Let’s remove the euphemisms: Aid-in-dying is assisted suicide
Once again, we find ourselves amid another legislative session considering the possibility of legalizing assisted suicide. Let’s remove the euphemisms and say what we mean. According to Merriam Webster suicide is defined as “the act or an instance of taking one’s own life voluntarily and intentionally.”
It is important for the citizens of Connecticut to understand several issues when deciding to support or rally against assisted suicide. First, there is no science behind the lethal doses of medication provided to the participants. Also, the most common drugs used are “make it up as you go” cocktails. Late last year I spent over two hours searching an academic library and a Google search trying to locate a standardized practice/protocol, best practices, or a standardized formulary for these drug cocktails. I only found one source, and it was a continuing education activity for physicians. It was a “formulary” without even one scientific citation and it was found on Google. It is important to note that the piece was sponsored by “Compassion and Choices,” the organization that promotes assisted suicide. For its part, the federal government has determined that assisted suicide is incongruent with the Controlled Substance Act and is rife with dangers to the disability community and all patients.
Another area of concern is the response to the legalization of assisted suicide by Accountable Care Organizations (a type of insurance company). An article from the respected journal Health Affairs notes “the challenges and opportunities” for ACOs concerning serious illness. Currently, ACO’s are rapidly saturating the home palliative care market. This is a good thing. It is a “win-win” for the insurers and the insured. With ACOs there are fewer hospitalizations, 30-day readmissions and more patients staying at home rather than having frequent emergency room visits and hospitalizations. But do you know what would be even less costly than palliative care and hospice? Assisted suicide. We know of a case in Canada where a woman was allowed to obtain life-ending drugs when she was unable to secure wheelchair-accessible housing. In her own words, she said she was seeking assisted suicide due to “abject poverty.” In the United States, people are qualifying for assisted suicide with a diagnosis of anorexia nervosa.
In Canada, the number of assisted suicides has increased exponentially. In 2016, 1,018 people chose to take their own lives. In 2020 that number rose to 10,064, which is 3.3 percent of all deaths in Canada for that year. This correlates with the consistent chipping away at what legislators refer to as “safeguards.” Last year while testifying against assisted suicide a senator on the Public Health Committee became frustrated and said, “We are only responsible for the verbiage in this bill as it is written.” I chided him and reminded him and his colleagues that the path of legislative good intentions is paved with catastrophic unforeseen consequences.
An often-quoted slogan by advocates is “my death, my decision.” Another Google search using this slogan brings up a suicide prevention phone number. The scientific literature has been clear, suicide is a contagion. During a mental health crisis and an epidemic of suicide amongst young people is it wise to normalize suicide?
When an individual learns of a terminal illness a natural response is “demoralization,” a state of hopelessness, helplessness, and loss of meaning in life. Palliative care provides “dignity therapy,” an intervention that works with patients to find resolution, reconciliation and meaning in their lives. I have seen this intervention result in almost miraculous outcomes. Addressing demoralization with interventions to achieve remoralization is the compassionate and loving response to the terminally ill. It is cruel and inhumane to allow those who are dying to do so without excellent end-of-life care, leaving them to die in despair. It is also true that proponents of assisted suicide do so because of prolonged and complicated grief. Their efforts are misguided efforts to find purpose in their own loss. There are ways to find meaning in loss but advocating for assisted suicide is misguided.
The recently formed Connecticut Hospice and Palliative Care Organization advocates for better end-of-life care and has taken a stance against assisted suicide. The bioethics discussion could take up three or four opinion pieces.