THE suicide rate in Virginia, 13.2 per every 100,000 residents in 2016, increased an alarming 17.4 percent between 1999 and 2016, according to the Centers for Disease Control and Prevention. So last year, the General Assembly passed a bill requiring the state Department of Behavioral Health and Developmental Services to come up with new suicide prevention policies. In March, Gov. Ralph Northam signed a bill requiring the department to report annually on the success of those measures.
Meanwhile, Virginia’s Joint Commission on Health Care was considering a proposal by Del. Kaye Kory, D-Falls Church, to legalize physician-assisted suicide, which advocates are calling by the more sanitized name, Medical Aid-in-Dying.
The irony of such contradictory efforts in several states has not been lost on a national grassroots disability rights group, Not Dead Yet, which points out that “legalized assisted suicide sets up a double standard: some people get suicide prevention while others get suicide assistance, and the difference between the two groups is the health status of the individual. This is blatant discrimination and a violation of the Americans with Disabilities Act.”
Physician-assisted suicide, which generally requires that patients be at least 8 years of age, deemed mentally competent and have six months or fewer to live, has already been legalized in nine states.
But there are compelling reasons why Virginia should not go down that path.
For one thing, it’s estimated that up to 20 percent of terminal diagnoses are wrong. A 2000 review of Dr. Jack Kevorkian’s medical records in Oakland County, Mich., found that only 25 percent of 69 patients he helped to die were terminally ill.
End-of-life care is expensive, and insurers will be tempted to view it as a way to keep costs down.
This is not just a theoretical danger. Dr. Brian Callister, associate professor of internal medicine at the University of Nevada, said that last year, insurers denied his requests to transfer two non-terminal patients out of state for lifesaving treatment, saying they would pay to help his patients commit suicide in California and Oregon instead.
In the appendix of the Joint Commission’s final report, which was released Aug. 22, the Family Foundation of Virginia noted that not only do such laws corrupt the bond of trust between physician and patient, they also create a crisis of conscience for other health care providers who may be compelled to assist with the deaths.
Laws that allow healers to actively participate in their patients’ suicides often become a slippery slope. For example, in Belgium, which legalized euthanasia in 2002 and lifted age limits on the practice in 2014, physicians recently euthanized three minors, aged 9, 11 and 17.
That’s why the American Medical Association’s Code of Medical Ethics states that “physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks. Instead, physicians must aggressively respond to the needs of patients at the end of life,” including “appropriate comfort care and adequate pain control.”
In both Oregon and Washington, less than half of patients cited inadequate pain control among their top three reasons for wanting to commit suicide.
Pain control was sixth on the list, after a perceived loss of autonomy, inability to enjoy activities, and loss of dignity—all of which could be symptoms of depression.
The Joint Commission’s final report referenced a study in Oregon that found “31 of 67 patients for whom a substantive intervention was made changed their minds about wanting a prescription” for suicide drugs. But pain control, treatment of depression, and referral to a hospice program can and should be offered without resorting to physician-assisted suicide.