Assisted dying is accepted practice today, especially in Western Europe, Canada and the Northwest United States. It is gaining traction in the United Kingdom with former British Prime Minister Rishi Sunak giving his support: “I’m not opposed to it, in principle, and it’s a question of making sure the safeguards are in place and are effective.” Unfortunately, history demonstrates safeguards have never been effective.
For centuries, assisted dying was abjured by most societies and specifically prohibited by the Hippocratic oath (“I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan.”). It became a legitimate movement in the 1970s, the product of an aging society, the emerging Western concept of patient rights and the gradual acceptance of the idea by the lay and medical communities.
Numbers reflect changing attitudes. More than 4% of all Canadian deaths in 2022 were the result of Canada’s medical assistance in dying legislation. A similar percentage in the U.S. would mean 120,000 assisted deaths annually, almost three times the number of motor vehicle deaths. In virtually every state and country that allows assisted death, the numbers are increasing dramatically. There was a time that proponents of assisted dying argued that only a small number of patients would avail themselves of the process — this has not been borne out.
Proponents say safeguards can be instituted, but safeguards, no matter how well intentioned, can falter. Assisted dying was originally intended only for those with severe intractable pain and a short time to live. Today, pain, which can be better controlled with medical intervention, is the primary reason in a minority of assisted dying cases. Many requests are for patients who have forfeited their autonomy, can no longer engage in enjoyable activities or have lost their dignity.
Many of these patients would be better served by support and counseling, but those services are often lacking. Moreover, some patients reject those options anyway, citing patient autonomy: Whose life is it, anyway? When patient autonomy becomes the guiding principle, it is difficult to envision how assisted dying can be restricted to those who are terminally ill or in severe pain.
Some patients requesting assisted death are clinically depressed and once properly diagnosed could be successfully treated. One common safeguard for these patients is an appropriate waiting time to treat depression, a waiting time that flies in the face of the goal to end pain and suffering. Recently, a healthy 29-year-old Dutch woman, who applied for assisted suicide in 2020 in the Netherlands, was “granted” an assisted death in 2024. Waiting time turned out not to be a safeguard.
Can physicians be a safeguard? Requiring consultants to identify terminal illness or depression is often a pro forma exercise because these diagnoses are usually subjective and do not always adhere to definite standards. Inevitably, an expert can be located to conform to the patient’s desires. Predicting how long patients with terminal illness will live is fraught with error as well.
The world is full of patients who lived longer than the six months they were predicted to live.
Reporting requirements mandated by law are often little more than a bureaucratic exercise. Not all cases will be reported and reporting boards, loath to ask too many questions, approve in most situations. For physicians who break the law, prosecution is extremely unlikely, and if it does occur, punishment likely amounts to attorney’s fees and occasional professional opprobrium.
Congress is considering a bill to pay for assisted suicide, and once government becomes involved in paying physicians, even assisted dying becomes a commodity. Private insurance could reckon the cost of assisted suicide would be less than paying for care, such as chemotherapy for the chronically and terminally ill. Assisted death could become a cheaper means of managing suffering in those patients.
There are advocates who welcome the option of assisted death, but others voice caution that people with disabilities will be regarded as less valued people simply due to physical limitation and thus targets for termination. Subtle coercion to death could replace medical treatment. The disabled require societal empathy and resources; they often have difficulty speaking for themselves and defending against the slings and arrows of bureaucracy. No safeguard can substitute for acknowledging human dignity when spiritual, cultural and religious understanding disappears.
An activist group in Vancouver is now suing a Catholic hospital for refusing to provide the procedure to a 34-year-old cancer patient. The hospital cared for her, provided hospice care and willingly transferred her to another health facility that carried out assisted death. If the lawsuit is successful and Catholic hospitals are forced by Canada to perform assisted death, then religious principle, the last redoubt, will be seen as failing.
The practice of assisted dying is now part of our culture. The tide cannot be pushed back, and safeguards tend to be discarded quickly and honored little more than in the breach.
What the future holds could be shocking.
Dr. Cory Franklin is a retired intensive care physician. Victoria Tiller, who has a master of science in nursing, is a patient advocate.
Submit a letter, of no more than 400 words, to the editor here or email letters@chicagotribune.com.