Why Patients Ask For Suicide

 


WHY PATIENTS ASK FOR
PHYSICIAN ASSISTED SUICIDE (PAS)

 

  • For Quality of Life Issues.  See the data below from the Annual Department of Health Reports, Oregon, which document that these patients had not received psychological, psychiatric, pastoral, social, or other forms of help normally given to palliative care patients and patients in hospitals that use an integrated medicine model.
  • Minimal Referrals of Terminal Patients for Psychological Help or Psychiatric Medical Treatments.  See the data below from the Annual Oregon Department of Health Reports. They show that from 2008 to 2012, of 272 patients who died from assisted suicide, only 4 patients were referred for psychological or psychiatric help prior to their death.  This is apalling. 
  • Superficial Referals to Alternatives to assisted suicide — Palliative Care &  Hospice.  Patients who are assumed to become candidates for assisted suicide by physicians and staff, as well as those who had signed up for it, generally do not receive medical services normally provided by hospitals through multiple programs. This was disclosed and explained by doctors at Sloan Kettering Cancer Center, Suicide Prevention International, and New York Medical College, in their paper called, “Physician Assisted Suicide In Oregon – A Physicians’ Perspective“.  Read about this additional atrocity below. See the full article at: http://www.michiganlawreview. org/assets/pdfs/106/8/hendinfoley.pdf
  • Physician assisted suicide destroys the trust between doctor and patient.   Doctors from the Association of Northern California Oncologists, Medical Oncology Association of Southern California, California Medical Association, American Medical Association American College of Physicianssay, share their opinion about this end-of-life option, “Under the pretense of providing compassion, the physician assigned to the patient is relieved of his or her primary responsibility to the patient – to safeguard life and to provide comfort to the suffering. it is the ultimate patient abandonment.


Quality Of Life Issues

In Oregon and Washington, where assisted suicide is legalized, the Departments of Health (DOH) in both states are required to report statistics including reasons why patients have been year after year,  requesting physician assisted suicide (PAS).  Their collected statistics contradict the claims of those who promote PAS, who claim it that assisted suicide is required to help people in extreme end-of-life pain.  Read the facts below:

  • Oregon 2009 Annual Report, “As in previous years, the most frequently mentioned end-of-life concerns were: loss of autonomy (96.6%), loss of dignity (91.5%), and decreasing ability to participate in activities that made life enjoyable (86.4%).” And that “None of the 59 patients were referred for formal psychiatric or psychological evaluation.” http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year12.pdf
  • The 2010 Oregon DOH Report states, “As in previous years, the most frequently mentioned end‐of‐life concerns were: loss of autonomy (93.8%), decreasing ability to participate in activities that made life enjoyable (93.8%), and loss of dignity (78.5%)”, and that “only one of the 65 patients was referred for formal psychiatric or psychological evaluation”. http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year13.pdf
  • Oregon 2011 Annual Report, “As in previous years, the three most frequently mentioned end‐of‐life concerns were: decreasing ability to participate in activities that made life enjoyable (90.1%), loss of autonomy (88.7%), and loss of dignity (74.6%). And “of the 71 patients, only one patient was referred for formal psychiatric or psychological evaluation”. http://public.health.oregon.gov/ProviderPartnerResources/
    EvaluationResearch/DeathwithDignityAct/Documents/year14.pdf

Data shared by the Department of Health in their Annual Oregon Reports confirm the many statements by the AMA and medical industry leaders that strongly oppose physician assisted suicide.  Some of these statements are shown in these paragraphs and on this page. They concur that physician assisted suicide is not needed among the medical profession’s spectrum of “end-of-life planning options” for patients.  It is a obstacle to introducing patients to the full spectrum of end-of-life care which mitigate some of the harshness of  reduced quality of life due to physical or mental limitations.

    • Dr. Gomez, AMA, who headed a national AMA program to educate 20,000 or more doctors around the United States on patient pain management and care, said, “We now have lots of documented evidence that an aggressive drug regimen can effectively protect end of life patients from pain”.
    • The AMA says that “Instead of participating in
      assisted suicide…..patients should not be abandoned once it is determined that a cure is impossible. Multidisciplinary interventions should be sought including specialty consultation, hospice care, pastoral support, family counseling, and other modalities.  Patients near the end of life must continue to receive emotional support, comfort care, adequate pain control, respect for patient autonomy, and good communication.”  But, as we see on this page, the physician assisted suicide law lets physicians neglect to effectively refer patients for these services with impunity.
    • The AMA puts it strongly: There is, in short, compelling evidence of the need to ensure that all patients have access to quality palliative care, but not of any need for physician-assisted suicide.” 
    • See these quotes at:  http://www.pregnantpause.org/euth/amagomez.htm


Minimal Referrals for Psychological or Psychiatric Treatments

The above data from the DOH reports show us that it has not been a regular practice to refer patients for psychological or psychiatric treatments and in 2009 they expressed their concerns in writing. To sum up and quoting the reports:

    • In 2009 none of the 59 patients were referred for psychological or psychiatric help
    • In 2010 only one of 65 patients were referred
    • In 2011 only one of 71 patients were referred
    • In 2012 only two of 77 patients were referred

In summary, out of a total of 272 patients who died from 2009 – 2012, only 4 were referred.  Links to the reports are below:

2009:  http://public.health.oregon.gov/ProviderPartnerResources/Evaluation
Research/DeathwithDignityAct/Documents/year12.pdf

2010:   http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/
DeathwithDignityAct/Documents/year13.pdf

2011http://public.health.oregon.gov/ProviderPartnerResources/
EvaluationResearch/DeathwithDignityAct/Documents/year14.pdf

2012:  http://public.health.oregon.gov/ProviderPartnerResources/Evaluation
Research/DeathwithDignityAct/Documents/year15.pdf

For all Annual reports: http://public.health.oregon.gov/ProviderPartnerResources/Evaluation
Research/DeathwithDignityAct/Pages/ar-index.aspx

This shows a lack of respect for human dignity and life.  Imagine, patients who are terminal, with only six months or less to live,  allowed by this law to linger in anxiety and in possible mental duress — without psychological help and psychiatric medical treatments — and then they are assisted to commit suicide.

[Dr. Marshal Mandelkern,  Chief of Psychiatry at the Hospital of Saint Raphael, said, “If someone says there’s no point in going on, I would first ask ‘How depressed is this person?’ If you let somebody die when they’re depressed, they don’t have a chance of getting better.”]
See: http://www.healthgrades.com/physician/dr-marshal-mandelkern-2vbpj  also see USCCB — on the Role of Depression  http://old.usccb.org/prolife/issues/euthanas/roleofdepression.pdf

 

Superficial Referrals  to the Alternatives to Physician Assisted Suicide  — Such as Palliative Care & Hospice

The AMA, Sloan Kettering Cancer Center, Suicide Prevention International, and New York Medical College report in their paper, Physician Assisted Suicide in Oregon — A Physicians Perspective”  say that,  “The Oregon law seems to require reasonable safeguards regarding the care of patients near the end of life, which include presenting patients with the option for palliative care;

  • ensuring that patients are competent to make end of life decisions for themselves;
  • limiting the procedure to patients who are terminally ill;
  • ensuring the voluntary nature of the request (no coercion);
  • obtaining a second opinion on the case,
  • requiring the request to be persistent, ie, made a second time after a two week interval;
  • encouraging the involvement of the next of kin; and
  • requiring physicians to inform OPHED of all cases in which  they have written a prescription for the purpose of assisted suicide.

“The evidence strongly suggests that these safeguards are being circumvented in ways that are harmful to patients

[Note: The presence of the suicide option, among others, is not helpful to patients.   Where promoters try to position this option as one among many; facts show that it does not refer patients to other options (such as palliative care, hospice or even for psychological or psychiatric help); instead, it keeps them hostage.  In other words, it is an incompatible option that carves out its own space and does not co-exist with other alternatives like palliative care or hospice to enable a practice of referrals.  If it were a priority to refer or possible to enforce referrals to other options, doctors in Oregon who are not associated with the suicide program would have made it happen, and more than a handful of those patients would have been referred for psychological and psychiatric help, palliative care, and hospice.]  According to records, this was not the case.  Clearly, this those running the suicide program did not treat referrals as critical to their mission with suicide patients.  

The doctors who authored the Physicians Perspective paper shared that, “OPHD has been issuing annual reports declaring that terminally ill Oregon patients are receiving adequate care.  The available evidence, which we will present in this article, suggests otherwise….The unintended consequence of this provision is that it enables physicians, to assist in suicide without inquiring into the source of the medical, psychological, social, and existential concerns that usually underlie requests for assisted suicide, even though this type of inquiry produces the kind of discussion that often leads to relief for patients and makes assisted suicide seem unnecessary…”

“When a terminally ill Oregon patient makes a request for assisted suicide, physicians are required to indicate that palliative care and hospice care are feasible alternatives. They are not required however to be knowledgeable about how to relieve physical or emotional suffering  …without such knowledge, which most physicians do not have, they cannot present or make feasible alternatives available.  Nor in the absence of such knowledge are they required to refer the patient to a physician with expertise in palliative care.”

“In the absence of adequate monitoring, the focus shifts away from relieving the distress of dying patients considering a hastened death to meeting the statutory requirements for assisted suicide.”

“Physicians can merely go through the motions of presenting the possibility of palliative care for their patients”.

 

Physician-assisted suicide destroys the trust
between the patient and doctor

Through the “Position Statement on Physician-Assisted Suicide and Opposition to AB 374”, doctors share that “Legalizing physician-assisted suicide strikes at the heart of what we do as physicians and adds ambiguity to the physician-patient relationship.

The physician’s primary directive is to first, do no harm. Physician-assisted suicide destroys the trust between the patient and doctor..

Under the pretense of providing compassion, the physician is relieved of his or her primary responsibility to the patient – to safeguard life and to provide comfort to the suffering.  it is the ultimate patient abandonment”

(See Position Statement on Physician-Assisted Suicide and Opposition to AB 374, by doctors at: Assoc. of Northern California Oncologists, Medical Oncology Assoc. of Southern California, California Medical Association, American Medical Association American College of Physicians) http://dredf.org/assisted_suicide/ Oncology%20Statement%20on%20AB%20374%20(Berg).pdf

Also see a testimony by, who was surprised to find himself inclined to mistrust doctors because of physician assisted suicide, and mentions some of his concerns.

Who Can Best Judge “Quality Of Life”?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1705248/pdf/canmedaj01476-0019.pdf
Philip G. Ney, M.D., Clinical Professor,
Department of Psychiatry,
University of British Columbia Vancouver, BC