Tuesday, March 20, 2012

PAS Opponent's "Flawed Rationale"

In a letter to the editor published in the Boston Globe on March 19, Robert Joyce of Newton responded to a Globe obituary of Dr. Peter Goodwin, who not only championed the Death With Dignity movement, but used that Oregon law to die on his own terms at age 83. 
In his letter, Joyce cited hospitalized patients’ need for an advocate. And on that point, Kathy Kaditz, a member of the Community Ethics Committee, which is responsible for this blog, agrees with him.
But Kaditz takes issue with much of the rest of Joyce’s letter. She writes:
Though his client’s case is not detailed, in my experience hospitals try to honor the “goals of care” as stated by a patient or their proxy. However, hospitals recognize disputes do arise and communication does break down.  Many hospitals are addressing this through the creation of a position called a “ hospitalist” whose job is to work with a patient or their surrogate to determine the patient’s “goals of care,” then to monitor and coordinate implementation of those goals during the patient’s hospital stay.
However, the referendum on the November ballot (called the Death With Dignity Act), allowing a physician to prescribe a lethal dose of medication to a terminally ill patient, is very different from the case Attorney Joyce cites, which he summarizes as a dispute between his client and hospital staff over the staff’s recommendation to withdraw the patient’s dialysis treatment. I believe his rationale is flawed. The Death With Dignity Statute by its expressed terms is completely voluntary. It can only be patient initiated.
The goal of the statute is to expand the choices for terminally ill patients who wish to have the option of controlling the time and manner of their death. The statute’s protections are limited to people who request a lethal prescription, are diagnosed to be within six months of dying and are determined to be mentally competent by their physician or a mental health professional. They must be able to voluntarily take the medication without assistance. The Death With Dignity Statute allows a person who meets these criteria to request a lethal prescription from their physician – a prescription which  the patient may or may not choose to fill or to use. Research in Oregon, which has a similar statute, has indicated that many terminally ill patients, after obtaining a prescription, feel a sense of control that reduces their suffering to the point they elect not to use it. It should be noted that the statute, by definition, excludes people with Alzheimer’s disease or ALS. There is room to debate whether the statute is too broad or too restrictive.
Finally, the vast majority of people express a wish to die at home.  In Oregon and Washington, where the Death With Dignity Statute is enacted, people choose to die at home. Physician involvement does not go beyond writing the prescription. I recommend Attorney Joyce review the proposed language of the statute before making misleading comparisons. A balanced documentary on this topic, How To Die in Oregon is available online, at no charge.
The Death With Dignity Act is clearly a significant piece of legislation that requires thoughtful deliberation. But let’s not start the conversation before the statute’s provisions are fully reviewed and understood. The misrepresentation of the statute through use of inflammatory examples and/or language inhibits a reasoned debate. This does a disservice to all residents of the Commonwealth, regardless of which side of this issue they stand.
The Community Ethics Committee for the Harvard Teaching Hospitals is currently studying the topic and plans to add to the community's understanding through publishing a report on physician assisted suicide later this spring and will encourage the conversation through this blog,

Kathleen Kaditz
Retired School Administrator
Secretary for Community Voices in Medical Ethics
Member of the Community Ethics Committee
Community Member, Ethics Advisory Committee, Spaulding Rehabilitation Hospital

1 comment:

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