During the November election, Colorado residents voted to
approve Proposition 106, The End of Life Options Act. I happened to be in Denver this past summer
when grassroots activists were pounding the pavement requesting signatures on
the petition. When I was approached, I
disappointed the young activist when I told him that my signature wouldn’t help
because I’m from Iowa. However, as I
walked away, I wasn’t sure if I would have wanted to sign the petition or not. Even after teaching the legal and ethical
issues surrounding end of life decisions for nearly 10 years, I’m still on the
fence on this issue.
On the one hand, I am a huge proponent of patient
autonomy. It is my firm belief, from a
legal and ethical standpoint, that patients should be informed of all their
treatment options and be able to choose treatment options without prejudice or
bias from healthcare professionals.
However, as more states choose to legalize physician-assisted suicide,
it becomes clear that not all patients are offered the same choices. Their choices are limited by geography.
Physician-assisted suicide statutes have been passed in
Oregon, Washington, Vermont, California, Colorado, and the District of
Columbia. In addition, court cases have
legalized a patient’s right to end their own life in Montana and possibly New
Mexico (pending new regulations). So, if
you live in one of those states, have a diagnosis of a long-term illness with a
prognosis of six months or less to live AND meet a slew of other qualifications,
you can obtain a prescription for a lethal dose of medication to end your own
life on your own terms. In many cases,
the patients will obtain the prescription and never take the medication – more
of a safety blanket, if you will.
As a huge proponent of patient autonomy, I feel that any law
that gives patients more control is a step in the right direction. However, after reading Atul Gawande’s book
“Being Mortal,” I was swayed in a different direction. If physician-assisted suicide is the best
choice that we can offer patients at the end of life, are we failing our duty
to balance beneficence and nonmaleficence?
If ending a life on purpose is the best way to keep a patient
comfortable in the end stages of a terminal illness, we might really be
focusing on the wrong issues.
That being said, as healthcare administrators, it’s
important to know and understand the law in your state. If your state has legalized physician-assisted
suicide, it is your legal and ethical duty to make sure patients are aware of
that option. Hospice facilities should
have information on the option and educate patients on the availability. Many religious institutions might not feel
comfortable doing this, but failing to inform patients of their options would
be a violation of the Patient Self-Determination act, which protects patients’
right to know ALL treatment options.
If you are not familiar, take a few minutes to learn more
about your state’s position on physician-assisted suicide today: https://www.deathwithdignity.org/take-action/.
Sources:
Death with Dignity: https://www.deathwithdignity.org/take-action/
Being Mortal: http://atulgawande.com/book/being-mortal/
Patient Self Determination Act: http://www.americanbar.org/groups/public_education/resources/law_issues_for_consumers/patient_self_determination_act.html
