By Marisa Demarco
April 12, 2012
Dr. Aroop Mangalik has been a cancer specialist for 30 years. He cares for a lot of people who are nearing the end of their lives. Sometimes—rarely—a terminally ill person in a lot of pain asks for a lethal dose of medication. “And the few times that request has been made, I told the patient, Sorry, given the law in New Mexico, I cannot do that.”
It’s a hard thing to say, he acknowledges, when someone is suffering immensely and there is no cure in sight. “We try and find as many other ways as we can to keep them comfortable.”
Mangalik and his colleague, Dr. Katherine Morris, are part of a lawsuit filed in District Court requesting clarification of a state law. The statute on the books makes it a fourth-degree felony to help someone take his or her life. The suit argues that the law doesn’t apply to a licensed physician providing aid to a dying person who’s mentally competent. The suit also makes the claim that state law is overly vague and violates the state’s constitution.
The doctors are represented by the American Civil Liberties Union of New Mexico and the legal branch of national nonprofit advocacy group Compassion & Choices. Mangalik and Morris work at the University of New Mexico’s Cancer Center, but Mangalik says he and his colleague are acting independently in filing the lawsuit and do not represent UNM.
Complicated issues surrounding what’s being termed “aid in dying” have become more prevalent in the last 40 years, Mangalik says. “The problem has been aggravated by the development of intensive care units and other advances in medicine.” It used to be that when people became seriously ill, they would grow weaker and eventually die. “But now, with the use of all variety of drugs, oxygenation and all of these things, you can keep the body going for long periods of time.” He avoids the word “alive” deliberately.
While a patient is propped up by modern medicine, family members hope for recovery. “That does happen in some cases.” But for certain stages of disease, he adds, there is no treatment.
Morality and Freedom
Two states— Oregon and Washington—have passed laws legalizing aid in dying. Montana’s Supreme Court ruled in 2009 that state law protects physicians who help a terminally ill patient seeking death. Compassion & Choices cites a 2005 Gallup poll and a 2011 Harris poll showing that more than two-thirds of Americans support allowing physicians to assist in the death of terminally ill patients.
Last year, the United States Conference of Catholic Bishops issued a policy statement opposing assisted suicide. “Catholic teaching views suicide as a grave offense against love of self, one that also breaks the bonds of love and solidarity with family, friends and God,” wrote the bishops. They say people fear being kept alive past life’s natural limits “by burdensome medical technology,” but that’s when the infirm truly need the support of the community, “assistance of others to assure them of their inherent worth.”
Laura Schauer Ives, managing staff attorney with the ACLU, says this is a personal freedom issue. “This is a right and a decision that people want to be able to make.” Terminally ill people aren’t likely to use their final days to file a lawsuit to ensure their rights, she points out.
With regard to New Mexico’s lawsuit, she says, it’s not a question of morality but of clarity. The assisted suicide statute does not specify that medical treatment is against the law, she says, and such treatment is not suicide. “We’re arguing for an individual to be able to make this very personal, private decision with their physician.”
Schauer Ives predicts it might be a couple of years before the lawsuit is resolved, especially if it makes it up to New Mexico’s Supreme Court.
Do No Harm
Everyone’s heard the story: The doctors tell a patient he has six months to live, but here he is 10 years later. “There’s no question that prediction is fraught with uncertainty,” says Dr. Mangalik. “For some diseases, it’s easier to make that prediction.” Terminal illness is defined by law and by Medicare, he says, and mental competency is also defined by the courts. If the lawsuit is successful, and both requirements are met, “a doctor would be doing a legal act by writing that prescription,” Mangalik says.
It’s generally considered best practice for patients to ingest life-ending medication themselves. At Dignitas, an assisted suicide clinic in Switzerland, employees film patients taking the medication to avoid legal trouble.
For many years, Mangalik has spoken against unnecessary medical procedures performed on the terminally ill. It’s part of a spectrum of end-of-life dilemmas that includes aiding a patient’s death, he says. “Many doctors and patients say, Oh let’s try this. Oh, let’s try that. I feel that many of those treatments also lead to discomfort and the prolongation of the body.” Families demand that every possibility is pursued, and he says disagreeing with them is difficult. “The doctors—rather than explaining that this is not going to work—just do what the family wants. It’s the easy way out.”
Decisions to cease treatment—or to prescribe a lethal dose of medication when a patient requests it—shouldn’t ever be made by a single doctor, he says. Instead, several should consult to ensure that all feasible options have been exhausted. “The decision is made with due deliberation,” he says. “Nobody would just write off a patient.”
Pressures bear down on doctors and families who want to save a loved one, he says, and there’s really only one chance to get things right. “Every situation is different,” he says. “You can’t have rules or government regulation on these things. They have to be determined by discussion at that time, with that patient, with that illness.”
For decades, Mangalik says, he’s hoped to reduce the discomfort of people who are dying by enabling doctors to consider ceasing treatment. That way, patients can leave intensive care, where visiting hours are limited, and enter hospice to be with loved ones as much as they want.
Opponents of aid in dying have argued that it’s a violation of doctors’ oath to do no harm. But Mangalik says there is harm in allowing continued pain. “The Hippocratic Oath, like anybody, understands and accepts that every human being will die. Death is not the worst thing that can happen.”