Doctors are aiding doctors in ending patients’ lives

Like the patients in this story, Joseph Solomon of Arlington, Va., fell ill with ALS, a fatal illness, last year. He was 86 at the time. A decade earlier, at 69, he had walked into the same hospital in Milwaukee to receive a medial assisted suicide.

His experience with terminal illness is not unique. A new book, Dying for Dignity, helps physicians provide full support for their dying patients. Many support patients like Mr. Solomon who don’t want to suffer unnecessarily at the end of life.

“We are losing people daily to hastened death, with all of its trauma and incontinence that that requires,” said Dr. Warren Harmon, a psychiatry professor at Duke University, who co-wrote the book, co-authored by retired neurologist Dr. David H. Bradley of Marlboro, N.H. “The surgical interventions are terrible for patients at the time they are given them and they are usually a waste of time and money.”

In 1983, in a landmark decision, the United States Supreme Court held that people have a constitutional right to physician-assisted suicide, ruling that the practice is not cruel and unusual punishment.

Although fewer states now issue physician-assisted suicides, in recent years medical practitioners have been increasingly accommodating. Doctors now need little supervision to end life in the case of acutely dying patients.

“It has opened the floodgates to discuss these issues, both ways, of end-of-life care, which we in the United States have never had to talk about for obvious reasons,” said Dr. Paul J. Ehrlich, a neurologist at the University of Maryland. “I am willing to give people the benefit of the doubt, especially in someone like a dying person.”

But all of the practice is thwarted by state laws that mandate the identification of both doctors and patients as the stipulation to a legal physician-assisted suicide. Under current laws, “Both sides have to be clearly identified. This is not the goal of a doctor of medicine,” said Dr. Gerald Greyson, chairman of medicine at Georgetown University.

Just since 2004, 23 states have passed laws to allow physician-assisted suicide. The physicians’ support of the option is a requirement to receive benefits, including catastrophic health insurance coverage, often for all or most of the month.

Dr. Geoffrey Jacques, a neurosurgeon at the University of California at San Francisco, said that he often moved to pick up patients early from hospitals near his home because he believed patients would be better suited to his services once they entered his care. The assisted suicide laws he often acts under do not make that matter.

“If patients have a decision to make, I am on their side. But it is impossible to know who is for them, and who is not,” he said.

Patients who hope for the choice to be discussed with their doctors before a lethal drug is prescribed for them are met with the same obstacles.

“In many cases, people are sitting next to physicians who don’t know how to get in touch with them,” said retired Yale professor Elizabeth M. Christopher, an expert on end-of-life issues.

End-of-life-care experts say the new kinds of medical aid in dying are cutting ties with providers that are used to administering life-sustaining medical care. Those in favor of the increased open approach have not studied the groups most likely to benefit from assisted suicide. They say the use of end-of-life care was reviewed by a study on Oregon, a state that made physician-assisted suicide legal there in 1997, and patients with terminal cancer only comprised 5 percent of all assisted suicides, and most were younger and healthier than average.

Dr. Richard Lee Dehn of St. Luke’s-Roosevelt Hospital Center in New York City was one of the first doctors in the U.S. to end medical life support for his terminally ill patient. This month the American College of Physicians held a workshop on this issue, where officials drew up a working definition of when a patient could be the last to get the permission to die. Their research and discussion will be published in a medical journal by the fall, Dr. Charlene N. Goodman, the vice president for publications for the organization, said.

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