I respect the personal and professional opinions of Dr. Mark J. Rollo, M.D., who opposes medical aid in dying, which he chooses to call physician assisted suicide. Each of us has our own story and philosophy on end-of-life care. This is mine.
My father loved life and wanted to live it to the fullest. He was a proud and dignified physician, a high school valedictorian, Phi Beta Kappa in college, president of his medical school Class of 1942 at NYU, a WWII veteran, and past president of the Kings County Medical Society. What happened in the last month of his life was a tragedy and a failure of the medical system.
He fought metastatic prostate cancer valiantly for eight years. On Aug. 31, 1998, he assembled our family to announce the fight was over. He was going into in-patient hospice care and would be dead by the end of the month. He lost a pound a day, had black and blue marks all over his body, and when not sedated to sleep was awake, crying with uncontrolled bone pain. When he stated, “It’s taking me too long to die,” my mother, married to him for over 50 years, collapsed hysterically. He died on Oct. 2, 32 days after his prediction. Upon his death, my mother tearfully said, “Don’t let this happen to me.”
As physicians bring babies into this world with multiple modalities, prevent disease with immunizations, cure us when we are sick during our lifetime, replace worn joints and ineffective hearts, livers and kidneys with new ones, they should be able to administer to our pain and suffering at the end of life. When quality of life is significantly diminished and the semblance of activities of daily living are no longer, when death is inevitable, we must allow for a humane demise.
Gallup and Harris Polls show 75 percent of Americans feel medical aid in dying is another end-of-life choice along with hospice and palliative care. Patients want autonomy, choice and control. They may not even use the medication, but just in case. Doctors across the country are now 56 percent in favor of medical aid in dying by medscape polling. In other words, with people living longer and with the tyranny of technology, the landscape has changed. Doctors have an obligation to relieve pain and suffering that has taken on a very different meaning than when the AMAand the MMS formed their policy years ago. Antiquated policies need updating to reflect the reality of modern medicine.
National health care organizations increasingly support medical aid in dying. These groups include the American Public Health Association, American College of Legal Medicine, American Medical Women’s Association, and the American Medical Student Association. In addition, the American Academy of Hospice and Palliative Medicine has adopted a neutral position.
Five state medical societies (Oregon, Washington, California, Colorado and Maryland) have adopted a neutral position and withdrawn opposition to medical aid in dying. Six states have made it legal: Oregon, Washington, Montana, Vermont, California, Colorado and most recently, the District of Columbia.
The Massachusetts state Legislature is considering an Act to Affirm A Terminally Ill Patients’ Rights to Compassionate Aid In Dying. Alawsuit for “Right to Die” by Roger Kligler, M.D., and Alan Steinbach, M.D., is pending At the AMAthis weekend in Chicago, the Committee on Ethics and Judicial Affairs is holding a forum to hear testimony on the issue. Resolution 14, “The Need to Distinguish Between Physician Assisted Suicide and Aid In Dying,” will be debated the next day by the Committee on Constitution and Bylaws.
By the end of the summer, the Massachusetts Medical Society will be polling its members about their position on medical aid in dying, Resolution I-16 A-102. Focus groups in favor have repeatedly made the point that suicide involves a generally healthy person, who is emotional or depressed, and impulsive. Medical aid in dying involves a terminal patient with six months to live, who is rational, realistic and thoughtful. He has time to plan a time and a place of death under safeguards.
Because this is a polemic issue for physicians, it is my belief that a position of thoughtfully debated neutrality may be the only answer to this moral and ethical question. Neutrality will allow each physician to decide which end-of-life treatment can be offered or administered in good conscience in the final days of the patient-doctor relationship.
Eric J. Ruby, M.D., is president of the Massachusetts Medical Society’s Bristol North Chapter Legislative Committee and co-sponsor of the Medical Aid-In-Dying Survey.
Upon his death, my mother tearfully said, “Don’t let this happen to me.”