Abdelbaset al-Megrahi, the Libyan convicted of the 1988 bombing of a Pan Am flight over Lockerbie, Scotland, died of prostate cancer on May 20. Nearly three years earlier, on August 20, 2009, Scottish authorities had released him on compassionate grounds so that he could return home to die. At the time, he was thought to have three months to live. Some think that al-Megrahi’s survival of his prognosis undermined whatever grounds there were for his early release. But if we set aside his crimes and consider him as a patient with medical needs, his case sheds light on the current proposal for doctor-prescribed suicide in Massachusetts.
Three days before al-Megrahi died last month, the disability-rights group Second Thoughts submitted a challenge to contest a measure on the November ballot in Massachusetts, arguing that the initiative’s language for legalizing doctor-prescribed suicide is “clearly misleading.” Second Thoughts objects in particular to the use of the term “terminally ill.” According to director John Kelly, “People will be encouraged to assume that being ‘terminally ill’ is a biological fact, rather than a human guess.” In the case of al-Megrahi, a human guess resulted in the transfer of a convicted terrorist to his home country of Libya, where, remarkably, he found care superior to what he was receiving in Scotland. The “human guess” that allowed for his release was off by over 1,000 percent.
The Massachusetts initiative proposes that “the public welfare requires a defined and safeguarded process by which an adult Massachusetts resident . . . who has been determined by his or her attending and consulting physicians to be suffering from a terminal disease that will cause death within six months may obtain medication that the patient may self administer to end his or her life in a humane and dignified manner.” The provision that the disease will cause death within six months is central to the proposal. But John Norton, a member of Second Thoughts, points out that “everyone knows someone who has outlived their terminal diagnosis.” As the cases of al-Megrahi and many others make clear, a diagnosis of death within six months is highly speculative — and a weak basis for securing the “public welfare.”
It is important to note that, according to the Wall Street Journal, the U.K.’s National Health Service had denied al-Megrahi “standard docetaxel chemotherapy.” When he was transferred to Libya, he received advanced chemotherapy, radiation, and testosterone inhibitors. To put it plainly, Britain’s rationing bureaucracy denied al-Megrahi the treatment that extended his life nearly three years beyond his 2009 prognosis. In an age of increasing bureaucratic control of health-care decisions, shouldn’t such rationing concern us, especially when we consider the question of legalizing doctor-prescribed suicide?
It has already been documented in Oregon, where doctor-prescribed suicide is legal, that the Oregon Health Plan has refused patients life-saving cancer treatments but offered “comfort care, including ‘physician aid in dying.’” Nor is the state making good on its purported goal of protecting patients from receiving lethal drugs when their decision is influenced by depression: Oregon’s latest annual report indicates that only one of the 71 persons who killed themselves with drugs in 2011 was referred for psychiatric evaluation, even though, according to a 2008 BMJ study, 25 percent of patients seeking doctor-prescribed suicide were depressed. Moreover, 9 of the 71 patients who killed themselves in 2011 received prescriptions for lethal drugs in “previous years,” making clear that the six-month-terminal-illness provision is a farce: “Death with dignity” laws are no more than efforts to elevate doctor-prescribed suicide to an accepted and inexpensive “treatment” under the pretense of compassion.
At first glance, legalization of doctor-prescribed suicide appeals to the libertarian in us all: If someone wants to end his life, who are we to stand in his way? But the members of Second Thoughts know what it is like for a medical professional to assume that their lives are not worth living, and they help us focus on the relevant question: What happens when death becomes a recognized and reimbursed medical treatment for “terminal” conditions? As a teenager, Norton was diagnosed with “terminal” Lou Gehrig’s Disease, but 50 years later he is alive and well.
What about the “terminal” mother who desperately wants to live but feels obligated to choose “death with dignity” so that her children can wrap up the division of her assets and property? What about the father who, on learning that advanced cancer threatens his life, loses for a time the will to live and is offered by his “compassionate” doctor a poisonous dose of barbiturates to end his life with? What about the patient who, in hope of a cure, is awaiting medical breakthroughs? Do these people deserve to be belittled with the offer of a fistful of lethal pills as a treatment option?
Al-Megrahi probably would have died earlier if he had stayed in Scotland, where his survival was balanced against the cost of his survival. In Libya, he was given state-of-the-art treatment for his disease. The prognosis is best when patients are free from pressure to accept the denial of medical care that they need and want. When care is rationed and the crime of assisting a suicide is redefined as medical treatment, the picture changes. Those who may see themselves as a burden on loved ones feel pressure to consider suicide a “treatment” option. How does that promote the public welfare?
— Greg Pfundstein is a member of the board of the Patients Rights Council.