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Physician-Assisted Suicide Is Still Suicide

September 16, AD2015

Kelli Ann - crucifix

A woman, “Katie,” talks about wanting to die, feeling trapped, being in unbearable pain, being a burden to others. She gives away prized possessions and tells loved ones goodbye. Most of us, hearing Katie’s story would be rightfully concerned about her. We might take her to see a psychiatrist or counselor. Perhaps we would call a suicide hotline. No one would dare to give her a gun.

The laws, however, are shifting in our country where, if Katie had a terminal illness, giving her the medical equivalent of a gun would be legal. Just last week, the California legislature fast-tracked and passed a bill which would allow physician-assisted suicide. The bill, modeled after the law in Oregon, awaits the governor’s signature. If it becomes law, California would be the fifth state to make legal physician-assisted suicide, following Oregon, Washington, Montana, and Vermont.

In a strange turn of irony, last week also marked National Suicide Prevention Week. Surprisingly, the California legislature did not see the irony: medical facilities in California may commit anyone whom they believe to be suicidal for evaluation and treatment under WIC Sec. 5150, yet soon it may be legal for that same physician to assist one seeking to commit suicide.

Somehow, we have divorced the idea of “suicide” from “physician-assisted suicide.” This is a great travesty because the same reasons why suicide is seen as a bad choice are the same reasons why physician-assisted suicide is a bad choice.

Eliminate the Problem, Not the Patient

When one types “suicide” into Google, the first results return are for suicide prevention lines. Rightly, we recognize that suicide is not a good decision. We recognize that, no matter the problems one may be dealing with or the situation one may be in, there is a better result than taking one’s life.

Suffering people don’t really want to die; they want an end to pain. Suicide happens when pain exceeds the resources one has for coping with pain. Obviously by increasing the resources to cope with pain and/or decreasing the amount of pain, the attractiveness of suicide diminishes. Dr. Herbert Hendin noted in his book Seduced by Death that, while some terminally ill patients have suicidal thoughts, “these patients usually respond well to treatment for depressive illness and pain medications and are then grateful to be alive.” Treating the underlying reasons why a patient is desiring to die, whether that is depression or inadequate pain control, should be the aim. We should not be seeing the patient as a problem to be eliminated.

Individuals desiring assisted suicide should be treated like those who desire to commit suicide. It should be understood as a symptom of a great problem. As with individuals who feel suicidal, individuals seeking physician-assisted suicide see it as a “solution” to pain, either presently real or perceived to occur in the future. Death is seen as a relief from the pain. This is obviously a false logic since relief can only be felt when one is alive.

Understanding the Psychological Similarities

Depression is often intimately tied to the sense that death is the only “way out.” A desire to die, regardless of whether it involves a physician’s assistance, reflects a patient’s psychological despair, beyond the concrete request. It would make sense, therefore, to involve a trained psychologist or psychiatrist when a patient seeks physician-assisted suicide.

In a study by T.B. Levy, et al. in 2013, published in Bioethics, it was found that psychiatrist had more conservative views regarding euthanasia and physician-assisted suicide than physicians from other medical specialties, even when controlled for religious practices. In other words, psychiatrists were less likely to approve a patient’s request for assisted suicide. They hypothesized, in part, that psychiatrists were more likely to appreciate the depression and other psychological stressors motivating the request and seek to address those instead of merely granting the request for assisted suicide.

Yet, overwhelmingly, psychiatric evaluations are not even being conducted when a patient seeks physician-assisted suicide. Data gathered by the Oregon Public Health Division demonstrate that in 2013, only 2 of the 71 patients who died under Oregon’s assisted suicide law were referred for formal psychiatric or psychological evaluation. In other words, less than 3% of patients who commit suicide with a physician’s assistance received an evaluation by a trained psychiatrist or psychologist to determine whether any psychological factors were impacting their decision. That is a shockingly low percentage.

Additionally, it is unknown how competent at identifying possible psychiatric conditions the physician assisting in the suicide was. Indeed, this concern was raised by T.B. Levy, et al. who questioned “to what extent non-psychiatrist physicians are trained in the discernment and understanding of these subtle messages and whether they are well enough informed and competent in order to identify the role that these often subtle messages play in the patient’s request.”

This lack of competency is particularly concerning since the average duration of the patient-physician relationship in the data published by the Oregon Public Health Division was only 13 weeks. In other words, the physician assisting in the patient’s death was typically not a physician who had been caring for the patient for a significant period of time, who might have an established relationship and personal experience with the patient.

Given the permanency of the decision to end a life, more efforts should be made to resolve the underlying concerns. If there is a psychological component, counseling or medication may help the patient view his or her situation in a more realistic light. If there is a concern about being a burden or loss of control, that may be addressed through counseling. If there is a concern about being a burden to family and friends, working with the patient’s support network may help.

Help Towards a Life of True Dignity

Most importantly, though, for one seeking suicide or physician-assisted suicide, help must be given to allow them to recognize their dignity. Pope St. John Paul II, in Evangelium vitae, no. 66, states that suicide involves “rejection of love of self and the renunciation of the obligation of justice and charity towards one’s neighbor” as well as a “rejection of God’s absolute sovereignty over life and death.” Suicide always is a rejection of the dignity of the human being for it is contrary to “the natural inclination of the human being to preserve and perpetuate his life” as stated in the Catechism of the Catholic Church. This is true regardless of whether a physician is assisting the person or if the person has a terminal illness.

Trust and faith in God must be encouraged and cultivated as a poultice to despair and hopelessness. Even through unavoidable suffering and pain, such as may come at the end of life, suffering can have meaning and be redemptive so that one may say with St. Paul, “I rejoice in my sufferings for your sake, and in my flesh I complete what is lacking in Christ’s afflictions on behalf of his Body, which is, the Church.” (Colossians 1:24)

Photography: See our Photographers page.

About the Author:

Stephanie To has worked for the Archdiocese of St. Louis's Respect Life Apostolate since 2014. Previously, she was a litigation attorney in a mid-sized law firm in St. Louis for nearly six years. She holds a B.A. in psychology from Washington University in St. Louis, a M.A. in bioethics and health policy from Loyola University in Chicago, and a J.D. with certificates in health law and health care ethics from Saint Louis University. In her spare time, Stephanie enjoys playing the violin and singing in her parish choir.

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  • RainingAgain

    One can imagine the telephone “help-lines”. For help in avoiding suicide, press 1. For help to kill yourself, press 2.

    As for the contradiction between committing the solo suicidal against their will with encouraging the one who co-opts professional help, the cynical might suggest that the common denominator for both is increased power and influence, not to mention remuneration, for the “caring” medical profession.

  • One does not solve existential angst (depression of the dying) with a pill or a psychiatrist or a priest. An antidepressant clouds the mind and moves it into another reality. Depression? People choose to die (if you really mine the Oregon, Vermont, etc data) when they feel a loss of autonomy, a loss of personal dignity, a loss of hope in the face of a terminal illness and intractable pain, when they lose their personhood. Suffering has no intrinsic value despite the stories we may fabricate. It just is a reality of our humanity and species. . A god does not have a calendar nor computer which says “today is your day.”.
    It is well known that the body and the soul (spirit) do not leave this place at the same moment. A false notion is that the body dies and the spirit, or soul or consciousness (whatever) leaves afterwards. It’s not always like that. At times, the spirit leaves as the person so chooses and there is only an exoskelton left behind to stop functioning….the person is really long gone. That’s why palliative sedation is so effective….it allows the body to stop fighting when the self has moved on.

    • RainingAgain

      A lecture from Satan’s School of Theo(he wishes)logy.

    • A very kind, thought and merciful response…..love the dialogue!

    • RainingAgain

      Don’t lecture me about kindness and mercy. These are qualities you subvert in order to Justify killing for convenience. We have nothing to dialogue about-you just need to change your way of thinking.

    • Since when is palliative sedation a form of assisted suicide…in hospice and palliative care sedation treats intractable pain and decreased respiration often allows for death to occur….do a bit of learning about palliative care. Or do you believe pain which is unrelenting should not be treated with morphine…so again, let’s be kind and merciful…and educated!