‘Physician-assisted suicide’ flouts role of medicine, doctor says

Dr. Jeff O’Connor, president of the Spokane County Medical Society, has argued against so-called Death with Dignity laws in national, state and regional medical meetings. Over the past two years, the Spokane County Medical Society’s board and the Washington State Medical Association’s House of Delegates have rejected proposals that it take a neutral position and maintained their opposition to “physician-assisted suicide.” O’Connor, who has practiced family medicine in north Spokane for nearly 30 years, discussed the group’s medical objections with The Spokesman-Review’s editorial board.

Q: Characterize the major opposition by the medical association.

A: It has been a long-standing tradition in medicine to not give medication that you know the patient will take to die. Physicians are here to heal. It’s in the Hippocratic Oath and embodied in the majority of physicians in Washington. It’s not something we can be neutral about.

Q: Why does assisting with suicide go against physician as healer?

A: We act as though we’re neutral arbiters of things, but when we get up every morning, we’re human. One of the best descriptions of how we as human physicians fall short is when you look at hospice: Everyone has to be diagnosed dying within the next six months. Yet 10 percent of people don’t die in six months. When you look at the Oregon numbers, a significant amount of people who wanted the medication to commit suicide didn’t use it for a couple of years. I tell my patients, “I don’t know when you are going to die, I just know I am going to stick with you and I’m not going to be the agent of ending your life … .”

Q: Proponents say it’s working beautifully in Oregon. Do you have any doctor contacts in Oregon, either contradicting or affirming that statement?

A: When you look at the Oregon numbers, frequently enough the doctor implementing this is not the patient’s doctor, not the person who knows the patient, the family. For them to feel comfortable giving a lethal prescription based on a short time, I don’t see how they can do that. Yet it’s supported in the law, and the law protects them from identification. When you look at the median time the (doctors) have known them, it’s 15 weeks. I don’t have to talk to docs, all I have to do is look at the numbers. The numbers tell a little different story.

Q: What do the numbers say?

A: The total number (who used the law) in 10 years is small – 292. But Oregon has 1 percent of the population of the United States. So if this were the law of the land, that would be 29,200 people in the United States in the last 10 years. That’s not a small number. The bulk of people who do this are college educated or higher. And they are almost all white. That’s the category of people (in which) autonomy and dignity are very important.

Q: What do those attitudes say about our society?

A: It reflects the American attitude of “I want control of what’s going to happen to me.”

Q: What do you say to those people about this “solution”?

A: I understand, in some respects, the desire to end it. Yet the vast majority of people who are losing autonomy and suffering are not dying. The vast majority are chronically ill. You describe loss of autonomy, loss of ability to engage an enjoyable life, loss of dignity, loss of control of bodily function, you are talking multiple sclerosis. You are not talking terminal illness. That would be my question to them. Why the artificial boundary of six months to live? It doesn’t even bring up the whole concept of the mentally ill who suffer interminably sometimes.

Q: And that’s the slippery slope?

A: I don’t like the term, but there are some very real holes in this.

Q: What argument can you use to assure people that dying doesn’t necessarily mean excruciating pain and suffering?

A: I’ve had a lot of patients die. I’ve taken care of nursing home patients. The vast majority of the time pain is not an element of it. One of the proponents said you are doing the same thing when you give patients a lot of morphine; you just don’t have the guts to tell people you are killing them. That’s not true. The studies show that when you treat pain adequately, people live longer. When you are aggressive with pain control, you prolong their lives. We’re not just afraid to tell people we’re killing Grandpa.

Q: That’s what we’ve heard. It’s the little secret. You just pump up the morphine and you’re gone in 24 hours.

A: In my 30 years in medicine in Spokane, that has not been the case. Maybe there’s this underground doing this, but I don’t see it happening. It’s an unsubstantiated claim.

Q: When you short-circuit the death process, don’t you shortchange the family?

A: The families that I’ve been involved with, there’s a completion that occurs. The last words have been said. The picture of this screaming-in-pain person, with vomit and diarrhea all over, it’s not my personal experience. Does it occur? Sure. Is it a common thing? No. Most of the time my experience has been that it’s a peaceful event, a profound experience. Will physician-assisted suicide damage that? My intuition is that it will.

Q: Let’s say you have a room full of Booth Gardners – highly educated proponents – how do you explain to this group what your objections are?

A: I would say their lives exemplify the opposite of their argument. Booth Gardner, in his loss of autonomy, loss of dignity, is fighting this crusade to change society. That to me is not a loss of autonomy or dignity. That to me is a person who has a purpose, a will, and he’s influencing society. They are creating a new society and that is a rare event and certainly belies their argument that they have no further control over society. I would say to them your definition of autonomy and dignity is wrong.

Q: In Oregon, some people got the medication but didn’t take it. They had it right there. They went through the whole process. Why do you think they didn’t take it?

A: The proponents are correct in that there’s a desire to feel like if I need this, it’s there. There is a fear of pain. Fear generates panic. Clearly, people feel better if they know the bottle is sitting there. I would not argue with that. I would argue that the cost of that bottle for society is pretty high.

Q: Is there anything you would like to add?

A: Hippocrates was not a Christian. He was a pagan. I think there are atheists and secularists and Buddhists and Muslims who say this is not a good idea. So to argue that this is just some zealots and fundamentalists against this is not really the picture of the objections. This is the long-standing wisdom of our elders: Don’t do this.