Legalized Suicide May Bring Better Care to the Dying
May 10, 2001 -- Opponents of Oregon's 1994 Death with Dignity Act worried that legalizing physician-assisted suicide would, among other things, undermine healthcare quality for the terminally ill. It would become cheaper and easier to "kill" these patients, they argued, than to make their remaining days as comfortable as possible. But new research shows quite the opposite: End-of-life care in Oregon has only improved since the law was enacted.
"The Death with Dignity Act, enacted in 1997, allows a terminally ill person -- a person who has an expected life of less than six months and who is competent -- to request a lethal dose of medication that they can take to end their life. It is basically physician-assisted suicide," study leader Linda Ganzini, MD, tells WebMD.
To determine how the measure may have influenced healthcare, her team mailed surveys to nearly 4,000 Oregon physicians eligible to prescribe the lethal dosages. About two-thirds of them returned the completed form, answering questions on their attitudes, concerns, and sources of information about the Death with Dignity Act, and their conversations with patients regarding assisted suicide.
"What we found was that either despite or perhaps because of the law, end-of-life care has improved substantially," she says. Ganzini is director of geriatric psychiatry at Portland VA Hospital and an associate professor at Oregon Health Sciences University.
In all, she tells WebMD, one-third of doctors "had increased their referrals to hospice since the Act passed, and 75% said that they'd made attempts to increase their skills and knowledge with regard to caring for patients at the end of life, including treating pain control and recognizing psychiatric disorders such as depression." Only 3% of respondents said that they'd decreased their referrals to hospice.
As opposed to a hospital, hospice "is a philosophy of caring for [the dying] that puts quality of life over attempts to prolong life. It focuses on pain and symptom management, and on closure, rather than on keeping people alive at any cost," Ganzini tells WebMD.
What this study shows, she says, "is that patients in Oregon now have a better chance of getting care at the end of life that focuses on improving quality."
That may be true, says William Toffler, MD, but "it may well be for very negative reasons." Concluding from this study that legalized suicide is a good idea is comparable to applauding the legalization of drunk driving "if it resulted in a redoubled effort to build safer cars," he says.
Toffler is a professor of family medicine at Oregon Health Sciences Center in Portland and national director of Physicians for Compassionate Care. He reviewed the study for WebMD.
Toffler tells WebMD that the Death with Dignity Act is wrong on several levels. First and foremost, physician-assisted suicide represents an ongoing and obvious conflict of interest. "On the one hand, these doctors are trying to protect the fiscal viability of their healthcare bureaucracy, and on the other, they're at the bedside [deciding] whether someone will receive lethal [drugs]."