Assisted dying is not suicide

This article was first published in The Kansas City Star on 4 August 2018 as "Medical aid in dying is not the same thing as suicide".

 

Dr David R Grube of Compassion & Choices Oregon
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The untimely deaths of Anthony Bourdain and Kate Spade have shone a spotlight on the suicide crisis our country faces. However, it is important to differentiate the act of committing suicide from medical aid in dying.

Suicide is a tragic result of untreated, reversible diseases such as depression or addiction. Suicidal patients want to end their lives as a result of impaired cognition and deficiencies of impulse control. They are most often alone and may use violent means.

By contrast, patients seeking medical aid in dying do not want to die, but they are dying of an irreversible and untreatable disease or condition. Their goal is to end, rather than prolong, their suffering. They are rational and their cognition is intact. They are connected to family and hospice.

Medical aid in dying is a medical practice that gives mentally capable, terminally ill individuals with a prognosis of six months or less to live the option to request, obtain and self-ingest medication to die peacefully in their sleep if their suffering becomes unbearable. It is a well-established, palliative end-of-life care option with clinical criteria and guidelines that meet the highest standard of care.

I am a retired family physician in Oregon with more than 35 years of experience caring for patients in all stages of life through death, including those who have requested and utilized medical aid in dying. When patients are dying from terminal illness and there is no alternative but suffering in their final days, it is crucial that they are presented with options that will enable them the freedom to face their passage from this life in a manner of their own choosing.

There is absolutely no evidence that in states where medical aid in dying is authorized suicide rates have gone up. National and state level data from the Centers for Disease Control and Prevention’s National Vital Statistics System suggest that suicide rates have varied slightly, but overall have gone down in Oregon since its Death with Dignity Act went into effect in 1997. And in the year and a half since California’s End of Life Option Act has been in effect, the state’s suicide rates have also gone down.

Oregon has 20 years of experience with medical aid in dying, with a tremendous amount of data that assures us of the safety and value of this option. We have seen this same trend in five other states with 40 years of combined experience with medical aid in dying: Washington, Montana, Vermont, California and Colorado.

As the data shows, many terminally ill patients get tremendous solace from knowing they have the option of a peaceful death. With the best possible end-of-life care, most patients will not find the need to use medical aid in dying. Yet we all benefit from the option to end terminal suffering should the need arise because these laws spur conversations between patients, their doctor and their loved ones about all end-of-life care options. As a result, we see better use of hospice, palliative care and pain control.

The debate over whether state legislatures should allow people to manage their passages from this life in the face of terminal illness is an important one. It deserves an honest dialogue that doesn’t falsely equate a violent, disruptive act like suicide with a proven medical practice that allows people in the final days of their lives to die a peaceful death.In Oregon, since our medical aid-in-dying law was passed, more people have not died. But fewer people have suffered.

David R. Grube is national medical director for the nonprofit Compassion & Choices Oregon.

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