Allowing physician-assisted suicides could lead to abuse and coercion of patients

Hawaii lawmakers are holding a key vote this week on a bill that would permit physician-assisted suicide in the state. As shown in a public hearing last week, the issue is a contentious one, and well-intentioned people may find themselves on either side of the debate. However, as lawmakers consider permitting the practice in Hawaii, we would urge them to consider the risks posed by allowing the practice to take place.

Though physician-assisted suicide is often presented as a matter of individual liberty, there are significant public health and safety concerns associated with the practice.

While advocates of assisted suicide often describe it as a means of allowing patients to avoid physical pain and suffering, data indicate that many turn to assisted suicide over financial concerns or fears of becoming dependent and a burden on their caretakers. In these cases, the patient’s distress is emotional rather than physical, and should be regarded and treated as such.

Allowing physician-assisted suicide could also lead to circumstances in which patients are coerced or even forced to undergo it. Supporters of legalizing assisted suicide often point to the lack of evidence of any abuse under Oregon’s Death With Dignity Act as a means of allaying this concern, however, estimates indicate that instances of elder abuse are actually around 10 percent, which suggests there is instead a lack of documentation. The drugs and their distribution are not sufficiently regulated to shield their recipients from abuse.

Despite the fact that there is often a link between a stated desire to die and depression, data from the most recent report about Oregon’s law indicate that less than 4 percent of patients seeking a prescription for lethal drugs were referred for a mental health evaluation. Typically, when a patient says they want to die, resources are directed to reversing this stated wish. The data however indicates these terminally ill patients are given a lower standard of care than the general population.

Physician-assisted suicide could also lead to an adverse impact on members of the patient’s community. Some terminally ill patients seek a prescription for lethal drugs in order to have access to them if they should so choose, but never take them and die of natural causes instead.

For instance, in Oregon — one of just a handful of states where physician assisted suicide is legal — 1,749 prescriptions for lethal drugs have been written, and 64 percent of these prescriptions led to documented deaths following ingestion. That leaves a remaining 36 percent of drugs that were not ingested by the patient who received them. What, then, happens to these unused drugs? Amid a national suicide epidemic, these unused drugs may fall into the hands of others if they are not adequately secured and regulated.

Research has shown, after controlling for demographics and other factors, physician-assisted suicide is associated with an increase in both assisted and non-assisted suicide rates. If the suicide contagion effect is beyond question how is it safe to make assisted suicide public policy?

As they weigh this bill, we would urge Hawaii lawmakers to consider legislation that would increase the quality of care for the elderly, the sick, the disabled and the vulnerable rather than sanctioning a law that results in the devaluing and destruction of their lives.

Daniel Fischberg and Michael Plumer are Hawaii physicians and certified specialists in hospice and palliative medicine.