“Inconvenient truths” undermine case for Physician-Assisted SuicideBy Dave Andrusko
I was lucky enough to be included in an email distributed to a number of people and organizations who are fighting the scourge of physician-assisted suicide. Included was a link to a fascinating piece that ran in the Psychiatric Times.
The author, Steven A. King, MD, MS, is described as being in private practice of pain medicine in New York. Dr. King is also Clinical Professor of Psychiatry at the New York University School of Medicine. We’re taking time to discuss his report because it reminds us of what Dr. King calls “inconvenient truths” which are too often lost in the debate over physician-assisted suicide.
King tells us he has no particular religious convictions, so the oft touted claim that opposition to PAS is essentially confined to folks of faith doesn’t apply to him. That is just one of many “inconvenient truths” he highlights.
Not being a physician, I was completely unaware how some/many argue that being depressed, so to speak, goes with the territory of wanting to be “assisted” to die. For me the most important paragraphs in “Physician-Assisted Suicide: More Than Meets the Eye” address that very troubling reality. Referring to the requirement “that if the attending physicians believe a mental disorder is a potential factor in the request, they need to make a referral to a mental health specialist, usually defined in the laws as a psychiatrist or licensed psychologist,” King writes
Any psychiatrist who has been involved in consultation/liaison psychiatry can readily recognize inherent problems in the laws. Most non-psychiatrist physicians have limited training in mental illness, so relying on them to identify such illness is a chancy proposition.
Furthermore, when it comes to terminally ill patients, there is a widespread perception that depression is normal and that there is no need to address it. The executive editor of the New England Journal of Medicine once wrote, “Dying patients who request assisted suicide and seem depressed should certainly be strongly encouraged to accept psychiatric treatment, but I do not believe that competent patients should be required to accept it as a condition of receiving assistance with suicide.” Some physicians fear that referring patients to psychiatrists and psychologists is an insult to the patients by indicating it is felt that they are considered “crazy.” A study from Oregon found that of those who died under its RTD law in 2014, fewer than 3% were referred for a mental health evaluation.
It has bothered me that many proponents of RTD laws choose to overlook this, preferring to leave the impression that this isn’t a problem and that every terminally ill person receives expert palliative care. When confronted with the evidence of the reality of deficiencies in pain management, they acknowledge it is a problem that needs to be corrected but that it shouldn’t stop the passage of RTD laws. …
Untreated pain or fear of it is far from the only reason for suicide requests but—along with a desire not to be a burden to others, fears about loss of autonomy, and depression and hopelessness—it is one of the most common.
Source: NRLC News