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Euthanasia Not Common Yet But an Increasing Concern

ve8QAd   |   January 01, 1999

Into the growing literature about euthanasia has come an article by the well known and respected Dr. Linda Emanuel and her colleagues in the August 12th Journal of the American Medical Association. It was titled “The Practice of Euthanasia & Physician-Assisted Suicide in the United States.” The article is well worth studying in depth. It purports to be only the third legitimate such study carried out in the United States. Reporting of it in the secular press has varied widely and has frequently given the impression that physician-assisted suicide and direct euthanasia is considerably more common than a close reading of the study shows.

On the other hand, the reports in the media have sharply downplayed or completely omitted its rather specific negative findings. These findings are very disturbing. If these abuses are as common as reported in a climate where assisted suicide is a felony, how more frequent and serious will such abuses become if and when it is no longer a crime? Let’s examine the study.

First of all, it studied only 355 oncologists (cancer specialists). Grant that these physicians are those most frequently faced with such situations. However, it is unrealistic to assume that the incidence of euthanasia, or assistance thereof, by such specialists is representative of the profession as a whole. They face many critical and dying patients every day. The average physician cares for such patients far less frequently, so it would be logical to assume that the opportunity for euthanasia among oncologists is sharply higher than that among physicians in the ordinary practice of medicine and surgery. Therefore, we cannot take the percentages of doctors in this study as representative of your own physician or community.

Of the 355 oncologists interviewed in depth, 38, or 10.5%, actually had been involved once or more in their lifetime with direct euthanasia, physician-assisted suicide or a combination of the two. They were not asked whether the case that they reported on was the only time in their career, or whether there had been several or even frequent instances. So, in a sense, this, then, is about as misleading as to compare all unmarried women by categorizing them as virgins or non-virgins. Clearly, among non-virgins, there would be women with only one sexual encounter, but others who were very sexually active. Even so, the current study has merit.

There were four criteria used in requesting and investigating the doctors’ involvement in this – (1) that the patient was terminally ill. All patients in this study were listed as terminally ill. That meant that, by the physicians’ judgment, they would die within six months. It is to be noted that when this is a criterion in your state for proposing legalization of euthanasia, be very skeptical. A physician’s ability to predict how many months a patient has to live is about as reliable as predicting the weather. Except in the very near term when there are only hours or days remaining, doctors are frequently wrong. Also, “terminally ill” can be interpreted as being “incurably ill.” But if you have diabetes, you’re incurable, and the same is probably true with hypertension. These cases are not “terminal” but can be so interpreted politically.

The second criterion was that the patient request euthanasia one or more times. A very disturbing finding here was that in one case out of six, the family or the doctor requested it, not the patient, even when the patient was conscious.

The next criterion was that the patient has extreme pain and suffering. The study indicated that this was true in almost every case and that, in most cases, narcotics had been used. No further details were given. Misuse and inadequate use of narcotics is almost the rule in the US rather than the exception. In the well-documented amicus briefs submitted by the AMA to the US Supreme Court in 1997, the AMA beat its breast admitting that doctors were grievously inadequate in giving adequate pain relief. If your loved one is suffering pain, and that pain is not being properly relieved, don’t kill the patient, rather, get another doctor. If your doctor can’t control pain, get one who can. Pain can be controlled.

The fourth criterion was that there should be consultation with another physician, preferably a psychiatrist. This certainly is good advice, as a second physician reinforces the attending physician’s beliefs and decisions as well as distancing his judgment from whatever biases he may have. We know from other studies that 95% of people who commit suicide, or request it, are clinically depressed. And so, what was the score here? Less than half, 39%, of these cases of assisted suicide or euthanasia had consultation with another physician – and only one in twenty had a consultation with a psychiatrist. That is scary!

Overall, in only one case in three did the attending physician observe all four of these criteria. This is similar to the practice in Holland. But euthanasia is still a felony in the US. Think of how much more careless the profession may become if and when euthanasia is legalized in this country.

The article looked with apprehension on the fact that, of the physicians who had been involved in killing, one in four later regretted having done so. The authors state: “Given that this action is irreversible, such a high frequency of regret should be a cause for concern.” We certainly agree.

Another finding was one that we have found consistently in Holland also, and that is that one patient in six failed to die from the dose of medicine given by the physician to assist them in suicide. In Holland this is no great cause for concern, because if, after several hours, the patient has not died, the doctor there simply gives a lethal injection in the vein. It is highly unlikely, the authors state, that such direct euthanasia will be legalized in the US in the foreseeable future. The fact that such patients don’t die is simply stated with no “solution” offered. It is judged to be a cause for substantial concern. It should be!

Conclusion: A critical look at this study, which is well done, and by competent researchers, on the one hand gives less cause for concern than one would have judged from the newspaper accounts, but on the other hand gives ample cause for major concern. First of all, it studied only oncologists, who are not at all representative of the average practicing physician who attends many fewer critically ill and dying patients. Oncologists should have a considerably higher percentage of assisted suicide and euthanasia. Then it does not detail how many times each physician has committed physician-assisted suicide. In some cases he may have “assisted” only one patient in a lifetime of practice.

Another cause for concern was that one patient out of six was sent to the Great Beyond without that patient’s knowledge or request. Less than half had another physician in consultation and only one in twenty had a psychiatric evaluation. Most were in “extreme pain and suffering,” but the study does not in any way detail whether or not consultation for the pain had been requested, as oncologists are certainly not pain specialists. One doctor in four later regretted his actions. One patient-victim in six failed to die from the dose of “lethal” medicine that was given.

In summation, then, considering the huge number of terminally ill, dying and critically ill patients in the United States, the number of those who are killed by doctors or assisted in suicide is an extremely small figure.

One final caveat is in order, however. The same used to be said for doctors in Holland, but once the law allowed euthanasia, very soon a significant percent of doctors began to kill patients – and in a significant percent of cases they have been doing so without the patient’s knowledge or consent. The situation in the U.S. today still looks good, but we should be thoroughly warned as to what can and probably will happen if assisted suicide (euthanasia) is legalized.

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