Morphing and Transforming: The Physician-Assisted Suicide Debate

May 31, 2016 • Posted in Blog

D. Joy Riley, M.D., M.A.
Executive Director

For years, Jack Kevorkian was synonymous with assisted suicide. Seeing patients after death was not sufficient for the pathologist; he wanted to help them to that state. Kevorkian’s first kit was made from flea-market items. That was 1989; the euthanasia group at that time was called “The Hemlock Society.”

Kevorkian lived in Michigan; ironically, his first subject, Janet Adkins, traveled from Portland, Oregon, in 1990 to use Kevorkian’s machine in his parked van. He started her i.v., but she had to activate the machine to administer the lethal substances.

Kevorkian went to prison for his illegal activities, and was released early due to serious illness. Nevertheless, Kevorkian remained an avid proponent of assisted suicide. His CNN interview with Dr. Sanjay Gupta (published in 2010), is indicative:

Not surprisingly, he strongly advocates assisted suicide, or euthanasia, or what he calls “patholysis.” Terms matter to Kevorkian, and this is the term he prefers when describing the “medical procedure” he performed on at least 130 people, by his own count.

“Path means disease or suffering,” he said to me.

“And lysis, means destruction,” I said.

“Exactly,” he answered. “Patholysis,” he repeated. “The destruction of suffering.”

Kevorkian died in 2011, but he was not alone in his advocacy — nor in his manipulation of terminology. The Hemlock Society (1980) morphed into the organization, “End of Life Choices” (2003), and then, joining with another group, became “Compassion and Choices.” Meanwhile, “euthanasia” morphed to the “right-to-die” then “physician-assisted suicide,” and “death with dignity,” and more recently, “aid-in-dying.”

A bill now in the New York Assembly (A10059) is of concern. It has passed out of the Health Committee and on to the Codes Committee, under the heading of “Relates to the medical aid in dying act; relates to a terminally ill patient’s request for and use of medication for medical aid in dying.” Several items should concern us:

1) A health care professional may be present when a patient self-administers the life-ending medication.

§ 2899-m provides that a physician, pharmacist, other health care professional or other person shall not be subject to civil or criminal liability or professional disciplinary action by any government entity for taking any reasonable good-faith action or refusing to act under the article, including without limitation, engaging in discussions with a patient relating to the risks and benefits of end-of-life options in the circumstances described in the article and being present when a qualified individual self-administers medication. (emphasis added)

Question: What happens when the patient is unable to self-administer the medication?

2) Complicity is expected:

§ 2899-n: . . . If a health care provider is unable or unwilling to participate in the provision of medication to a patient and the patient transfers care to a new health care provider, the prior health care provider shall transfer or arrange for the transfer, upon request, of a copy of the patient’s relevant medical records to the new health care provider. . . . In addition, where a health care facility has adopted a prohibition under the subdivision, if a patient who wishes to use medication under the article requests, the patient shall be transferred promptly to another health care facility that is reasonably accessible under the circumstances and willing to permit the prescribing, dispensing, ordering or self-administering of medication with respect to the patient. (emphasis added)

3) It cannot be called “suicide,” “assisted suicide,” “attempted suicide,” “mercy killing,” or “homicide.”

§ 2899-o provides that (i) a patient who self-administers medication under the article will not, because of that request, be considered a person who is suicidal, and self-administering medication under the article shall not be deemed to be suicide for any purpose, (ii) action taken in accordance with the article shall not be construed for any purpose to constitute suicide, assisted suicide, attempted suicide, promoting a suicide attempt, mercy killing, or homicide under the law, including as an accomplice or accessory or otherwise (emphasis added)

Comment: “A rose by any other name . . .” (Shakespeare)

4) The certifying physician is legally compelled to lie:

§ 2899-q provides that if otherwise authorized by law, the attending physician may sign the qualified individual’s death certificate. The cause of death listed on a qualified individual’s death certificate who dies after self-administering medication under the article will be the underlying terminal illness. (emphasis added)

Comment: If the state can compel a physician to lie about death, by whom else and about what else can the state enforce lying?

5) What happens will be hidden; there will be no public accountability.

§ 2899-r provides for the annual review by the commissioner of health of a sample of the records maintained under section twenty-eight hundred ninety-nine-k of the article. The commissioner shall adopt regulations establishing reporting requirements for physicians taking action under the article to determine utilization and compliance with the article. The information collected under the section shall not constitute a public record available for public inspection and shall be confidential and shall be collected and maintained in a manner that protects the privacy of the patient, his or her family, and any health care provider acting in connection with such patient under the article, except that such information may be disclosed to a governmental agency as authorized or required by law relating to professional discipline, protection of public health or law enforcement. The commissioner shall prepare a report annually containing relevant data regarding utilization and compliance with the article and shall post such report on its website. (emphasis added)

Questions: How will patients know if their doctor participates in assisting suicides? How can trust between patient and physician survive?

The terms may morph with some regularity, and the state provide legal “cover” for physicians, pharmacists, and other health care professionals. But at the end of these secretive procedures, some living citizens will be transformed into dead ones at the hands of other citizens — healers who have been transformed into killers. No amount of linguistic legerdemain can eradicate that truth.