Should Doctors Assist in Death?

iStock_000056500374_MediumShould physicians assist people who wish to die to do so? That roiling debate continues, but several states have moved forward with laws that delineate and enable the process, among them Oregon. A study of Oregon's experience with the Death With Dignity Act over the last twenty years along with the American College of Physician's position paper and two great editorials on physician assisted suicide are published in Annals of Internal Medicine this week and comprise fodder for spirited debate for Rick and me on PodMed. Wow, that's a sentence.  Here goes:

First of all, Oregon stipulates their language as death with dignity rather than physician-assisted suicide, which can be considered an important distinction. Since passage of the act 1857 residents of Oregon have received prescription medicines to achieve their own death. Of this number 64% chose to utilize the medicines. Overall the rate of death with dignity deaths is 54.6 per 10,000 deaths, so relatively few choose to exercise this right. Following passage of the act the rate at which people exercised their right increased over several years but now seems to be stable. One ongoing concern relative to this practice is that people who are uneducated or otherwise vulnerable would be disproportionately channeled into making this decision. Oregon's experience seems to show that on the contrary, those who choose to end their own lives are on the higher end of the education spectrum and seem fully able to appreciate their choice.

Also in this issue of Annals is the aforementioned position paper, coming out against physician participation in assisted suicide, and advocating instead for palliative care physicians to step into the place of assuring that all measures for comfort and relief of symptoms are employed. Is this adequate? According to the issues people in Oregon have identified regarding their desire to be able to choose their own time of death, no. Intractable pain is not primary, but rather loss of autonomy figures large, and a palliative care consult is unlikely to resolve that. My own view, informed by exposures in the role of chaplain, is that people who are carefully screened and assessed should be given a choice, and physicians are the gatekeepers of that. Rick disagrees, and we both are thankful for the thoughtful and respectful debate of many on either side of the issue.

Other topics this week include Death and Cardiac Arrest in U.S. Triathlon Participants, 1985 to 2016: A Case Series, also in Annals, Weight and Other Outcomes 12 Years after Gastric Bypass in NEJM, and in JAMA Effect of Post–Cesarean Delivery Oral Cephalexin and Metronidazole on Surgical Site Infection Among Obese WomenA Randomized Clinical Trial. Until next week, y'all live well.



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