Opinion: End of life choice part of freedom
In America, we do anything to uphold freedom of choice; it’s what makes us the land of the free. We allow people to jump out of a plane at 10,000 feet in the air, we allow people to buy unlimited amounts of alcohol, and we allow people to walk into supermarkets to buy cigarettes that we know will shed years off their lives.
But the one choice we have difficulty granting is the ability to choose death. The attention physician-assisted suicide (PAS) has garnered in recent years revolves around one question: Doctors are supposed to save patients’ lives, but can they also assist patients who wish to end their own life?
Many would argue they shouldn’t. Physician-assisted suicide, or when a physician provides a prescription for a lethal dose of medication upon the patient’s request, is illegal in all but four states under the pretense that the value of life is precious, and doctors should do all they can to extend their patients’ lives. All which is true, but oftentimes circumstances are beyond medicinal help, even though loved ones might not want to admit or accept that.
For this reason, we spend millions of dollars trying to keep our elderly population alive. Around 30 percent of the Medicare budget is spent on the 5 percent of Medicare patients who die each year — an unreasonable distribution of spending, many would argue, especially given that most treatments only extend life by 4-6 weeks. If a patient who is in excruciating pain or diagnosed with late-stage terminal cancer wants to die, as many deem it, with dignity, why can’t we grant them the freedom to make that choice?
PAS would not be such an issue if it weren’t for the high demand — many doctors feel trapped in a world where it is illegal, yet many patients beg them for drugs that will end their suffering. While 67 percent of doctors oppose PAS, their main reason for doing so is that they believe it violates a doctor’s oath not to harm a patient. This is key: the stigma against the idea of PAS is stronger than the costs of allowing it.
One way to combat this stigma is to remove the label of “suicide.” In itself, suicide is a taboo word, one whose connotations we condone as a society. While PAS is a form of suicide, other terms such as “physician-assisted death” have been suggested as more acceptable alternatives.
Additionally, the cost savings that legalizing PAS would bring are substantial. One 1995 study estimated that 2.7 percent of patients who die each year would chose physician-assisted suicide if legalized. While this is a small number, these patients would forgo an average of four weeks of life, which is estimated to cost $10,118. The authors estimated total savings from legalizing physician-assisted suicide to be $627 million 1995 dollars: That is equal to $976 million 2014 dollars.
That said, existing legal PAS systems are not perfect, as many opponents to its legalization argue. Oregon’s system has no way of prohibiting doctors or family members who may have ulterior motives from prescribing or encouraging PAS, which can lead to abuse of the procedure and an unfair burden on the elderly who might feel pressure to spare their families costs. One solution is to have multiple doctors confirm that there is no treatment available for a patient that will extend their life or alleviate their pain substantially. Another is to include all close family members in on the conversation to avoid one-on-one pressure induced by doctors or family.
Having recently legalized PAS, Vermont must address these issues. If we allow patients to sign a “Do Not Resuscitate” waiver, which respects the wishes of a patient not to undergo advanced cardiac support, we should grant those diagnosed with terminal or painful diseases the ability to chose death over costly and often wasteful treatment.
Of course, oftentimes there is middle ground between PAS and aggressive care — an alternate treatment or diagnosis — so the priority should be to avoid situations where either is necessary. However, we must rethink our labeling of PAS if we wish to remove the negative connotations that the word “suicide” carries, and allow those who wish to die in a period of pain or discomfort to do so.
If highly regulated, PAS has the potential to save our healthcare system millions of dollars, as well as save many elderly and terminally ill patients painful months of their lives. Choice is indeed a powerful thing.
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