LETTER: On physician-assisted suicide

To the Editor:

“I will give no deadly medicine to any one if asked, nor suggest any such counsel.” This is an excerpt from The Hippocratic Oath – the oath that guides my practice as a physician. On the November ballot, the Massachusetts Question 2 about physician assisted suicide, runs contrary to the foundation of medical practice. Since the 5th century BC when Hippocrates crafted the oath, the notion of Physician Assisted Suicide (PAS) has been debated in Western Society and repeatedly rejected as a violation of civilized behavior.

If adopted, MA Question 2 would legalize PAS for terminally ill patients who have fewer than six months to live. The assumptions underlying this question are erroneous. In 27 years as a primary care physician, I have never told a patient how long he or she has to live. An individual lifespan is scientifically impossible to predict with exactness. Time and time again, standards in medical literature that project survival for particular diagnoses are wrong. Today in my practice, I have numerous vibrant patients who have long outlived calculated life spans. This is not only for people with cancer, but diseases like multiple sclerosis, chronic obstructive pulmonary disease, kidney failure and heart failure. I never tell my patients how long they have to live. Why? Because the best prediction is based on old literature and past practice. New therapies combined with preventive and behavioral medicine change the true experience of each disease.

What motivates some people to elect PAS? Those who support Question 2 typically cite the patient’s right to self-determination and desire to avoid pain. But, the little we know from pre-death interviews in states such as Oregon, Montana and Washington shows otherwise. Some patients claim that it is their inability to do what they want to do that motivates their desire for death. Not wanting to burden loved ones can also motivate the choice to elect suicide. For my work as a physician, part of the job is helping patients and families to adjust to new circumstances. People who fear losing control of basic bodily functions can grow to realize that their humanity is about so much more than those acts. Despite new limitations, they can still fulfill significant roles in their communities and families. Furthermore, clinical depression is present in at least 25 percent of people with chronic illness. Depressed people think about suicide. Depression, however, is treatable. Question 2 does not mandate that the patient submit to evaluation and therapy for depression. Furthermore alleviating pain and suffering is the objective of all doctors. Some even specialize in hospice and palliative care.

Again, the Hippocratic oath guides practice: “I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.” In working with the sick, I am in awe of my patients. Sickness presents the opportunity for partnership for healing and caring among the doctor, the patient, the family and the community. I see people bear their illnesses with extraordinary dignity. I see families pull together and grow in love when faced with hardship. I see amazing generosity and goodness come from surrounding community members who rally kindness for the frail. Illness can be a time of growth and dignity for both the sick person and us.

Question 2 is prejudiced against certain classes of sick people. As written, it demands the patient to consent and to swallow his or her own lethal pills. People with dementia, with confusion or in a coma are disqualified. People with multiple sclerosis or Lou Gehrig’s disease who could not swallow are excluded. In states that already have the PAS practice in place, more prescriptions are written and filled than are ever actually consumed. What about those lethal doses of pills sitting in medicine cabinets? Who else might swallow them? Then there is the ugly instance of a patient who took the pills but didn’t die. What then? Does society leave the patient in the agony of moribund paralysis or resuscitate and revive? A great privilege of my work as a doctor is to be present with people at their comings and goings — at births and deaths. Sadly, Question 2 excludes the physician presence with the patient at this end of life.

What is the true motivation for the Question 2 ballot initiative? Question 2 is thinly veiled to look like an act to alleviate suffering and promote self-determination. But to promote “suicide” – the taking of one’s own life, a lonely act for a vulnerable soul, is a sad commentary for a civilized society. Really, Question 2 simply devalues human suffering. It abhors the natural human life by promoting premature death. Question 2 undermines the work of a physician – to care for patients from birth to natural death. The Massachusetts Medical Society wants Question 2 defeated. As a doctor and 27 years witness to the courage and dignity of people as they live and die, I too urge the defeat of Question 2.

Respectfully submitted,

Mary Louise C. Ashur MD
Associate Professor, Health Services, School of Public Health at BU School of Medicine
Clinical Instructor in Medicine, Harvard Medical School
(617) 696-7601
mashur@bidmc.harvard.edu