Tuesday, January 15, 2013

Oregon Doctor's Letter to Medical Society

I practice internal medicine in Oregon where assisted suicide is legal.  I write to urge you to maintain your policy against physician-assisted suicide and have attached a copy of this letter to this e-mail.  Contrary to marketing rhetoric by suicide advocates, the safeguards do not protect patients.  Please consider my patient’s story below.

I was caring for a 76 year-old man who presented to my office with a sore on his arm, eventually diagnosed as metastatic malignant melanoma.  I referred him to both medical and radiation oncology for evaluation and therapy. I had known this patient and his wife for over a decade. He was an avid hiker, a popular hobby here in Oregon, and as his disease progressed, he was less able to do this, becoming depressed, which was documented in his chart.
My patient expressed a wish for doctor-assisted suicide to the medical oncologist, but rather than take the time to address depression or ask me, as his primary care physician, to talk with him, the specialist called me and asked me to be the "second opinion" for his suicide.  I told her that assisted suicide was not appropriate for this patient, but unfortunately, my concerns were ignored, and two weeks later my depressed patient was dead from an overdose prescribed by this doctor. His death certificate listed the cause of death as melanoma.
The public record is not accurate. My depressed patient did not die from his cancer, but at the hands of a once-trusted colleague. This experience has affected me, my practice, and my understanding of what it means to be a physician. What happened to this patient, who was weak and vulnerable, raises several important questions that I have had to answer, and that the Massachusetts Medical Society should also consider. 
    • If assisted suicide is made legal in Massachusetts, will you be able to trust your colleagues?  I referred my patient to specialty care, to a doctor I trusted, and the outcome turned out to be fatal.
    • Will your patients, your family and/or you find yourself steered to suicide?  In Oregon, patients under the Oregon Health Plan have been denied coverage for treatment and offered coverage for suicide instead. See e.g. KATU TV story and video at http://www.katu.com/home/video/26119539.html (about Barbara Wagner). Do you want to put vulnerable patients at risk for this kind of influence?
    • Will this “path of least resistance” become your new standard of care?  It is easier to give a patient a lethal prescription than to diagnose and address the issues underlying despair at the end of life.  If you work for an institution that allows assisted suicide, will you be pressured to dispose of your patients?
In most states, suicidal ideation is interpreted as a cry for help. In Oregon, the only help my patient received was a lethal prescription, intended to kill him.  Is this where you want to go? Please learn the real lesson from Oregon. Despite all of the so-called safeguards in our assisted suicide law, numerous instances of coercion, inappropriate selection, botched attempts, and active euthanasia have been documented in the public record.

Protect yourselves, your patients and your families. Don't let legalized assisted suicide come to Massachusetts.

Charles J. Bentz MD, FACP
Clinical Associate Professor of Medicine,
Division of General Medicine and Geriatrics
Oregon Health & Sciences University
Portland Oregon