On Difficulties with Assisted Suicide

Monday Musings for Monday March 10, 2014

Volume IV. No. 10/166

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THINKING THINGS THROUGH:

Assisted Suicide

By Assad Meymandi,, MD, PhD, DLFAPA*

I know this is the quadrennial issue of “Monday Musings”. I know we should break out the champagne and give cheers. However, important medico-social issues beckoning the practice of medicine prevent us from that luxury. A few years ago, an event took place that has profoundly affected me personally. The passage of time has helped to calm the emotions which now are transformed into an intellectual challenge. The event was the death of a friend I most admired and loved. He was the gifted, knighted, and holder of the rank of Commander of British Empire (CBE), conductor Sir Edward Downes. He was 85. The lives of both his and his wife, Lady Joan, were shortened by design. Here is the story:

Sir Edward was partially deaf and completely blind suffering from terminal illnesses and failure of multiple organs including heart and kidneys.  His wife Joan, 74, had terminal cancer and was in a great deal of pain requiring enormous quantities of narcotics and opiates. They wanted to take their lives, but the British law does not provide for such plans. Therefore, they travelled to Switzerland where the law on assisted suicide is the world’s most liberal. Their son and daughter watched them as they drank a lethal dose of barbiturates and died while holding hands.

In most of the Western world, suicide is not a crime but helping another to commit suicide is a crime. Not all the incapacitated, terminally ill, or permanently disabled patients are willing to wait for a natural death. Nor are they willing to take the messy and uncertain measures to kill themselves without medical help. Increasingly they travel to Switzerland, often with members of their families, to seek assistance in terminating their lives. In Switzerland, assisted suicide is a crime only if it is done for gain. However, there are strict rules and guidelines as to who qualifies. Belgium, the Netherlands, Luxemburg, and the American states of Oregon and Washington are a few places in the world where assisted suicide is allowed. People who go to Switzerland to receive assistance for suicide are often called suicide tourists.

The history of assisted suicide in England is interesting. In every case of assisted suicide police investigate the suicide thoroughly. Over one hundred cases, including Sir Edward and Joan, there have been no prosecutions of those who accompanied seeker of suicides. In the case of Sir Edward, Joan, their son, and daughter, no slippery slopes of misdeed and no conspiracy have ever been uncovered. Nonetheless in England, July 2009, a law to guarantee exemption from prosecution of those persons who accompany suicide tourists was defeated. Likewise, it is the case in the United States. The laws are strictly against assisted suicide. Our readers recall the case of pathologist Jack Kevorkian who was sentenced to 25 years of imprisonment and but was freed on parole (he died in 2011). He defied the law and assisted terminally ill with lethal doses of drugs.

It is not suggested to do away with the existing laws without thoughtful debate. The laws are designed to protect the elderly against avaricious shuffling and coercing older relatives off to die before they wasted their assets on nursing home fees and depleting their inheritance. In addition, granted, many terminally ill suffer reversible depression. In my own daily practice of geriatric psychiatry, I see many elderly who suffer from reversible depression. They need to be treated and returned to enjoyable life. However, we have adequate diagnostic skills to separate those who are depressed from those who are terminal and close to death. We should allow the patients of this category to die quickly and peacefully. We also have enough linguistic skills to frame a law that clearly offers guideline to achieve these goals. Studying the laws of Netherlands, Switzerland and Belgium could be helpful (I have copies of these laws and would be happy to share with readers.)  A law of this sort would have allowed the esteemed, honored, honorable, the famed composer and conductor, Sir Edward Downes and his wife, Lady Joan, to die as they wished in their own country and in their own home. Physicians and organized medicine, such as American Medical Association (AMA) and American Psychiatric Association (APA) should bring this matter to the forefront of public consciousness.

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*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He serves as a Visiting Scholar and lecturer on Medicine, the Arts and Humanities at his alma mater the George Washington University School of Medicine and Health.

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