A single-page report released last month by the D.C. Health Department states, “In 2018 there were four prescriptions written for a covered medication, two qualified patients died.” Few other details are offered about the two female cancer patients who ingested lethal medications or about the two patients who died without taking the drugs.
We know that the four patients who sought this all had cancer and received prescriptions from three doctors, and two never took them. What don’t we know? We don’t know if they received palliative care or had psychological evaluation or counseling. We don’t know what sort of medications they were given, how effective they were, whether they caused pain or how quickly they took effect. We can’t know how freely they acted in taking the pills themselves, or who was there with them. Some of these issues are recorded as standard practice in assisted suicide reporting in other states. The D.C. Health Department, however, leaves much to the imagination, shrouding an unpopular program in secrecy.
Is the program unpopular and controversial? Of 11,000 doctors licensed to practice medicine in the District, apparently only three volunteered for the program. Four hospitals in the District reportedly would permit its doctors to write lethal prescriptions for end-of-life patients, but these events typically would take place at home, not in a hospital. Meanwhile, according to the The Post, critics say people could be steered to early deaths to reduce medical costs if the practice becomes widespread. They have raised a host of other concerns ranging from the sanctity of life to the potential for racial disparities in how the law is used. The American Medical Association recently reaffirmed its opinion that “physician-assisted suicide is fundamentally incompatible with the physician’s role as healer.”
The AMA states that physician involvement in assisted suicide would ultimately cause more harm than good, and “would be difficult or impossible to control, and would pose serious societal risks.” The dearth of doctors who are participating in the D.C. program suggests that the majority may agree with the position taken by the AMA: Doctors should be helpers and healers for their patients, not their killers.
Furthermore, doctors should be suspicious of any program that either withholds records of its terminally ill participants or keeps so few records in the first place. Perhaps eliminating such details in the D.C. report will keep the public in the dark about questions like why people choose to die early. In Oregon, where assisted suicide has been legal for more than 20 years, the information has been made public: Contrary to proponents’ claims, the issue of unbearable pain doesn’t even make it into the top five reasons. There too, complications that patients experience with the drugs, such as regurgitation or seizures after the lethal potion is ingested, are only reported anecdotally without official investigation.
Whatever the case, the lack of transparency in this report of the first full year of the D.C. assisted suicide program, as well as the lack of participation, call into question both its efficacy and its necessity. Any such program is susceptible to exploitation of vulnerable individuals, erroneous estimates of the end of life and the potential for abuse by those who perceive that an early death is always cost-effective compared to the hefty price tag that often accompanies continuing care. For these reasons and others, the D.C. Council should reconsider its obligations and its assisted suicide program. Palliative care benefits all of those patients dying in the district, not just a paltry but privileged few.