OPINION

Doctors' views on aiding suicide shift

Derek Draplin
The Detroit News

A dying California woman's highly publicized campaign last year to legally end her life and recently published results of polls showing doctors are less opposed to the concept than they were several years ago have added a spark to the debate on physician-assisted suicide.

Brittany Maynard, an activist in the right-to-die movement, died in November 2014 after a long battle in the courts to end her life. She chose to move to Oregon to take advantage of the state’s “death with dignity law.” Oregon is one of five states with some form of law that allows physician-assisted suicide in specific circumstances.

While much of the public attention shone on Brittany Maynard, the 29-year-old California native who moved to the state of Oregon, where physician-assisted suicide is legal, a new annual survey of medical professionals shows a growing change in attitude among doctors about physician-assisted dying.

Maynard died in November 2014 after a long battle in the courts to end her life. The battle had been watched nationwide and revived remembrances of the Michigan physician Jack Kevorkian, who became known in the 1990s for his efforts to legalize euthanasia.

The poll, the Medscape Ethics Report, a survey of 17,000 U.S. doctors released in December before the media picked up Maynard's story, found that 54 percent of doctors surveyed in 2014 think physician-assisted suicide should be allowed. That's up from 46 percent in 2010.

For years, doctors have publicly opposed the concept on the principle that physicians are supposed to protect life, not end it.

"I thought it was very significant to see that shift," said Arthur Caplan, director of the Medscape Ethics Center. "The trend is clear — there's more support among doctors, no doubt about it. This could change the legislative landscape."

According to the Medscape poll, 31 percent of doctors remain convinced that physician-assisted suicide should not be allowed, down from 41 percent in 2010, while 15 percent of doctors responded "it depends," a one-percentage-point rise since 2010.

The public, meanwhile, is more accepting of a patient's right to die.

A 2014 Gallup poll found that 69 percent of Americans support laws allowing doctors to "end the patient's life by some painless means" if the patient has an incurable disease. In the same poll, 58 percent of Americans said they support laws allowing doctors to "assist the patient to commit suicide" if the patient has an incurable disease and is in severe pain.

Adding fuel to the debate was the move in Canada last month when the country's high court unanimously ruled that a law banning physician-assisted suicide was unconstitutional. Considered a victory for the "right to die" movement, the court also suspended its ruling for a year so the various governmental jurisdictions can amend their related laws.

Geoffrey Fieger, the Southfield-based attorney who represented Kevorkian in three trials, contends doctors are just catching up to public opinion.

"Doctors aren't particularly courageous and tend to be conservative. ... Kevorkian was the exception to the rule," Fieger said, noting it's a "fundamental right" to be able to end one's own life. "Society precedes doctors, then doctors catch up."

Jack Kevorkian became known in the 1990s for his efforts to legalize euthanasia. Geoffrey Fieger, the Southfield-based attorney, represented him in three  different  trials.

Maynard, an activist in the right-to-die movement, chose to move to Oregon to take advantage of the state's "death with dignity law." Oregon is one of five states with some form of law that allows physician-assisted suicide in specific circumstances.

"The story of Brittany Maynard definitely made the issue very public," said George Eighmey, a former Oregon state representative and current vice chairman of the Death with Dignity National Center, which promotes "end-of-life" rights legislation. "Her case and the 17 years of exemplary implementation of Oregon's law have been the impetus for the introduction of death with dignity laws in several states."

The Oregon law, which is similar to legislation approved in Washington, Vermont, Montana, and a county in New Mexico, requires patients to receive their prescription of a lethal dose of medication from a licensed physician in their state of residence. Patients must be suffering illnesses that are considered terminal — which is typically considered as having six months or less to live — and be mentally competent.

Eighmey said bills similar to Oregon's law have been introduced in California, Connecticut, Hawaii, Kansas, Massachusetts, New Hampshire, New Jersey, New York and Pennsylvania. There has been no recent activity on the subject in the Michigan Legislature.

The last legislative effort in Michigan was in 1998, when a Proposal B — Michigan Legalization of Lethal Medication to Terminally Ill — was introduced as a ballot proposal. That measure was defeated by voters with 71 percent voting no and 29 percent voting yes.

The Oregon Legislature approved physician-assisted suicide in 1994, but the measure didn't become law until 1997. The law went into effect in Washington in 2009, in Vermont in 2013, with courts ruling in favor of "death with dignity" laws in Montana in 2009 and in Bernalillo County, New Mexico, in 2014.

Some scholars said they believe these moves are heading down a slippery slope, suggesting that the law is the first step in allowing medically induced suicide whether a patient really needs it or not.

"Once it's established that there's a right, the next stop is everyone who is rational can make the case to end their life," said Yale Kamisar, professor emeritus at the University of Michigan Law School, who's been a vocal opponent of legalization. "It's inevitable that five to 10 years down the road, anyone who has a good case has a right to die."

The medical industry, meanwhile, remains the loudest opponent to the legislation. That opposition is based on the principle that physicians are supposed to protect life, not end it.

"The American Medical Association strongly believes that physician-assisted suicide is fundamentally incompatible with the physician's role as healer," said Dr. Robert M. Wah, president of the association.

"Legally authorizing physician-assisted suicide is not the way to alleviate the fears and concerns people have about suffering from a terminal illness," Wah said. "The response is a better informed public and medical profession working together to meet the needs of patients at the end of life with compassionate care, comfort and support."

Other doctors and activists echoed the traditional Hippocratic Oath understanding of the physician's role to protect life.

"They're just recognizing that taking care of people at the end of life is difficult," Dr. Paul McHugh, former head of psychiatry at Johns Hopkins Hospital said of the Medscape Ethics Report statistics. "Too much of the debate is around how to die," instead, "doctors should help their patients live as good a life as possible to the end."

Ed Rivet, legislative director for Right to Life Michigan, said the state's 1998 vote proved "we didn't need assisted suicide." That group, along with the Michigan Catholic Conference, played a major role by raising $5.5 million toward the campaign opposing that last Michigan effort.

"The power shifts to the physician — the one who has the power to write the prescription — we don't want to do that to our health care providers," he said.