On Law

May 12, 2015

May 26, 2015

June 9, 2015


The devil's in the details of physician-assisted suicide

Bob Lawton, my uncle, was a husband, father, and lawyer. He died in October 2006. He had mesothelioma, a rare type of cancer that began destroying his lungs. During the last two months of his 80-year life, he endured severe pain.

At times, the only dosage of painkiller that dulled his pain was so high that it made him unconscious or, when awake, unable to talk. I wasn't there when it happened, but he begged one of his doctors for a lethal injection. The hospital discharged him and sent him home to die. With great compassion and skill, hospice workers cared for him in his last days. He spent them with his wife and children.

I first heard of Senate Bill 128, the End of Life Option Act, this year. SB 128 is pending in the state Senate. When I heard of it, I thought of my uncle right away. If this had been on the books in 2006, I thought, he'd have gotten that shot. At that moment, SB 128 sounded like a compassionate law that I would favor.

SB 128 affects life and death. So it deserves more than 900 words in a column. But that's all I've got in which to tell you that SB 128 deserves a closer and more cold-eyed look than most seem to be giving it. That look ought to be divorced utterly from emotion and sad stories.

SB 128 would allow adult patients suffering from terminal disease to request lethal drugs for the purpose of suicide. It would authorize physicians to prescribe those drugs. It would require two California physicians to agree that a mentally competent patient has six months or less to live before prescribing life-ending drugs. The patient would have to self-administer the drugs. The bill is modeled on Oregon's assisted suicide law, which that state enacted in 1997.

SB 128 is rife with the potential for abuse and unethical behavior in the real world in which we have to live and die. The potential abuse would be of chronically ill people. The potential unethical behavior would be of physicians and payers for health care. Let me explain.

End-of-life choices are sometimes unduly influenced by the biases and wishes of others. These others include private and public payers for health care. Doctor-prescribed death costs less than palliative or other care that would extend life.

Given that reality, those biases and wishes are not hard to imagine. In Oregon, there has been at least one reported case in which a health plan denied chemotherapy while offering instead to pay for the patient's killing.

In this setting, California's medical marijuana experience offers some troubling precedent. Everyone knows that we have medical marijuana physicians-for-hire. These physicians know nothing of their patients, except what they learn in a cursory "examination" that precedes their recommendation of medical marijuana (for a cool $100 in cash per head).

It isn’t hard to imagine that physicians of similar ethics would be called on to deliver a paid-for, dubious medical opinion that a patient has six months or fewer to live and to prescribe lethal drugs for that patient.

Then there is the assumption that two physicians' opinions that a patient has six months or less to live deserves decisive weight. What a joke. Physicians don't like to admit it, but they're wrong about such matters from time to time. Once given and acted on in a matter decisive of life or death, such mistaken opinions will become irrevocable and permanent.

Many of us don’t stand for that when it comes to judicial errors resulting in capital punishment of convicted criminals. That we should endorse it from physicians in cases of innocent, terminally ill people seems bizarre.

People at the end of life are susceptible to severe depression. Understandably, they want to commit suicide at one time or another, as my uncle did. This is not necessarily because they're terminally ill, but because they are afraid and depressed.

There are treatments for depression. Giving those treatments ought to have at least as much primacy in the discussion as killing the patient in order to end his depression. SB 128, however, seems to ignore this.

Brittany Maynard was a 29-year-old native of Anaheim, married, and beautiful. In 2014, terminal brain cancer prompted her to decide to end her own life. She moved to Oregon. YouTube broadcast her end-of-life videos. She died via physician-assisted suicide in November 2014.

The glowing media accounts that I read glossed over the medical and ethical issues around her suicide. They chose instead to highlight what a wonderful person she was and how thoughtfully she had planned her death. She became a poster child for something that the media bothered not to study in any depth. Now, perhaps Californians can study it in a way that the media were too lazy or too ratings-hungry to do.

There is plenty that physicians can do to alleviate the suffering of a terminally ill patient in terrible pain. Hospice care is there, too. In the meantime, if they want to help people commit suicide, they belong in another profession. Whether they like it or not, doctors take a sacred oath never to harm a patient knowingly.

SB 128 deserves a deeper analysis than the superficial and sentimental reaction prompted by stories like Brittany Maynard's and Bob Lawton’s. I wonder if the politicians in our state Senate are capable of it.


Lawton is the principal of Lawton Law Firm in downtown San Diego. His column appears twice monthly.


May 12, 2015

May 26, 2015

June 9, 2015