Aid in dying about compassion and respect for our patients

Kindness should be a factor in the timing and manner of an inevitable death

In his opinion piece “Assisted suicide wrong for doctors, patients” (Jan. 20 Journal), Dr. Anthony Vigil argues the Elizabeth Whitefield End of Life Options Act, which would legalize medical aid in dying in New Mexico, undermines physicians’ identity as healers and how our patients view us. But what threatens our identity and patients’ trust most is when we fail to listen to their wishes with compassion and respect.

I, too, am a physician who has had much experience with dying patients. While good palliative care can relieve much suffering at the end of life, on rare occasions even the most expert care is not enough. Symptoms like pain, weakness, loss of bodily functions, shortness of breath and nausea may be overwhelming. Patients may spend their last days, weeks or months in discomfort, sedated, and wholly dependent on care by others. They may wish for death but live in terror of just when and how their final moments will arrive.

Vigil points out the primary reasons listed by patients for requesting medical aid in dying are not pain and physical suffering, but existential suffering such as loss of autonomy, loss of dignity, loss of enjoyment of life, and being a burden on family and caregivers. It is a false dichotomy: physical suffering and psychological and existential suffering are intertwined. But more importantly, are these latter forms of suffering any less important? They are certainly less treatable. I am surprised Vigil feels so confident in addressing these problems with “science, technology, engineering, and mathematics.” There are limits to our powers.

It is true that in general physicians should be healers, but when death is imminent and healing no longer possible, the physician’s role should shift from extending life to relieving suffering in accord with their patient’s wishes. This is not a matter of life versus death, but about the timing and manner of an inevitable death. Most physicians today reject the paternalistic notion that terminally ill patients can’t be trusted to know what they want and need to be protected from themselves. The majority of both physicians and the public support legalizing medical aid in dying. Nine states and the District of Columbia have already approved medical aid in dying, as has all of Canada.

Oregon’s Death with Dignity Act, which is similar to the New Mexico bill, has been in effect for 24 years, and the experience there is reassuring. First of all, it is used only rarely. There were initial concerns that aid in dying would be used mainly by socially vulnerable populations and would come to supplant good palliative care. But there has been no evidence of disproportionate use in minority or uninsured populations nor cases of abuse, and palliative care in Oregon remains among the best in the country. The great majority who seek aid in dying have widespread cancer. About one third of patients who receive the medication never use it but keep it on hand for peace of mind. It is immeasurably comforting for these patients to know that they have control and an option for a quick and merciful death in the event their suffering becomes unbearable despite palliative care.

As in Oregon, it is likely the N.M. bill would not lead to widespread use of this option. Physicians have a deep professional commitment to heal, and patients almost always want to live. But medical aid in dying is an important option for those few whose suffering just becomes too much. To deny patients this final and most desperate request seems to me a form of abandonment at precisely the time when we physicians are most needed. To help is both compassionate and respectful of patients’ rights to determine their own future. I would remind Vigil the most important part of our identity as physicians is to be kind.