The U.S. health care system does many things well, but it is becoming increasingly clear that helping people die peacefully is not one of them. Many people spend their last months of life in emergency rooms, infusion centers or intensive care units, receiving interventions that not only fail to prolong life, but instead increase suffering for both the dying and their survivors.
There has been a recent swell of interest in physician aid in dying – giving doctors the power to prescribe lethal medications to terminally ill patients so they can end their lives at the time of their choosing. Brittany Maynard, a young woman with a fatal brain tumor, popularized this idea when she used Oregon’s Death with Dignity Act to end her life. In response to the interest she generated, states across the country, including California, are considering legislation to legalize doctor-assisted suicide.
As a palliative care physician who focuses on improving the quality of life of seriously ill and dying patients, I wholeheartedly agree that we are at a crossroads, and it is time to fight for better care at the end of life. But aid in dying should not be the focus of the battle cry, because it actually meets the needs of very few and endangers many more.
Most people who avail themselves of assisted suicide in Oregon and Washington are educated, white and affluent. They have access to good end-of-life care and have resources to get help at home, and yet still crave the ability to exert control over their exact moment of death. Their numbers are very small, accounting for less than 1 percent of all deaths in Oregon in 2014.
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By contrast, most dying people I meet do not want to acknowledge – let alone plan for – the approaching end of their lives. As a result, many miss out on supportive care that might improve the quality of the time they have left. Some patients hesitate to take medication to alleviate pain for fear it might hasten their death, or wait to seek services such as hospice because they think that would signal “giving up.”
There is often racial and socioeconomic variation to this – the more marginalized patients are, the more they will grasp at any treatment offered to them, no matter how uncomfortable or expensive it is, or how unlikely it is to help. Making assisted suicide an acceptable medical practice would unequivocally alter the patient-doctor relationship and endanger trust in medicine at the end of life, driving away those who need it most.
Many patients have asked me to hasten their deaths, but when we explore this feeling, there is often something else under the surface. They may need help with depression or pain, or they feel like a burden to their caregivers. In a world where physician-assisted death is ubiquitous, busy or untrained doctors could take requests for aid in dying at face value and provide means to end someone’s life instead of trying to restore a quality of life that is worth living to them. Legalizing aid in dying implicitly condones the idea that someone can be a burden or that a life can lose its value, and could subtly coerce the frail and infirm to end their lives.
A bill in the state Senate would legalize doctor-assisted suicide, and a lawsuit was filed by a group of patients and doctors against the state to overturn a statute that prohibits it. Though I understand the frustration that spurred this movement and believe strongly in respecting patient autonomy, I also believe that there are many things we can do to restore dignity to the dying process that do not involve lethal medications, such as reforming hospice care and being more thoughtful about end-of-life treatment.
Doctor-assisted suicide inappropriately channels a completely justified outrage against our broken system into a dangerous public policy that puts vulnerable people at risk.
Laura Petrillo is a hospice and palliative medicine fellow at the University of California, San Francisco.