End-of-Life Choice, Palliative Care and Counseling

Aid in Dying Is Not Suicideby Jay

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By Dr. Charles F. Miller
Honolulu Civil Beat
12/20/12

I was interested to read Christopher Flanders’ letter on behalf of the Hawaii Medical Association in response to Civil Beat’s Oct. 5, 2012, article, “New Aid-in-Dying Service Gets Inquiries.” Flanders was responding to the piece’s closing question, “Is the aid-in-dying movement a humane approach to a difficult subject, or is it a violation of ethical standards?” I appreciate this opportunity to keep the issue of end-of-life choice in the forefront for healthy discussion.

I believe Flanders is correct when he states that, “The physician’s primary obligation is to advocate for the individual patient.” That is why I, and the majority of Hawaii physicians as well as state residents, feel that physicians should help their terminally ill patients achieve a peaceful death when patients request it and when options for recovery are nil.

Aid in dying is widely supported in the medical community precisely because it empowers physicians to respect the wishes of their patients. The American Medical Women’s Association, the American Medical Student Association, and the American Public Health Association all support terminal patients’ right to choice at the end of life.

The American Medical Student Association position reads: “We support aid in dying as a way to allow competent patients with terminal diseases to decide how to live the last moments of their lives. When all other approaches to relive the suffering of a terminal illness have failed…assisted death is an extension of compassionate medical care.”

A January 2012 QMark Poll found that 77 percent of Hawaii adults and 76 percent of Hawaii doctors support access to aid in dying. The survey showed overwhelming majorities believe self-determination at the end of life is their right, and they favor allowing mentally competent adults dying of a terminal illness to ask their doctors to prescribe medication that gives them peace of mind as they approach death.

Opponents like Flanders consistently make false arguments about aid in dying. They deliberately use the intimidating and inaccurate word “suicide” to imply that legal aid in dying would somehow cause the deaths of healthy people. In reality aid in dying applies only to people whose deaths are already imminent.

Opponents of aid in dying claim that it would allow doctors to “kill” people. In fact it allows only those already dying to request a prescription. This then supports the patient’s autonomy. They have control of their life and can, if they choose, self-administer medication to initiate their deaths should they feel their suffering has become unbearable.

The Hawaii Medical Association does not represent all the doctors in the state. It is grossly contradictory that Flanders can support allowing doctors to (1) provide palliative support to voluntarily stop nutrition and hydration, (2) withdraw a ventilator or other life-sustaining treatment, or (3) provide palliative sedation even to the point of unconsciousness—but he would deny terminal patients the choice to ask their doctors for medications to self-administer for a peaceful and certain death if suffering became unbearable. A physician who has followed and cared for a patient, sometimes for many years, should be the one to care, advise—and yes, assist—that patient in their choice of how to end their life.

Thankfully, experts on Hawaii law, medicine, elder care, legislative and end-of-life issues have concluded Hawaii physicians may already provide aid in dying subject to professional best practice standards—and they are doing so now. Organizations like Compassion & Choices Hawaii, for which I serve as a medical advisor, offer free advice and services on all aspects of end of life choice, including aid-in-dying (http://www.compassionandchoices.org/hawaii or 808-225-4563).