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March 9th 2005 @ 6:02 am

The facts about end-of-life decisions

Assembly members Patty Berg and Lloyd Levine have introduced a bill in the California Legislature to legalize physician-assisted suicide.
This raises a number of concerns for me.
I have been a doctor for nearly 40 years. For 22 of these years, I have been actively involved in the field of bioethics. Through hands-on experience, I have come to realize the importance of focusing on facts, rather than hearsay or fear when it comes to end-of-life decisions.
Common belief incorrectly suggests that fear of severe pain is the primary reason patients choose physician-assisted suicide. In Oregon - the only state with legalized physician-assisted suicide - a study found that more than 90 percent of 171 patients undergoing physician-assisted suicide between 1998 and 2003 feared?losing autonomy and worried about becoming less able to engage in activities making life enjoyable.
Eighty percent had concern about their loss of dignity, 60 percent were afraid of losing control of bodily functions and 40 percent of being a burden on their family. Only 20 percent mentioned worry about inadequate pain control and 2 percent about the financial implications of treatment.
When introduced into an individual’s therapeutic program early enough, hospice organizations can address the primary issues affecting the dying patient and family by administering spiritual and emotional support as well as by helping guide the patient’s doctor in adjusting medications for pain and comfort.
This team is able to help the terminally ill patient retain dignity, improve well-being and be less of a burden to their family as they proceed through the process of dying.
For thousands of years, physicians have developed a trusted relationship with their dying patients. The legalization of physician-assisted suicide may subtly change this bond.
In 1992, the Netherlands was the first nation to legalize physician-assisted suicide. CNN.com in December reported, “Dutch health officials are considering guidelines doctors could follow for euthanizing terminally ill people with no free will, including children, the severely mentally retarded and patients in irreversible comas.” These individuals did not, or could not, express their desires before their illness.
Legalized physician-assisted suicide could favor the “quick fix” of assisted death and ignore the possibility of comfort care. It may begin as an option and silently turn into an expectation. The high cost of medical care and the emotional burdens placed on the patient’s family or support group may result in vulnerable patients looking upon their doctor with an element of distrust, fearing the possibility of unwanted euthanasia. This could result in patients failing to seek medical treatment in a timely manner, which could greatly increase their emotional and physical discomfort. Even worse, the patient may feel guilt y for not choosing physician-assisted suicide.
Overwhelmed with fears, a patient’s request for euthanasia may be an unconscious cry for compassion. Webster’s Dictionary defines dignity as “proper pride and self-respect.”
Is there more self-respect with the termination of a human life or by allowing a human to celebrate the end of his living journey with the emotional support of his community in comfort and in peace? We all begin to die the moment our parents conceive us. Let us, as a civilized society, do what we can to eliminate the fears surrounding the process of dying, rather than hasten the death of those who are dying.

J. Michael Gospe is a retired physician and currently acts as the medical director of ethics for Santa Rosa Memorial Hospital, which is part of the St. Joseph Health System.

-Camille
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Take away God, all respect for civil laws, all regard for even the most necessary institutions disappears; justice is scouted; the very liberty that belongs to the law of nature is trodden underfoot; and men go so far as to destroy the very structure of the family, which is the first and firmest foundation of the social structure.
- St. Pius X, Jucunda Sane, March 12, 1904