The Wall Street Journal posted an opinion piece this morning about the impact of doctor-assisted suicide on the practice of medicine. The author of the piece is Dr. William L. Toffler, national director of Physicians for Compassionate Care.

The article points out that in recent years, there have been about two dozen suicide bills introduced in legislatures in America. Dr. Toffler suggests that before we support these measures, we examine what has happened to the practice of medicine in Oregon, where assisted suicide was introduced 20 years ago.

The article details some of the impact of assisted-suicide laws:

In one case a patient with bladder cancer contacted me. She was concerned that an oncologist treating her might be one of the “death doctors,” and she questioned his motives. This was particularly worrying to her after she obtained a second opinion from another oncologist who was more positive about her prognosis and treatment options. Whichever of the consultants was correct, such fears were never an issue before.

Under Oregon’s law, a patient can request lethal drugs only if he has a terminal illness and less than six months to live. However, it is nearly impossible to predict the course of an illness six months out, and many patients given such prognoses live full, rewarding lives long past six months.

There is also the question as to whether cost enters into assisted-suicide decisions:

Also concerning are the regular notices I receive indicating that many important services and drugs for my patients—even some pain medications—will not be covered by the Oregon Health Plan, the state’s Medicaid program. Yet physician-assisted suicide is covered by the state and our collective tax dollars. Supporters claim physician-assisted suicide gives patients choice, but what sort of a choice is it when life is expensive but death is free?

It also appears that the statistics on physician-assisted suicide are being hidden:

A shroud of secrecy envelops the practice of assisted suicide. Doctors engaging in it do not accurately report the actual manner of death. Instead they are required by state law to fabricate the death certificate, stating that the cause is “natural” rather than suicide. In late 1997, right before assisted suicide was about to begin, the state legislature implemented a system of two different death certificates—one that is public and includes no medical information and another that is kept private by the state. As a result, no one outside of the Oregon Health Division knows precisely how many assisted suicides have taken place, because accurately tracking them has been made impossible.

Dr. Toffler shared his own experience with a patient afflicted with MS:

One inquiry came from a patient with a progressive form of multiple sclerosis. He was in a wheelchair yet lived an active life as a general contractor. I asked him how the disease affected his life. He acknowledged that MS was a major challenge and told me that if he got too much worse, he might want to “just end it.”

I told him I could understand his fear and frustration and even his belief that assisted suicide might be a good option. I also told him that should he become sicker or weaker, I would work to provide him the best care and support available. No matter how debilitated he might become, his life was, and would always be, inherently valuable. As such, I said that would I not recommend nor would I participate in his suicide. He simply replied: “Thank you.”

As our population ages, there will be an increase in the number of terminally ill patients. Most of us have watched a loved one struggle with terminal illness and wondered what in the world was being accomplished by their suffering. I suspect we will never know the answer to that question. However, we need to look at the impact of doctor-assisted suicide on the practice of medicine.

When researching this article, I discovered the following at Wikipedia:

It is a popular misconception that the phrase “First do no harm” (Latin: Primum non nocere) is a part of the Hippocratic oath. Strictly speaking, the phrase does not appear in the oath, though an equivalent phrase is found in Epidemics, Book I, of the Hippocratic school: “Practice two things in your dealings with disease: either help or do not harm the patient”.  The exact phrase is believed to have originated with the 19th-century surgeon Thomas Inman.

It seems to me that even if “First do no harm” does not appear in the Hippocratic oath, it is a really good idea. I have no answers as to why some people suffer through terminal illness, but I also do not feel that as mere human beings we have the right to decide when a person dies. I truly think that decision is above all of our pay grades.

Just as an aside, I recently attended my 50th High School Reunion. The person I sat next to at the reunion was told years ago that he would only live a few months (he had cancer). He was sitting next to me, cancer free, and fully alive. It would have been a shame if someone had wanted to ‘end his suffering,’ which I am sure he went through in fighting the disease.