By Dr. Paul Sansone
I read with interest the opinion that, in states where physician aid in dying is legal, there does not appear to have been any disproportionate impact with the use of this act upon persons with disabilities, nor any other vulnerable population. The journal article quoted within the piece is interesting and, while it does not truly clarify that vulnerable groups are not impacted by medical aid in dying, it does reference significant statistics relative to those most likely to participate. In particular, the state of Oregon, where the death with dignity act has been legal for over 20 years, the data are notable for the population that most frequently utilizes it.
Representing the vast majority are white people, who account for 97% of those who use the act. It is also telling that many are well-educated – 53% hold a bachelor’s degree or higher. In reference to the article’s comment “that a disproportionate percentage of people of color and poor people have not used medical aid in dying,” I submit that this may be more the result of choice, and not from discrimination or lack of access.
The authors make an important distinction regarding the values highly cherished by people with disabilities and others who support physician aid in dying, including “autonomy, independence and self-determination.” The data from Oregon show clearly that the primary and overwhelming reason people seek to end their lives by ingestion of a lethal dose of medication is related to autonomy (91% of the time), and declining ability to engage in enjoyable activities (90%). Much less common is intolerable suffering, or fear of future suffering, at 27% of the time.
These data contrast with the argument frequently proposed by advocates for passing legislation in favor of medical aid in dying: they usually highlight avoidance of intolerable pain and suffering as the impetus for their cause. Clearly this is not the case, as evidenced by Oregon’s statistics. As a physician in hospice and palliative medicine, I can confidently attest to the ability to markedly reduce pain and suffering, especially for those enrolled in hospice. We have developed highly effective means to mitigate pain and other burdensome symptoms while not hastening death. For hospice patients at home whose symptoms are not well controlled, they can be admitted to the hospital where more intensive measures can be employed.
The authors also seem to conflate withdrawing or withholding extraordinary treatment and choosing physician assisted suicide. Withholding therapy that is burdensome and no longer of any clear benefit, such as the person with metastatic cancer whose disease is progressing despite multiple regimens of chemotherapy, is ethically appropriate. Withdrawing treatment, as in the case of someone in the intensive care unit dying of Covid-19 on a ventilator and other life-sustaining treatment, is also morally acceptable. Both scenarios represent people in the process of dying of their respective diseases and allow for a natural end-of-life. Clearly, these two examples are not the same as someone ingesting a lethal dose of medication with the explicit intention of ending their life. A person with a terminal illness who partakes in physician aid in dying dies as a direct result of voluntary ingestion of lethal medication, not from the natural progression of their illness.
This brings us back to the issues of autonomy and self-determination, and why it is wrong to allow people to take their own life with a fatal dose of prescribed medication. Regardless of one’s cultural, religious or ethnic background, there are certain moral truths inscribed upon the heart of each and every woman and man. Who among us would argue that stealing, for example, is morally acceptable? I suggest the verdict against this would be unanimous. Even more so, the taking of innocent life — either one’s own or that of another person — would never be considered ethically appropriate. Autonomy is a highly valued gift and should be respected. However, it has limits. The legal right to end one’s own life crosses a morally acceptable boundary and is unnecessary in coming to a meaningful and dignified end-of-life.
Dr. Paul Sansone is Director of Palliative Medicine at St. Joseph’s Hospital, in Syracuse.
Source: “Medical aid in dying puts all groups at risk,” Syracuse.com