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Thursday, April 13, 2017

Hospice is the right choice for end of life care danger with physician assisted suicide

Physician point of view about Physician Assisted Suicide danger

Family and emotional issues leave assisted suicide open to abuse. 

Hospice care is a humane, less risky option.

Maine Voices: ‘Death with dignity’ bill well-meaning, but overlooks 
drawbacks- by Dr. Chuck Radis

PEAKS ISLAND, Maine — Last year, Betty Brown, my elderly Aunt Izzy’s best “friend,” was sentenced to up to 10 years in a West Virginia prison for financial exploitation of an elderly person. As my aunt’s heart failed, Ms. Brown had insinuated herself into every aspect of her life. She took her to doctor’s appointments and church, helped her organize her finances and eventually became her power of attorney.
At the same time, Ms. Brown drew down my aunt’s bank accounts and convinced Aunt Izzy to name Ms. Brown as the sole inheritor of her land and home. There is little doubt in my mind that if Aunt Izzy lived in Maine and the measures proposed under L.D. 347, the “death with dignity” bill, were in place, Betty Brown would have tried to convince my aunt to take her own life.I share this very personal story not because it is a rare occurrence, but because it is all too common. As a practicing physician in Maine for 32 years, I have seen the best and worst of human behavior directed toward those with terminal illnesses. Inheritances are often at stake. Bills are mounting. Patients worry about pain. Depression may cloud judgment. Every aspect of a dysfunctional family may become magnified.
Here’s an example. Years ago, I treated a woman with bladder cancer who suffered a stroke, could not speak and required a feeding tube for nutrition. A family member arrived from out of state and was livid that we were artificially keeping her sister alive. She demanded, as the power of attorney, that we pull the feeding tube, keep her loved one comfortable with narcotics and allow her to die in peace. 

A day went by, and another family member arrived, informing the staff that the sister who was the power of attorney was about to be removed from the will. A lawyer confirmed this. We kept the tube 
in.Can we really write a bill that protects people like my aunt? Can we create and fund a system that can deter people like Betty Brown, who slowly work their way into their victim’s life? Can a Legislature that could not properly supervise the Maine Turnpike Authority while a decade of embezzlement happened under its nose pass a law that safeguards our most frail population? I believe the answer is no.

The Hippocratic Oath states: “I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.” Physicians must be compassionate in their end-of-life care, but they cannot judge whether the intentions of the “two or more witnesses who are … not interested persons,” as required by L.D. 347, are coercive or supportive. We are trained to treat, not to judge.

Sen. Roger Katz and other supporters of this proposal are good people who believe in individual choice, but they downplay the negative aspects of passing L.D. 347.

For one, we have a dysfunctional and poorly regulated health insurance industry. Stephanie Packer, a woman with scleroderma, recently spoke at a news conference about her experience in California, where a similar law was passed in 2015. Her health insurer denied coverage for a medical treatment for her scleroderma, but did agree to cover a lethal medication. With more and more physicians employed by large health care organizations, I am concerned that subtle pressure will be brought to bear to control health costs. The Hippocratic Oath may be an anachronism to some, but it can protect society from the worst abuses of our current health care system.

Lastly, I believe that with the growth of hospice, L.D. 347 is unnecessary. For many who support physician-assisted suicide, their greatest fear is of the unknown. Will my pain be unmanageable? Will I be a burden to my family? Will I lose control?
With hospice, each person’s end-of-life care can be humane, caring and supportive. Hospice not only treats the patient who has a terminal illness, but also helps family and friends navigate their own complex feelings toward death and dying. It is not about a pill or a shot. It is about community and hope. It protects those at risk – like my Aunt Izzy.

Dr. Chuck Radis of Peaks Island has practiced in Maine as both a primary care physician and a specialist in rheumatology, for 32 years.

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