Physician Assisted Suicide is a horrible end of life policy to end the lives of mentally ill people

Physician Assisted Suicide (PAS) or Medical Assistance in Dying (MAID) is morally and ethically wrong. Full Stop. The ambiguity around this method of mis-treating end of life care by normalizing suicide is personally disgusting to me. In fact, suicide is among the most prevalent causes of death in the U.S. With tens of thousands of people perishing from suicide each year, it is the 10th leading cause of death overall.

Suicide prevention ribbon

Suicide is already a tragic act by people who are victims of substance use disorders or because of untreated depression.  Creating the policy to normalize suicide is just morally inconsistent with improving the human condition.   

Echo report published in MedScape Nurses:

One of the most controversial issues today is whether a physician should be permitted, or even obligated, to assist patients with a terminal or incurable illness to end their life — a process known as medical assistance in dying (MAID) or physician-assisted suicide (PAS.)

Until recently, this contentious issue applied only to patients with physical illnesses who want to end their suffering and who seek out a physician willing to assist with that objective. 

In the United States and other countries, this is the patient population who may be able to avail themselves of this option.

However, newly proposed legislation in Canada — which has the largest number of physician-assisted deaths worldwide — would expand the indication for MAID to include serious mental illness. Originally set to be passed in March 2023, the law has been deferred for final decision until March 2024. (This policy issue in Canada is a mystery to me because Canada already has a population deficit problem but killing their own is now accepted? Makes no sense.)

A recent Medscape commentary by psychiatrist Dinah Miller, MD, explored the ethics of this proposed legislation for mental health professionals. "To offer the option of death facilitated by the very person who is trying to get [patients with serious mental illness] better seems so counter to everything I have learned and contradicts our role as psychiatrists who work so hard to prevent suicide," Miller writes. "As psychiatrists, do we offer hope to our most vulnerable patients, or do we offer death? Do we rail against suicide, or do we facilitate it?"

Miller's piece garnered a huge amount of reader response that included many, laudatory comments: a "nuanced and open-ended inquiry here," "timely and honest," and "beautifully written." 

One reader thanked the author for "this thoughtful, questioning, and open reflection on what it means to be a psychiatrist facing a thorny and deeply personal practice and philosophical question."

Cognitive Distortion or Objective Reality?

Vincent van Gogh had a history of mental illness. He painted Starry Night in 1889 during his stay at the asylum of Saint-Paul-de-Mausole near Saint-Rémy-de-Provence.

Many readers were opposed to any type of physician involvement in hastening a patient's death, regardless of whether the condition is medical or psychiatric. "Let others who wish to die make their own arrangement without the aid of the medical profession," one reader writes.

But others felt that for those with terminal physical illnesses or intractable pain, it is justified for medical professionals to either facilitate death or, at the very least, withhold life-prolonging treatments.

A critical care physician described responding to families' accusations that withdrawal of life-sustaining measures means "playing God." On the contrary, the physician writes, "there is a limit to our abilities; and withdrawing those life-prolonging interventions allows nature or God or whatever to play a role and take its course."

Another US reader pointed out that "multiple polls in this country have shown that the majority of the general public, physicians in general and psychiatrists in particular, support the option of MAID for the terminally ill. They do not find it at variance with their calling as physicians." (So, what is the purpose of the physicians' Hippocratic oath to "first do no harm")

"I and many of my elderly friends don't fear death but fear prolonged dementia with its dependency and lack of quality of life," one reader writes. "We would be much more at peace if we could put in our advanced directive that we request MAID once some point of dependency has been reached."

(P.S. Maine Writer- a person experiencing dementia is not competent to make any decisions. Selecting suicide to end their lives is morally, ethically and legally wrong.)

Unethical for Dr. Bill Cassidy to defend slash and burn of Medicaid

William Morgan Cassidy (born September 28, 1957) is an American physician and politician currently serving as the senior United States Senator from the state of Louisiana.

Physicians all over the world hear their patients cry for lack of ability to pay for curative treatments. 

Dr. Bill Cassidy, the physician turned politician and Louisiana Senator, knows what his patients have endured or given up in their struggles to afford health care.  Consequently, he should be defending Medicaid and the expansion of this benefit to more poor people, rather than forcing un-vetted legislation with Senator Lindsey Graham, for the purpose of capping the reimbursement in a "slash and burn" bill, to erode this important benefit.

Hippocratic Oath- "do no harm"

In my opinion, it's unethical for Dr. (Senator) Cassidy to support the Graham-Cassidy bill to repeal Obamacare, aka the Affordable Care Act.  In his profession of being a physician, he should seriously remember the Hippocratic Oath and protect his patients from avoidable harm.  

Instead, Dr. Cassidy is supporting the repeal of public policy, the ACA, that has helped to provide uninsured people with health coverage for the purpose of gutting Medicaid. I can't help but believe there are #KochBrothers incentives behind this unethical behavior. In other words, some back door deals. Maybe this unethical connection can't be proven, but Dr. Cassidy's behavior mystifies me because he is not exercising good or ethical judgement.

Nevertheless:

Cassidy defends his repeal bill as provider and insurer groups heighten criticisms~ by Virgil Dickson

One of the Republican co-authors of the new Senate bill to repeal and replace the Affordable Care Act said at a hearing Monday that the biggest beneficiaries of his bill are the states that chose not to expand Medicaid.

"I think if you're in a state that did not expand Medicaid, you are pleased about this bill," Sen. Bill Cassidy of Louisiana said at the Senate Finance Committee hearing to consider the Graham-Cassidy bill.

The bill would convert the ACA's funding for premium and cost-sharing subsidies and Medicaid expansion into $1.2 trillion in state block grants through 2026 and let states design their own systems, with few limitations on how they could use the money.* There is no provision for funding the block grants after 2026.

States that expanded Medicaid and enrolled lots of people in ACA marketplace plans would suffer the biggest financial losses. Many of those states, such as Ohio and West Virginia, are represented by GOP senators whose votes are needed to pass the bill.

Over the weekend, Republicans added $14.5 billion to the measure including extra funds for states of wavering GOP senators. But hospital leaders in those states remained fearful that the bill would lead to a loss of coverage in their states and a rise in uncompensated-care costs.

A chart that Senate Republicans circulated said the bill's revised version, released Monday morning, would provide 14% more federal funding for Arizona than under current law, Kentucky would get a 4% increase, Texas 49%, Alaska 3% and Maine 43%.

Alaska and Maine are represented by Sens. Lisa Murkowski and Susan Collins, respectively, two Republicans who helped kill the previous Senate repeal bill and whose votes are pivotal to passing this one.

The amended bill adds hundreds of millions of dollars in funding for sparsely populated states such as Alaska.

"It is highly unlikely that they could make enough funding or policy changes to end our concern," said Shayna Diamond, a spokeswoman for the Arizona Hospital and Healthcare Association.

Hospitals in Alaska also remained unmoved by the eleventh-hour changes to bill. Even with the additional money, on a net basis the state still would be a loser, said Becky Hultberg, CEO of the Alaska State Hospital and Nursing Home Association.

"It would still result in an increase in the uninsured population, and the bill's block grants would be technically challenging to implement," she said. "Both of those remain major concerns for the association."

Hospitals in Maine were concerned that there were still too few details about the bill to determine the impact, said Becky Schnur, a spokeswoman for the Maine Hospital Association.

Physicians, hospitals, insurers and patient groups also continued to slam the bill Monday.

The American Academy of Family Physicians said the revised version of the bill released over the weekend fails to ensure coverage for essential benefits. It issued a joint statement with America's Health Insurance Plans, the Blue Cross and Blue Shield Association, the American Hospital Association and the American Medical Association opposing the bill.

The AAFP said the Graham-Cassidy bill allows insurers to charge older Americans premiums that are five times greater than those for younger people. The bill would destabilize the individual insurance market and end the Medicaid expansion for low-income adults, the AAFP said.

"The result will be millions of Americans who have no access to needed medical care because they cannot afford or are denied health insurance," AAFP President Dr. Michael Munger said in a written statement.

*"few limitations on how to use the money?"- Including skillful u$e to creatively balance state budgets!