‘Do no harm.” Three short words, but to physicians they represent a sacred charge. Three short words that now hang in the balance here in the District of Columbia, after the D.C. council passed the Death with Dignity Act (Act 21-577), legalizing physician-assisted suicide in the nation’s capital. In authorizing doctors to violate the Hippocratic oath of “do no harm,” physician-assisted suicide undermines a key safeguard that protects our nation’s most vulnerable citizens and helps to ensure our loved ones receive the best medical care when they need it most.
Personally, as doctors, we are concerned about providing care and comfort to those facing the heart-wrenching difficulty of dealing with a terminal disease. It is an issue close to our hearts. However, for patients with terminal diseases who are not seeking treatment and instead coping with the complexities of end-of-life preparations, there are already a myriad of end-of-life care options currently at a patient’s disposal.
Instead of simply providing end-of-life comfort, D.C.’s new law is poised to do more harm than good. Even those disagreeing on the merits of the larger issue should take a close look at the text of Act 21-577, which leaves patients unprotected, doctors unaccountable, and our most vulnerable citizens at risk of having fewer medical options at their disposal rather than more.
Act 21-577 allows adults diagnosed with a terminal disease, having less than six months to live, to receive a prescription for medication to end their life. There are concerns that the definition of “terminal disease” is too broad, since most doctors will admit that accurately predicting life expectancy is almost impossible. Additionally, many conditions, such as diabetes and HIV, are considered “incurable and irreversible” or “terminal” if left untreated.
One of the greatest concerns that medical professionals have about Act 21-577 is its failure to adequately protect patients from potential coercion and abuse. When someone is considering ending his or her own life, regardless of the reason, he or she is in a vulnerable mental and emotional state. A report by the National Institute of Health found that, contrary to popular belief, pain is not the primary factor motivating patients to seek assisted suicide. More frequently cited motivations include depression, hopelessness, dependency, and loss of control or autonomy. Despite the fact that depression is commonly associated with a patient’s seeking assisted suicide, D.C.’s legislation does not make screening for mental illness mandatory. It also has no safeguard against pressure that family members, heirs, or health-care providers might exert on a patient to choose assisted suicide. This leaves some of our nation’s most vulnerable citizens — the disabled, the elderly, and those fighting mental illnesses — at the most risk under this law.
Additionally, a stunning lack of accountability is built into the bill, as doctors self-report their participation in assisted suicide and their compliance with regulation. Compliance with the bill’s limited safeguards is difficult to track because the bill directs doctors not to place the actual cause and manner of death (assisted suicide) on the death certificate, and the reporting requirements in the bill are not subject to the Freedom of Information Act. Once the prescription for lethal medication is filled, oversight is non-existent. This means that after the lethal medication, which can cause death in hours, leaves the pharmacy, it can be left unsecured in the medicine cabinet or on a bedside table. The lack of oversight opens up a number of potential nightmare scenarios: The medication could be accidentally taken by a child. It could be administered to a patient against his or her will. It could be used on an individual for whom the medication was not intended.
Perhaps most troubling of all, under the new law, patients may end up with fewer options, not more. D.C. residents who are not able to pay for health care out of pocket may find their options severely limited when facing a new diagnosis, suffering from a chronic illness, facing a disability, or struggling with mental illness. For certain medical conditions, assisted suicide could become the cheapest option. By some estimates, lethal medication costs no more than $300. The consequences could be harmful on two levels: given less incentive, innovative treatments could become less likely to develop, and then insurance programs could deny payment for costly treatment options even if they prove to be successful for many cases.
At age 53, Randy Stroup was living in Oregon after assisted suicide was legalized there. Uninsured and fighting prostate cancer, he was relying on Oregon’s state-run health plan for care when he applied for an expensive form of chemotherapy that his doctor recommended and was denied. Instead, he received a letter informing him that the state of Oregon would pay for physician-assisted suicide. As much as we wish it weren’t the case, cost factors into practical implementation of health-care policy. Because assisted suicide could end up being the cheapest “treatment,” it’s not difficult to see how patients could be incentivized to end their lives when the alternative is a costlier treatment option.
Ultimately, whatever its intentions, D.C.’s new law puts patients at risk and could limit their access to high-quality health care. It prioritizes cost over compassion. Since the Constitution charges Congress with legislative jurisdiction over D.C., Congress has a duty to carefully scrutinize this bill, its impact on medical patients, and its effects on our health-care system. We have weighed the legislation and found it wanting. D.C. residents deserve better.