Doctors for Dignity Bulletin – March 2017
We sent the following email, part of a monthly series, to our Doctors for Dignity last week:
Hearings on U.S. Supreme Court nominee Neil Gorsuch begin on March 20. Author of The Future of Assisted Suicide and Euthanasia, Mr. Gorsuch has spent much of his career arguing against legalizing medical aid in dying based on the “inviolability” of human life. The U.S. Supreme Court last visited the issue in 2006 when it upheld (by a vote of 6-3) the ruling that states, not the federal government, have the authority to govern their residents’ end-of-life options.
As lawsuits from patients and doctors in New York, Massachusetts and Vermont continue to progress, it is quite possible that a future U.S. Supreme Court would have the opportunity to weigh in on medical aid in dying.
Watch for an Action Alert urging your Senators to vote against the Gorsuch confirmation.
This month, Compassion & Choices’ National Medical Director Dr. David Grube answers the following:
Q: Isn’t medical aid in dying inappropriate given that prognoses for life expectancy in terminally ill patients can be wrong by months or decades and end-of-life wishes to die can wax and wane?
A: We doctors are much more likely to overestimate our patients’ length of survival than to underestimate. In fact, a study of physicians’ prognostic skills showed that sixty-three percent of us tend to overestimate by 500%.
With cancer, the most common diagnosis among those seeking medical aid in dying, predictions about length of survival are clearer. For many reasons, oncologists, however, are often reluctant to tell patients their disease is not curable. A far greater problem is not informing patients when treatments are no longer likely to have a benefit. According to the National Hospice & Palliative Care Organization, in 2014, nearly half of all hospice patients were enrolled for fewer than 14 days. Similarly, in my experience, most patients request medical aid in dying in the very last days of their life, when the process cannot be accomplished. Clearly, we physicians hold out the hope for patients longer than may be in their own interest.
It is important to remember that medical aid in dying is patient-centered care. The dying individual remains in control and determines if and when to ingest the medication. Of course, if their hospice care allows for them to improve for a time, or if a new and remarkable treatment prolongs their life in a way that they believe isdignified, enjoyable, and tolerable, they can then choose to delay aid in dying, or not opt to employ it. Most recent statistics from Oregon show that approximately 1 out of 3 patients who received a prescription for medication never used it.
In this article, twelve ethicists discuss core issues related to aid in dying in the ICU. All agree that conscientious objection should be respected, but did not reach consensus on the basic ethical dilemmas. This underscores the need for medical professional associations to adopt engaged neutrality as the preferred public policy position.
If you find this resource useful, please forward to a colleague andencourage them to join Doctors for Dignity.
Rebecca Thoman, M.D.
Manager, Doctors for Dignity