and Donald Abrams
‘Physician-Assisted Dying’: Church vs. Compassion
Physician-assisted dying (not "suicide" — a term that is not truly relevant here) is a complex and emotional issue. Here is a perspective done with a leading physician with much direct experience — and who has quit one of his professional medical associations due to their lack of integrity on the topic. Regarding religious opposition to the bill in question, which has now been put on hold primarily due to organized Catholic opposition and lobbying, we can only observe that there is supposed to be a "separation of church and state" in our nation, and that the California Council of Churches supports the legislation. There are lawsuits to legalize the practice pending, and a ballot initiative — expensive and even messier than legislation — might be the next step.
* * *
The California End-of-Life Options Act (SB128) which would legalize physician-assisted dying (PAD), has been front-page news and stirred much controversy.
One casualty of such emotional debates can be basic truths about the personal, clinical and policy decisions surrounding this issue. Both of us have much experience in these arenas and hope to shed some light here.
Approaching the end of their lives, patients most want two things from their doctors — that they have clinical competence and know everything that might be done to help a patient not suffer, and that they will be there for the patient no matter what.
Rarely — not often, but not never — that can include hastening the end to some degree, and always at the patient's own choice. Most of the time such requests are not carried out — but just knowing that one has some added control and choice at the end can actually extend life in some cases — ironic, but true.
The California Medical Association (CMA) opposed PAD for many decades, until this year. Their change in position came for three main reasons.
First, accumulating surveys of doctors' opinions on this topic — over 30,000 physicians in published surveys thus far — indicate that at least half, and likely more, physicians now support some legal options for PAD. Second, experience in states that have legalized PAD for years shows that the many fears about abuses have not come about, and that, again, the practice is uncommon and legalizing it can actually lead to improvements in general care at the end of life. And finally, the hallowed medical dictum "Do no harm" is now seen to include the possible harm of keeping patients alive and suffering longer than nature, their God, or first and foremost whatever they might want for themselves.
The CMA conducted a survey of its leadership and found that a substantial majority supported legalizing PAD, or at least not opposing it. While still working to ensure that all reasonable safeguards against abuse are in any PAD policy, the CMA then changed to a "neutral" position. This is how a democratic organization, which purports to represent the profession, should work.
The one vocal medical group against SB128, the Association of Northern California Oncologists, also conducted a survey of members on this topic. Their survey also came back with a majority supporting PAD legality. But the executive leadership of the Association felt otherwise and discounted the members' vote in deciding to continue to oppose SB128. We wish they would have had the integrity of the CMA in this regard and as a result, Dr. Abrams has terminated his membership in the Association.
For those who care for patients coping with end-stage malignant disease, support of PAD, or at least neutrality, increasingly seems a humane option. The PAD issue comes down to an issue of patient choice and control towards the end of life, when we are very vulnerable. Most of us will be such patients at some point, and hope that by that time, we and our doctors will be empowered to make ultimate choices without outside interference.
(Dr. Donald Abrams is chief of Oncology at San Francisco General Hospital and a Professor of medicine at the University of California San Francisco. He was a pioneer in the response to the AIDS epidemic. Steve Heilig is co-editor of the Cambridge Quarterly of Healthcare Ethics, health policy director for the San Francisco Medical Society, a former hospice worker and director, and drafted the original resolution urging the California Medical Association to be neutral on physician-assisted dying.)
I believe assisted suicide is the only honest big pharma campaign.
Assisted Suicide for Mental Illness Gaining Ground
http://www.medscape.com/viewarticle/848910
25 Surprising Physician Assisted Suicide Statistics
http://healthresearchfunding.org/physician-assisted-suicide-statistics/
Aleksandr Solzhenitsyn’s, CANCER WARD, 1974
Gives you reasons why Russia isn’t likely to have assisted suicide, and of course after the holocost Germany isn’t about to have assisted suicde anytime soon. http://www.assistedsuicide.org/suicide_laws.html
Assisted suicide may feel compassionate, but it’s banking on suicide and why it’s not moral.
Who is BB Grace to decide what’s compassionate? He and his tribe don’t show much compassion for the Palestinians whom Israel helps with assisted suicide every day.
I have watched my mother and a beloved aunt die in an agony that no longer was alleviated by morphine. I am a cancer survivor who may well experience the same agony myself in the not so distant future.
It’s distressing that in the 20th Century, women are still obliged to bear children they don’t want because of deranged religious fundamentalists. And It’s distressing that sanctimonious hypocrites like Grace want to proscribe physician assisted escape from this valley of tears because of their religious beliefs–no matter how much they try to disguise these beliefs.
I thank Mr.Helig and Dr. Abrams for their excellent article.
In January I will be 86 so this subject is of interest to me. For me I see nothing wrong with assisted suicide. Why keep alive someone who who is suffering with an incurable disease and wants to end it.I have made many choices during my life and if have an incurable why shouldn’t I have assistance if I want to end my life?
86? May you live to 106 and remain lucid, articulate, and above all, humane. If I live to be 86, I hope I too can retain my eloquence and sense of outrage against the many injustices of this world.
It is not only people our age who must consider the possibility of seeking help from an agonizing death. I often think of the actor Christopher Reeves. He was much tougher than I am. I would have chosen to die.
When I fell down the stairs in January of 2014, I couldn’t move for a few very long moments. I thought I might be paralyzed or have a broken back; that I might never be able to run my bicycle or run again. My first impulse was to crawl to my office and get the loaded revolver in the bottom drawer of my desk. I want to live to 86 or 106: but not paralyzed or crippled.
We should distinguish between physician assisted suicide and euthanasia. Euthanasia is more nuanced, more difficult. Should we delegate to a physician, a team of physicians, or the state the right to end someone’s life? I go back and forth on this.
However, on physician assisted suicide and abortion I do not waver. To bear a child is the sole decision of the woman in whose body the fetus is growing. To continue to live or to die is the decision of the person whose life is in question.
First to Mr. Updergraft; There is end of life assistance in the forms of pallative care and hospice services provided by genuinely compassionate, trained volunteers and professionals.
My biological sprem doner, AKA Daddy, Dad, Father, Asshole, depending on my physical and emotional place in time we shared together, beat prostrate cancer and then survived a decade of three rounds chemo, radiation, graduation of morphine patches with mantal cell lymphoma.
He was an atheist aka objectivist, who shamed Louis Bedrock in his passion against religion. He was a man of the world who knew how to get what he wanted, beat the odds, and see justice without revenge. He came to the point in his life that he would arrange his end and succeed. He was well aware of what he was doing and why when he decided, “enough was enough”, and volunteered himself into hospice with orders, “no visitors”.
What went on during the last two weeks of his life was between him and hospice. He had no funeral.
For family and friends, the end of his life might as well been an earthquake with aftershocks that rolled on for years more sincere than a ghost from never never land AKA afterlife.
No one is stopping any doctor from working in hospice as a volunteer.
All “dying with dignity’ is a collaboration between insurance, big pharma and privatized doctor associations to profit off death.
While it may be unethical, immoral, illegal, there is nothing anyone can do, because no one would ever know, if a hospice worker was to accept cash for appreciation in finding a way to give the shot of morphine requested.
To Mr. Bedrock,
Christopher Reeve might as well have been my brother, as a 27 year old superman, very handsome, popular, good guy, who met with a speeding bullet to his neck rendering him a C3 guadriplegic for 27 years. I give credit to my Mom’s LOVE OF LIFE for keeping him alive three decades.
At one point, about 3 years into his C3 being, my brother took on pneumonia, and then got mercer in the hospital, which landed him in ICU, on so many life saving machines, the doctors and nurses paralyzed him to not disturb the machinery, thus he couldn’t move for weeks. Three years of our family learning to cope and provide for his well being, adapt to this new life of ramps, lifts, hospitals, social services, the VA, costs for machines, monkeys and experiements, took their toll, as there is no support groups we ever knew about outside of training.
I once came to visit my brother and talk to him with the understanding that he could not talk back. After a few hours having run out of things to think to say, I looked at my brother and it occured to me, through the wires, tubes, pumps, hums of the machines, the smell of an ICU, the nurses and staff in and out, that I was looking at a human waste. All the things I remembered and loved about my brother the Superman were now replaced by this mass of transfused blood and bedsore prone flesh kept alive by PG&E.
When my brother’s doctor showed, I accused him of keeping my brother alive for profit. The doctor and I had a little talk, which I’ll sum up to say that he was a good doctor and a good man, and I was wrong. But that didn’t stop my feelings of doubt or grief over losing Superman and getting Stephen Hawking, it just took me some time to discover the Stephen Hawking at that time, you see, my brother improved and went home.
My brother the Steven Hawking had more girlfriends than my brother the Superman. I had no idea so many women are attracted to wheelchairs. Maybe they just liked going for a ride in his lap when he participated in parades flying the American flag on his right and his POW flag in his left? He opened a concession stand in a very popular location and everyone seemed to know him and admire him. I for one learned far more from my brother the Stephen Hawking than my brother the Superman.
His death was unexpected. He took a friend out for a few brews, was traveling home (his wheelchair could go over 25 miles per hour) hit a rock, the chair flipped giving him road rash, ambulance took him to the VA, and the VA tells us that he had a heart attack (I think it’s because my Mom wasn’t there making sure the VA didn’t mess up).
I think that there are some people who think that Superman is more worthy than Stephen Hawking, and resent money going to care for Stephen Hawking, but no problem using money to assist poor Stephen Hawking out of the misery they think Stephen Hawking is in. I imagine that there would be far more wrongful death law suits if folks could afford an attorney.
Because I know people who should be dead but are not, one example is that of a man who swallowed a shot gun muzzle and blew the left side of his head off, survived, only to put the same muzzle in his mouth to shoot off the right side of his head and live physically fit. And I’ve known those who die unexpectedly and suddenly.
I believe that when it’s your time to go, you go.
The irony to me, who appreciates the concept of ethical capitalism, is observing those who don’t appreciate ethical capitalism approving profit off suicide as a form of justice.
Finally, I was not instructing anyone what is “compassion”. Feelings change, and why I posted that assisted suicide may FEEL like compassion, as my point being that assisted suicide is a collaboration of insurance, big pharma, and privatized associations looking to profit off suicide. To me, that is immoral, not compassion; However, I can accept your finding profit off suicide compassionate and just, as I can agree to not agree without arm twisting or shaking hands. Have a nice posting day.
To continue to live or die is the decision of the person whose life us in question Mr Bedrock states.
The fetus is a living human being (a person) and is unable to make said decision.
The woman who feels she has a right to do what she wants with her body and decides on abortion
Is making the decision for the life within her.
When I hear woman state that they can choose to do what they want with their own body forget there is another body within them who can’t choose.
Giving the baby up for adoption is a better choice than ending it’s life.
“A fetus is not yet a human being. It is nothing but a clump of cells with the potential to become a human being. It is “alive,” but that is also true of all the other cells in a woman’s body. It has no life of its own yet. It is not yet a separate life from the life of the woman in whose uterus it is.”
The fetus has not lived the world, has not had an education, cannot make choices. The woman who bears this fetus is a human being with the capacity to make decisions and the understanding of the consequences of these decisions.
It is unjust to award the fetus “rights” that abridge the rights of the woman who bears it. Neither you, nor the Pope, nor the Church he represents has the right to impose your archaic beliefs on women who do not share these beliefs.
A woman’s body o is her body not withstanding the misogynists who oppose any concerns about the body or status of a woman. As I have said before I do not think any self respecting woman would support those who oppose abortions. As sometimes happens M. Bedrock speaks my mind.
As for Mr. Grace if he would correctly spell my name I might be more responsive to his comments.
Please accept my sincere appology Mr. Updergraff in mispelling your name, not that I write expecting response to my comments, but because I respect your name which I did not intend to mock or dishonor.
My Achilles heal is dyslexia, which takes every opportunity to mute me with shame, fear, misunderstanding and error, all mine to own until death do us part. Oh how I wish I could abort the dyslexia! Alas
Ms Grace
Who has never met a woman that planned for abortion as in, “Know what I’m going to do for myself this year? I’m planning to get pregnant and have an abortion. I hear that Planned Parenthood needs the body parts, and it would make me feel good to know that my human waste is their treasure that will give renewed life to the elite that can afford it, ya’know? I really thought about it. The money I save getting off the pill, and not having to mess around with all that spermicide crap, I need a break y’know? Do I want new clothes, or throwing a dinner party for friends, or taking a three day cruise, or riding in a hot air balloon, or buying an 8 ball of Coke, or putting a down payment on a Smart Car? All those things pale to the dream, the thrill, the joy, of spending my mad money on getting an abortion.”
Talk about shame, fear, misunderstanding and error, or the fact that lack of economic, material, intellectual and emotional support are the reasons why most women chose to have abortions.
To be fair Mr. Updefgraff, I never met a man planning for an abortion either. Abortion is a crime against humanity, but the elite need those stem cells to keep themselves young looking and healthy, so by all means, keep it legal and by all means, don’t make vasectomies or tying tubes free for those who don’t want children (take that old religion!) Some very special folks depend on the fruit of the womb from the poor folks who find the potential of carrying the weakest of all human life to term, more than they can afford, in more ways than financial.
Mr. Grace – good heavens you misspelled my name again – two times! Why don’t you just call me Jim.
From a letter to The British Medical Journal by Graham Winyard and Liza Macdonald
Graham Winyard,is a former deputy chief medical officer, Liza Macdonald is a retired consultant radiotherapist.
Patients wanting the sort of open discussion about their impending death that Boyd and Murray advocate will have one topic denied them; taking their own life should palliative care prove ineffective. This option is important because the medical literature demonstrates clearly the limits of even the best palliative care.
The medical and religious establishments accept this but contend that the suffering of a small number of individuals is a necessary price to pay to protect the vulnerable. Discounting daily suffering against hypothetical risk seems dangerously complacent without knowing the numbers involved. How small is this small number? Society needs to understand the full price it is requiring some of its members to pay for the general good.
To date, no surveys have examined directly the frequency of such refractory suffering. The latest National Bereavement Survey (VOICES) of end of life care in England, however, offers a way into the question. Even in hospices, where we can assume that excellent palliative care is available, more than 2% of patients with pain were reported as experiencing no relief during their last three months of life. Figures for poor pain control and poor relief of other symptoms in the last two days of life are similar. Extrapolation from this, excluding sudden deaths and those with only a short preceding illness, suggests that at least 6000 adults would experience severe distress while dying, every year in England, even if excellent palliative care were universally available. This seems a high price for society to pay, and certainly one that requires better informed consent by the public. This level of suffering would help explain the degree of public support for the option of an assisted death, in spite of the acknowledged excellence of our palliative care services.
These figures require confirmation, and the obvious way is to undertake a proper study, to inform the public and its legislators. The risks of changing the law on assisted dying are theoretical; the daily suffering is real.
I had two elderly relatives – one who was in a lot of pain and the other who was confined to his bed. They both said they were not going to live that way – in effect they willed themselves to die and both were dead in a couple of weeks.
Mr. Updegraff,