Clinician Insights

Doctor Support for Assisted Death Rises, but Debate Continues

Alicia Ault

July 07, 2017

The number of physicians who support the concept of assisted death seems to be on the rise, but even in states where it is legal to provide a prescription to a patient who wants to die, few doctors have done so.

Sixteen percent of almost 300 physicians who responded to a recent Medscape Medical News poll said they practice in states with a physician-assisted dying law. Only 17% of those physicians said they have used it with a patient. Thirteen percent said they'd received a request but had declined, and 70% said they'd never been asked to facilitate a patient's death.

Some 62% of doctors who practice in states that do not allow assisted death said they had been in a situation in which they wished the patient could have been able to exercise that right.

Six states now allow physician-assisted death. A Medscape ethics report published in December 2016 found that 57% of doctors who participated said physician-assisted death should be available to the terminally ill, up from 54% in 2014 and 46% in 2010.

In the latest Medscape poll, 56% of doctors who responded said they thought the passage of physician-assisted dying laws was a positive development.

A large number of commenters on the poll said that allowing people to choose to end their lives was good medicine, as alternatives merely prolonged suffering.

Some, however, said physician-assisted death was not acceptable. "The golden rule of medicine is: 'First, do no harm.' Allowing death to occur with dignity, medical support, et al is fine ― picking a time and causing it — not," said Dana Panknin, MD, a family medicine specialist.

"Needless suffering is more painful for patients as well as families," said Saraswati Chhetry, MD, a family practice doctor. "Although [the] oath says 'Do no harm,' allowing prolonged suffering is doing more harm by not giving peace."

Concerns Abound

Many also sounded a note of caution.

"Our role is to ease the suffering of the dying patient and their family," said said Ian Hunt, MD, a pulmonologist who said a significant part of his practice was in the intensive care unit. "I am acutely aware that our modalities of treatment can become modalities of torture. As such, components of ICU care should be withheld at times," he said. Dr Hunt said he did not consider that to be patient-assisted death, but added, "I am very concerned that patient-assisted suicide could be misused."

Edward Childe, MD, a psychiatrist, said he was in favor of physician-assisted death, but added, "I would be hesitant to prescribe it for the mentally ill because I have found that severely ill patients who have worsened with years of physical treatments have been able to become well with modified psychoanalytic therapy."

Internist John Bakos, MD, said he also was concerned about patients who might be depressed. "The ability to rationally choose to end your life should be a protected right of every human," said Dr Bakos. "The issue of state of mind, is, however a tricky one. Having a terminal medical condition with months to live should unarguably be a reason to shorten your life painlessly," he said.

"However, to those profoundly depressed, death can seem an overly attractive option," said Dr Bakos. He added, "With safeguards regarding diagnosis, a two physician requirement, most of these concerns can be addressed."

Requiring evaluation by two physicians is one way to help determine whether someone is mentally capable to make the decision, said Roger Kligler, MD, an internist. Dr Kligler, who said he has metastatic, incurable prostate cancer, has been working to pass an aid-in-dying law in Massachusetts.

"Having cared for many patients who have died with my disease, I know that the end of my life will be difficult," he said. Making assisted death available can improve the use of hospice and palliative care and end-of-life discussions, decrease suicide in the terminally ill, and give them peace of mind, said Dr Kligler.

"Because of my work on this, I was able to have a good conversation with my physician that would not have taken place," he said. "Please put yourself in my shoes and ask what options you would want for you or your family members having a difficult death."

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