Week of November 10, 2014

LEGALIZE
ASSISTED
SUICIDE?

Our preview, and the Intelligence Squared debate

PREVIEW
by Robert LeFevre, M.D.

Click here to watch the replay of the debate.

The winner could be you. Dr. Bob on his retirement job, taking therapy dogs to hospitals and nursing homes.

Many debate topics generate profound cerebral interest, often with accompanying passionate, and even visceral, gut-tightening responses. In the long run, however, regardless of the outcome, after the dust settles, there's often little personal impact. Not so with the upcoming "Intelligence Squared" debate on "legalized assisted suicide."

This debate is current to events that recently played out in Oregon, specifically concerning Brittany Maynard, the 29-year-old woman with terminal brain cancer who died November 3. The debate has implications for every person as he or she considers personal health care directives, or acts as a designated attorney for health care. It touches on a topic that is deeply personal to all of us, more so every day.

Is this a debate about the ethics of assisted suicide at the academic level, or about the right and freedom you as an individual have to choose how you want to live? When life fails to meet your standards or is too painful do you have the right to choose how you die?

While making rounds with Baron and Zach, my therapy dogs (my retirement job), I visited a person in the emergency department who said, "You know, we do not come with an expiration date." So there is not only "the how" of assisted suicide but "the when." Timing can present its own dilemma. In the discussions Brittany had with interviewers and on video, this was a very important issue.

Death with dignity has always been a key goal of hospice care. I was privileged to have been a founding medical director of a hospice at the dawn of the movement in the early 1980s. I firmly believe that hospice and palliative care doctors, nurses, social workers and chaplains (the team) have the resources, medications and skills to help patients and families through the end game the vast majority of the time.

Brittany Maynard

However, a question arises. In spite of the best of care, what if a person is still experiencing intractable suffering? Suffering comes in many forms: Loss of control, pain, and feelings of being a burden to others. In Brittany's case, intractable seizures and severe headaches.

A key medical principle is "primum non nocere." First, do no harm. If we cannot control the suffering aren't we doing harm? Is assisted suicide a potential option in this scenario?

Given the choice and the means to end one's life, the data from Oregon show that very few people elect this route. In wondering why, I am reminded of my days as a resident on one of the surgical services at the Cleveland Clinic. One of the surgeons gave all his patients admitted to the hospital a bottle of pain pills to be left at the bedside. Yes, a bit radical and of course impossible in this day and age, but guess what?! The patients did not have to fight the nurses for pain medication. They also took less total pain medication. Brittany in her video clearly elucidated the calming effect of having the medication she needed. Being able to be in control leads to less stress.

A question to consider in this debate is "Who is in control?" Is there a chance that those representing the medical profession under the guise of "our job is to cure not kill," do not want to give up their control?

A key hospice and palliative focus is on patient values. Thus another question is: For a person making a decision in accordance with their personal value system that includes assisted suicide, should we not honor this decision?

How society deals with these issues may have a profound personal effect on what medical help you can or cannot count on when you go to "cash in your chips." When you go to "buy the farm," will the deed be free and clear or come with a lot of conditions?

Tune in!

Will the focus be on the latest events in Oregon? Brittany wanted to be public in her decision and actions. Will her videos help or hinder her cause in the long run?

Should each state decide? Brittany had to move from California to Oregon.

Will you have a choice in your end-of-life care? How much choice do you want? If assisted suicide is not an option, are the reasons valid?

Does the data from current experience really validate the "slippery slope" theory stating that people with non-terminal diseases such as depression will seek assisted suicide?

For the few with intractable suffering and pain who need "terminal sedation," would not termination be better?

You might want to check out the Frontline documentary "The Suicide Plan," (August 22, 2014) and many other You Tube offerings before you watch the debate.

Finally, I believe we are using the wrong terminology. "Assist in dying" or AID may more closely describe what is occurring and it certainly might be a less charged phrase than assisted suicide.

The winner in this life and death debate has the potential to be you.

Click here to comment on Bob's preview at any time, and to watch the replay of the debate.

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To read comments on Intelligence Squared debates held earlier this season, click here.