addressing worries and apprehension about the future with the goal of reducing anxiety about the dying process. Some Oregon clinicians have expressed surprise at the paucity of suffering at the time of the request among these patients. Addressing patients’ concerns with concrete interventions that help maintain control, independence and self care, all in the home environment, may be an effective way to address requests for PAD and improve quality of remaining life.
