Dramatic change to medical culture

By Merrill Matthews via www.philly.com

RFD-Right-to-Die-tmagArticleCalifornia has joined four other states allowing physicians to write lethal prescriptions that dying patients can administer to themselves.

Oregon was the first, blazing that trail in 1997. But with only five state “victories” in nearly 20 years, you can’t really call physician-assisted suicide legislation a trend. Indeed, there is a lot of public resistance to it.

Why? There is widespread concern that embracing physician-assisted suicide will change the culture of medicine and the nature of the doctor-patient relationship, as well as undermine the country’s longstanding value for the sanctity of life.

Before more states take such a step, they should seriously weigh several questions:

Is demand for physician-assisted suicide widespread? No. For example, 859 Oregonians have taken advantage of the state’s law through 2014; that’s an average of about 50 a year in a state of four million.

Will it change the way medical providers practice? Physician-assisted suicide undermines the first principle of medical providers: First, do no harm. That’s why the American Medical Association’s code of ethics opposes it, noting: “Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer.” Taking that step can change doctors and the doctor-patient relationship.

Dr. William F. Toffler, a professor of family medicine at Oregon Health and Science University, wrote recently in the Wall Street Journal, “I have seen firsthand how the [assisted-suicide] law has changed the relationship between doctors and patients, some of whom now fear they are being steered toward assisted suicide.”

Will constrained budgets mean denial of care? For decades, both patients and physicians have complained that private health insurers would deny paying for certain types of care – especially very expensive care – to boost profits.

While the Medicare and Medicaid programs are not for profit, both are under pressure to keep health-care costs down. And with President Obama’s health-care law driving up costs, that cost-control pressure will only intensify.

If a very expensive new cancer drug emerges in a physician-assisted suicide state, but the average extra survival time it provides isn’t that long, a state might decline to cover it for Medicaid patients because it doesn’t meet the state’s cost-benefit ratio.

In short, the cost of death is so much more affordable than the cost of life that it could become an option.

Are the poor and disabled more vulnerable? Disabilities organizations certainly think so, which is why many oppose physician-assisted suicide. Health-care rationing always targets the sickest, poorest, and most marginalized patients, who often include the disabled.

Given a fixed amount of available funds, governments and doctors want to help as many people as possible for as long as possible. That’s why many have long argued that it often makes economic sense to give inexpensive palliative care to those close to death – Oregon’s law limits assisted suicide to terminal patients with six months or less to live – and save as much as possible for others. Physician-assisted suicide laws make that task easier.

What drives most public support for assisted suicide is the understandable desire for terminal patients to have that option – just in case. But once turned into law, it opens a number of doors that may never be closed.

Physician-assisted suicide will slowly erode the medical culture and create red flags for the terminally ill and disabled. Even if the vast majority of providers, insurers, and officials act appropriately, there will be a fear that care for the sickest and weakest among us has deteriorated. That already seems to be happening where the law has been in effect.

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