Why A Leading End-Of-Life Specialist Opposes Assisted Suicide

By Dr. Ira Byock
Guest contributor

Dr. Ira Byock, considered one of the country’s leading palliative care specialists, is the chief of palliative care at Dartmouth Hitchcock Medical Center and author most recently of “The Best Care Possible.” He opposes Question 2, the Massachusetts ballot question that would allow terminally ill patients to request prescriptions for life-ending drugs, and here he explains why:

My take is as a doctor who has been caring for seriously ill people for over 30 years. I’m also a lifelong political progressive. But I have a different perspective on physician-assisted suicide than many liberal Americans and many of the voters in Massachusetts.

Dr. Ira Byock

Dr. Ira Byock

One thing on which we all agree is that there is a true national crisis that surrounds the way Americans are dying. The folks who are trying to legalize physician-assisted suicide are well-intended but I think they’re making a serious error. The crisis that surrounds our way of dying is a crisis of our own making: A chilling admixture of excessive medical treatment on one hand and near social abandonment on the other. While doctors are not the cause of this, we’re not entirely free of blame either.

Medical education is deficient not only in instruction on pain but on communicating with patients, discussing diagnoses, helping patients and families sort through their business and reach a satisfying sense of life completion. Many of the people I meet who are facing the end of life are suffering not just from their physical conditions but from the indignities our health system imposes: The inability to pay medical bills, watching family savings dwindle…

‘It will quite literally be easier to get a lethal prescription in Massachusetts than to have hospice care through the end of your life.’

I don’t practice in Massachusetts but I’m appalled that some of the prominent spokespeople in favor of physician-assisted suicide are physicians who have no experience in caring for dying patients. Some are part of Big Medicine, the medical-industrial complex which takes care of us really well as long as it can bill us, but doesn’t have much use for us when our conditions become incurable and billing opportunities wane.

Proponents of Question 2 allege that those of us who are physicians who oppose assisted suicide are somehow protecting our own sensibilities and the profession. They have turned our stance on its head. The prescription against physicians killing patients has been in place since the beginning of the medical profession as a progressive value to protect vulnerable patients.

Physicians always have more power than patients and once it is legal, physicians will agree to write a lethal prescription when they cannot imagine anything else to do for a patient. But I know from 34 years of clinical experience that the limitation is within the physician – in his or her ability to imagine what else we might do. Perhaps the physician is undertrained in end-of-life care, or exhausted and spent, or has had a fight with a spouse or is simply over his or her head. That’s why we work in teams. That’s why we have professional principles that stop us from doing things that violate medical ethics.

Patient vulnerability is ever more important in this time when our resources are stretched and strained, and when people are suffering from system-imposed, socially-based stresses. In fact, after the Question 2 proponents get their way, we will still not have addressed any of the sources of suffering that plague dying Americans.

We’ll still require terminally ill patients to give up treatment for their disease to get Medicare to pay for their hospice care. In 2012, 14% of hospice patients in Massachusetts were eventually discharged from hospice care. Is there anything in Question 2 that would guarantee continuance of hospice care for people who get lethal prescriptions? No. It will quite literally be easier to get a lethal prescription in Massachusetts than to have hospice care through the end of your life.

We’ll still be teaching more obstetrics than hospice and palliative care to every medical student. We’ll still be graduating more doctors who have never been trained to have these conversations or in ways to help people sort through their unfinished business. But, those doctors will now have the authority to write lethal prescriptions.

This does not seem like progress to me.

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  • jsmit7y

    I think that it is cruel to make people suffer through the ends of there lives if they do not wish to live. You make great points and I understand these points of view but if we have a choice to be DNR then why cant we make the choice for euthanasia? If we can put our pets to sleep to stop there suffereing why is euthanasia not ok for humans? This practice has been going on since the 1800′s and we as a society owe it to our elderly who have already enjoyed there lives, and endured our mistakes. Why look for a cure for cancer if we can not stop the pain and suffering without social and legal sanctions?

  • CircusMcGurkus

    Thank you for this thoughtful opinion. It is clear that you do not practice in MA because MA doctors are more akin to Wall Street bankers who would sell out their mothers to make a profit on a deal. The “great” reputation MA has is based not upon services but upon the grants that the hospitals can attract. Arrogance, ineptitude, superiority, and an utter lack of concern for patients’ concerns, needs and desires is rampant in MA – and there is no incentive for this to change.

    To the person that mentioned “best practices”, MA hospitals COMPETE with each other, they do not collaborate. Ergo, it is not “best practices” that they employ; it is a terrifying salesmanship that puts patients last. They are looking for the marquee case, the face transplant, not the end of life case that is just going to die anyway.

    Because of this reality, it is imperative that we pass this ballot initiative. Not because it is the very best idea that ever occurred (indeed, this initiative has so many checks in place it will be a wonder if anyone can ever get the prescription) but because the level of care is so low and the lack of compassion is so high all in an atmosphere where doctors are competitive and do not want to “lose” the battle against death which has really already won, dying patients need this option to maintain some level of autonomy and dignity in their final days. Their doctors have either written them off or see them as their next poster presentation for the 5 extra minutes of life based on some horrific scheme they invent to prolong something the patient doe snot want anymore.

    So, while I applaud Dr. Byock’s heartfelt approach to end of life care, the reality is that in this state, this really, truly is the most compassionate choice available. It gives people who have tried all else their lives back if only for the determination of when it will end and under what circumstances and with whom. Very few will qualify, fewer will choose it and even fewer will partake, but just to have the choice is a great gift.

  • Paul Sawyer

    Dr. Byock has unwittingly described the problem which is to quote him: “Physicians always have more power than patients…” This is bad because physicians can’t think for themselves or allow the patients to think for their selves. Instead physicians have to follow the medical “best practice”. Medical best practice is driven by the medical-industrial complex and always errs on the side of more treatment which is invasive, expensive and of questionable efficacy. Time and time again we see that their wonder drugs and procedures have more side effects than benefits. It’s time for patients to realize that they know their bodies, minds and life situations better than anyone. It’s time for physicians to realize that their medical knowledge pales in comparison to the bodies innate ability to heal itself. And its time for the legal system to give the power to make medical decisions back to the patient for end of life and all other aspects of medical care.

  • Star1977

    iam on the fence about this and my heart breaks for those that are so sick that this question2 sounds good to them. the biggest thing on my mind is how the hell can they let someone go through this with out a doctor present at the time that the patient takes these deadly drugs that sounds crazy to me. if this question2 passes it should be requiered that a doctor be present

    • Frank

      There arrives a time in life when many dying patients do not want any more wonder drugs or costly medical procedures to keep them alive so that they can spend more uncomfortable days bed-ridden after lives of active productive participation. Suicide is the wrong description. These courageous people want to die with dignity, and the support and love of their families. Doctors have gone on too long with their good intentions. The time has come for us to stand up and show them another way.

    • klf

      I am an RN with more than 25 years of experience helping people heal & recover, or die a peaceful, dignified death.Why do you think a Dr. needs to be present? It’s required the patient be seen by 2 Medical Dr’s & 1 Psych all of whom will educate pt. as to all aternative treatments & how to administer the medication given & what will happen. What do you want a Dr to do? Do realize that when a patient is dying & terminal sedation is used a Dr does not administer that drug. A nurse gives the meds if the pt is in a facility, but if the pt is at home family or friends are instructed by the Dr. pharmacist or nurse & they give the meds. I don’t think you have a clear understanding of the functions of a Dr. Why would someone pay a Dr to go to a home give a drug & sit & watch the pt die. Dr’s are not at their patients besides when most of them die, nurses, aides, families, friends & clergy are with them. A Dr.’s time is much better spent with those they can help get well. No one will ever make you or anyone participate in DWDA, but What right does anyone have to deny people this option? I find most of those that object do so out of ignorance & fear. Eduction can cure both.

    • jsmit7y

      i agree!!

  • Laura T

    Somehow the fact that physicians are not and will not be trained to handle end of life patients competently, does not argue for allowing them the maximum length of time to do so. We are talking about aware people, who will not be recovering, being allowed to decide how long the futile battle must be fought WITH more than one physician (a team as you describe as necessary) being in agreement. It is an approach that need be chosen only by those so inclined.

  • Ian Wood

    To quote from the 2012 Oregon DWDA Report, “Most (94.1%) patients died at home; and most (96.7%) were enrolled in hospice care either at the time the DWDA prescription was written or at the time of death”. Ian Wood, Christians Supporting Choice for Voluntary Euthanasia, AUSTRALIA.

  • Sara

    Thank you for this deeply thoughtful posting. It is making me reconsider my ideas/vote about this.

  • LoriB

    good points but allowing physician assisted suicide seems to me another tool we have available for accepting our deaths and enabling individuals to end our current lives when we’re ready. this is progress and an essential aspect of evolving human consciousness.