A right to die?
Maryland bills seek to legalize medical aid in dying for the terminally ill Maryland psychiatrists oppose medical-aid-in-dying bill for good reason
This year, the Legislative Action Committee of the Maryland Psychiatric Society, an organization that represents physician psychiatrists in Maryland (excluding Montgomery and Prince George’s counties), voted to oppose the End-of-Life Option Act (Senate Bill 443/House Bill
403), which has been discussed in the Senate and House this month.
This bill would allow physicians to prescribe lethal drugs to terminally ill and mentally capable adults who request to die. The practice has alternately been known as “physician-assisted suicide,” “medical aid in dying” or “death with dignity.” However, its essence remains: It involves medical professionals as active agents in the death of patients. The bill, as written, supports a practice that is contrary to the professional philosophy of psychiatrists, our training and the reasons why we choose this occupation.
In 2020, MPS conducted a survey of our members about the topic of medical assistance in dying. While there was support for a right of terminally ill patients to choose to die in principle, there was considerably less support for any physician role. Most of our members opposed the idea of physicians administering medications with that goal. While there is not unanimity, the highest agreement existed for a question stating “a physician who prescribes or administers lethal medication should be trained to recognize signs and symptoms of mental illness,” followed closely by “a patient who requests lethal medication should be evaluated by a psychiatrist.” In other words, the members who responded to the survey mostly supported ensuring that those patients who requested to die were not suffering from depression, a treatable disorder.
Providing a lethal drug to a patient without a proper psychiatric evaluation to rule out depression is simply malpractice. Our Maryland Psychiatric Society colleagues have suggested many amendments to the bill over the years which the supporters of the bill have refused to adopt. The guardrails are essential in a bill that deals with life and death.
The only way to ensure that a patient is not depressed is by conducting a comprehensive psychiatric evaluation. These evaluations are to depression what a blood pressure read is to hypertension. We cannot diagnose without them. The evaluation would also allow a physician to determine if the person is competent to make the decision to die. Competency evaluations are the core of a consultant psychiatrist’s work. For physicians to prescribe, we first need to diagnose. In order to diagnose, and to rule out depression and lack of competency, a psychiatric evaluation is warranted.
Supporters of the bill often mention a Medscape 2020 poll completed by 5,000 American physicians that asked if physician-assisted dying should “be made legal for terminally ill patients” to which 55% responded positively. It is important to point out that something can be legal and still require safeguards and that this survey indicated that roughly one out of two physicians disagreed with it being legal.
As physicians and psychiatrists, our goal is always to minimize physical and emotional suffering in our patients. Hospice care provides comfort to those suffering from pain in the later stages of a terminal disease.
However, providing a lethal drug to a patient without a proper psychiatric evaluation to rule out depression is simply malpractice. Our Maryland Psychiatric Society colleagues have suggested many amendments to the bill over the years which the supporters of the bill have refused to adopt. The guardrails are essential in a bill that deals with life and death.
The only way to ensure that a patient is not depressed is by conducting a comprehensive psychiatric evaluation. These evaluations are to depression what a blood pressure read is to hypertension. We cannot diagnose without them. The evaluation would also allow a physician to determine if the person is competent to make the decision to die.