CAUTION: The following information contains content of a graphic nature to describe the actual methods, dangers, and ramifications of doctor assisted suicide. We do not recommend this lethal practice or advocate for its legalization.
What is Doctor Assisted Suicide (DAS)?
Meriam Webster’s simple definition of PAS- physician assisted suicide or (DAS) is
“Suicide that is done with the help of a doctor.”
And that’s exactly what it is.
According to the American Medical Association, physician or doctor assisted suicide occurs when a doctor or medical professional facilitates a patient’s death by providing the means or information necessary for a patient to take his or her own life.
Essentially, a person requests and then ingests a lethal dose of medication prescribed by a physician, and commits suicide.
Where is it legal?
Nine states and the District of Columbia have legalized physician assisted suicide. California, Colorado, Hawaii, Maine, Oregon, Vermont, Washington, and DC have legalized the practice via legislation. DAS is legal in Montana via court ruling. In the remaining states, DAS is illegal, although Utah, North Carolina, Nevada, and Wyoming have no specific statutes outlawing the practice.
For twenty-four years, DAS has been legal in the state of Oregon. It was the first state to legalize physician assisted suicide in the country and set the standard for the practice in the other states that followed. The Oregon Death with Dignity Act (DWDA) was enacted in October of 1997. According to the 2017 Data Summary on the Oregon Death with Dignity Act, 1,967 people have been given the deadly prescriptions under the DWDA since it was legalized. 1,275 deaths have been reported after patients ingested the medications. The rate of deaths by assisted suicide in Oregon in 2017 was 39.9 per 10,000 deaths.
Since the law was enacted, the state has witnessed a steady increase in the number or assisted suicide deaths, every year.
How do patients get it?
Although specific laws differ by state, there are similar requirements for people to obtain the lethal drugs. According to Death with Dignity – one of the leading pro-death organizations in the country – a person must be:
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an adult resident of California, Colorado, District of Columbia, Hawaii (2019), Oregon, Vermont, or Washington; and now Maine and New Jersey
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mentally competent, i.e. capable of making and communicating healthcare decisions;
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diagnosed with a terminal illness that will lead to death within six months.
One must also have the capability of self-administering and ingesting the lethal drugs.
After it’s determined by two physicians that said person “qualifies,” there must be two oral and one written request by the patient.
How is it done?
Secobarbital
LETHAL DOSE: 100 capsules (9000 mg.)
DIRECTIONS: Empty the contents of all 100 capsules into juice or apple sauce. Consume on an empty stomach. Death should occur within 30 minutes
However, Seconal has been replaced with a variety of experimental drug combinations, with the most frequent being:
DDMP2 is a combination of diazepam, digoxin, morphine sulfate and propranolol. Researchers have described DDMP2 as “blue-whale sized doses….And the mixture tastes extremely bitter. ‘Imagine taking two bottles of aspirin, crushing it up, and mixing it in less than half a cup of water or juice.’” In Oregon in 2020, the median time until death was longer for the DDMP2 compound (85 min) than for secobarbital (25 min) [Patients’ Rights Action Fund – Lethal Assisted Suicide Experimental Drug Combination Put Patients at Risk]
WARNING: Immediate death is not guaranteed. Complications include side effects such as nausea, vomiting, seizures and prolonged time from ingestion of the lethal dose until death.[1] Prior to use, take an antiemetic (nausea suppressant) one hour before to prevent vomiting.[2]
Say you are the patient who has requested and received drugs from your doctor to commit suicide.
If you do decide to end your life with the lethal drugs that are now sitting, unattended, in your medicine cabinet. What are they? Death with Dignity explains,
“None of the medical aid-in-dying laws tell your physician exactly what prescription to give you, but all medications under these laws require the attending physician’s prescription. It is up to the physician to determine the prescription.”
What can go wrong?
According to doctors, symptoms are: face reddened, then ashy pale, then blue; seizures may occur; respiratory failure with slowed breathing; loss of cough reflex, fluid collects in throat, gurgling with breathing; coma; and of course, death.
Since it is our body’s natural reaction to vomit when overdose or poisoning occurs, it is even recommended that patients take an antiemetic to suppress the urge to vomit the lethal dose.
But these are only symptoms. These are expected.
What does assisted suicide gone wrong look like?
Dr. Bill Toffler, MD, National Director of the Physicians for Compassionate Care Education Foundation (PCCEF) told the San Francisco Chronicle,
“In many of the cases, the death lingers for hours. It’s not a dignified death. It’s not pretty to watch somebody struggle with breathing or having irregular, shallow breathing for hours and hours on end.”
It might sound like things should end quickly, but this isn’t always the case.
George Eighmey, executive director of End of Life Washington, an organization that assists in PAS deaths, told Crosscut News that the average amount of time it takes (or should take) for a patient to die after ingestion of the drugs is 2 hours. However, several of the Oregon physician assisted suicide reports have indicated that many patients were actually alive for much longer than this.
The Oregon 2017 Data Summary revealed the following:
“Data on time from ingestion to death are available for only 40 DWDA deaths during 2017. Among those 40 patients, time from ingestion until death ranged from ten minutes to 21 hours.”
They also describe that of the 130 patients who ingested the lethal drugs in 2017, one patient regained consciousness.
Accordingly, PCCEF maintains that if the person does not die, the following may occur:
- Complete recovery
- Agitation
- Nightmares
- Hallucinations (sometimes for weeks)
- Anxiety or abnormal thinking
- Parkinsonism
- Acute Schizophrenia
- Dementia
- Permanent Brain Damage
The Patients’ Rights Council also cites several articles and documented cases from the state of Oregon, where DAS attempts had frightening aftermaths. An article from the Oregonian describes the tremendous distress which the overdose of barbiturates can inflict on the human body. It states,
“Extreme gasping and muscle spasms can occur. While losing consciousness, a person can vomit and then inhale the vomit. Panic, feelings of terror an assaultive behavior take place from the drug-induced confusion. Other problems can include difficulty in taking the drugs, failure of the drugs to induce unconsciousness and a number of days elapsing before death occurs.”
Dr. Sherwin Nuland of Yale University School of Medicine is a physician in favor of physician-assisted suicide and euthanasia. Commenting on the Oregon report, which lacks records of complications, he stated:
“This is information that will come as a shock to the many members of the public – including legislators and even some physicians – who have never considered that the procedures involved in physician-assisted suicide and euthanasia might sometimes add to the suffering they are meant to alleviate.”
According to the 2016 Data Summary on the Oregon Death with Dignity Act, 1,127 patient deaths were reported since its legalization in the state, with 133 dying in 2016. Of these reported patient deaths, 30 people are documented as having experienced complications, while 554 did not. However, there are no details regarding the remaining 543 who took the lethal dose. They are simply marked “unknown.”
The Oregon state Health Department, according to PCCEF, obtains very limited information regarding the deaths of patients who request DAS. Interestingly, the Oregon assisted suicide law even prohibits investigation of several of the details surrounding these deaths.
Why do people choose DAS?
The Oregon Death with Dignity Act 2017 Data Summary reports that the biggest reason patients chose assisted suicide (88.1%) was the concern that they would not be able to participate in activities that made life enjoyable.
The next two primary reasons were concerns over loosing autonomy (87.4%) and dignity (67.1%).
Here is the full breakdown:
The above statistics are a matter of great concern.
According to the National Institute of Mental Health, loss of interest or pleasure in activities, feeling helpless, hopeless, or worthless, and thoughts of suicide or death are some of the key signs of depression and related mental illness.
This, along with the statistics from reports, raises a legitimate question:
How many patients are choosing to kill themselves essentially because they are depressed?
The National Alliance on Mental Illness even confirms that an estimated 90% of suicides in the U.S. are associated with mental illness, most commonly depression.
With psychiatric care, patients with depression can be diagnosed and subsequently treated to help alleviate the depressed feelings and get back to enjoying life. Nevertheless, psychiatric testing is not a requirement for patients requesting DAS.
Shockingly, in 2017, only five out of the 218 patients who requested the lethal drugs were referred for psychiatric/psychological evaluations.
On top of these feelings of worthlessness and depression, pressure from outside influences can also be a factor in making the choice to commit assisted suicide. As seen from the Oregon report, another common reason for why people choose assisted suicide is because they’re afraid of being an added burden on their family, friends, and caregivers.
Hearing the words “I love you and I want to care for you” can make a world of difference for someone who may be already feeling worthless. Hearing the opposite from family and friends can be emotionally devastating and exacerbate feelings of worthlessness.
Health insurance companies, in particular, are also becoming a noted source of pressure. The Washington Times recently reported on a doctor from Nevada who claimed that the insurance companies of his patients were refusing to cover expensive, life-saving treatments and suggesting physician assisted suicide instead – a much cheaper option. They relate,
“In 2008, Barbara Wagner received a letter from her state’s Medicaid program declining to cover a lung cancer drug that would have cost $4,000 per month. The Oregon Health Plan, however, did offer to pay for the 64-year-old to procure assisted suicide drugs, priced at $50.”
Anne Sommers, board chair of disability rights group Not Dead Yet, also agrees that insurance companies encouraging assisted suicide is an inevitable consequence of the practice’s legalization.
What about those in excruciating pain?
As seen in the reports charted above, inadequate pain control or concern about pain was one of the least frequent concerns that patients had when opting for DAS.
Dr. Greg Hamilton, a psychiatrist from Portland Oregon, states:
“There is no documented case of assisted suicide being needed for untreatable pain. Instead, patients are being given lethal overdoses because of psychological and social concerns, especially fears that they may no longer be valued as people or may be a burden to their families.”
Dr. Linda Ganzini, a professor of psychiatry at Oregon Health & Science University, conducted a survey on the family members of Oregon patients who requested DAS. In her report, she explains,
“No physical symptoms experienced at the time of the request were rated higher than 2 on a 1 to 5 scale. In most cases, future concerns about physical symptoms were rated as more important than physical symptoms present at the time of the request.”
The study also found that physicians were surprised by the lack of suffering experienced by patients who ask them for DAS. She goes on to state:
“Experts on suicide speculate that depression is an important reason that patients request PAD [Physician Assisted Death].11,12 Numerous surveys of terminally ill patients indicate that endorsement of interest in PAD or desire for hastened death is associated with depressed mood, even major depressive disorder.13–15”
It is a tragedy when a patient chooses to end his or her life out of fear of pain. With the proper treatment and effective pain management techniques, most pain can be eliminated or reduced significantly. Although not all doctors are trained in pain management, there are many doctors who are, and patients should never hesitate to ask.
For people with serious illness, palliative care is one option to help improve quality of life for both patients and their families. This type of care is centered on providing relief from the symptoms and stress of illness. In Illinois, there are 71 hospitals, 54 nursing homes, 10 clinics, and 20 in-home care organizations that offer palliative care, according to the Center to Advance Palliative Care. Palliative care is offered by a team of specialists, including doctors and nurses, who can work in conjunction with primary care physicians.
Does DAS effect overall suicide rates?
A recent study performed by David Albert Jones, DPhil, and David Paton, PhD, published in the Southern Medical Journal, found that the legalization of assisted suicide is associated with an increased rate in total suicide cases. The study found that the legalization of DAS was associated with a 6.3% increase total suicides and a 14.5% increase in suicides among individuals older than 65 years. It concludes:
“Legalizing PAS has been associated with an increased rate of total suicides relative to other states and no decrease in nonassisted suicides. This suggests either that PAS does not inhibit (nor acts as an alternative to) nonassisted suicide, or that it acts in this way in some individuals but is associated with an increased inclination to suicide in other individuals.”
According to the Oregon Health Authority, suicide is the second leading cause of death among 10-24 year-olds in Oregon. As explained in their report, the rate of suicide among young people in 2012-2013 was the 14th highest in the nation. Oregon has repeatedly been ranked as one of the top states for youth suicide. Reportedly, suicide is the eighth leading cause of death among all Oregonians (as of 2012) and the overall suicide rate has been increasing since 2000.
Interestingly enough, another report from the Oregon Health Authority states:
“Suicide rates among adults aged 45 to 64 years rose more than 50 percent from 18.1 per 100,000 in 2000 to 28.7 per 100,000 in 2012; the rate increased more among females than among males.”
When Physicians for Compassionate Care contacted the Oregon Health Authority inquiring about the state’s suicide prevention programs, particularly for older age groups, the response was,
“Staff resources to work on older adult suicide prevention have not been developed in OHA (the agency has two staff members working on Youth Suicide Prevention and Intervention).”
In this state, it appears adult suicide is seen as a non-issue.
What effect does DAS have on the culture of medicine?
From the very origin of the profession, doctors and other medical professionals who entered the field of medicine have done so with the purpose of healing the sick and improving human lives. For centuries, the Hippocratic Oath was an accepted moral code of conduct for physicians. “The Oath of Hippocrates,” holds the American Medical Association’s Code of Medical Ethics (1996 edition), “has remained in Western civilization as an expression of ideal conduct for the physician.”
To this day, doctors still look to the Oath and hold many of its principals sacred. Though there are various modern versions, the Oath states:
“I WILL FOLLOW that system of regimen which, according to my ability, I consider for the benefit of my patients and abstain from what is deleterious and mischievous. I will give no deadly medicine to anyone if asked, nor suggest such counsel; and in like manner I will not give to a woman a pessary to produce abortion.”
But Physician Assisted Suicide presents the healers of our society with a different task: initiating death.
In a study performed by Kenneth R. Stevens, Jr., M.D., FACR and published by the U.S. National Library of Medicine and the National Institutes of Health, it was found that the legalization of assisted suicide can have substantial negative emotional and psychological impacts on physicians. Dr. Stevens writes,
“Doctors describe being profoundly adversely affected, being shocked by the suddenness of the death, being caught up in the patient’s drive for assisted suicide, having a sense of powerlessness, and feeling isolated. There is evidence of pressure on and intimidation of doctors by some patients to assist in suicide.”
As mentioned in the report following his study, physicians from other countries around the world, where euthanasia and physician assisted suicide have been legal for some time, have reported negative emotional effects. As reported,
“In 1995-96, 405 Dutch doctors were interviewed regarding their feelings after their most recent case of euthanasia, assisted suicide, life ending without an explicit request, and alleviation of pain and other symptoms with high doses of opioids. The percentage of doctors expressing feelings of discomfort were: 75% following euthanasia, 58% following assisted suicide, 34% following life ending without an explicit request, and 18% for alleviation of pain with high doses of opioids. Fifty percent of the euthanasias and 40% of the assisted suicides were followed by ‘burdensome’ feelings; and 48% of the euthanasia and 49% of the assisted suicide cases were followed by emotional discomfort.”
In addition, the American Medical News reported on comments made by Pieter Admiral, a leading figure in Holland’s euthanasia movement. He states:
“You will never get accustomed to killing somebody. We are not trained to kill. With euthanasia, your nightmare comes true.”
Physician assisted suicide and euthanasia alike drastically change the culture of medicine. Essentially, doctors are forcibly transformed from healers to killers, destroying the sacred patient-doctor relationship.
Does DAS negatively impact the vulnerable?
There is a substantial argument that legalization of physician assisted suicide will have a negative and disproportionate effect on the weak and vulnerable in society. Not Dead Yet is a “national, grassroots disability rights group that opposes legalization of assisted suicide and euthanasia as deadly forms of discrimination against old, ill and disabled people.” The target market for assisted suicide are those whose lives are seen as not worth living anymore, hence the disabled. Disability rights groups, in particular, are up in arms. The fact of the matter is:
“Although people with disabilities aren’t usually terminally ill, the terminally ill are almost always disabled. People with disabilities and chronic conditions live on the front lines of the health care system that serves (and, sadly, often underserves) dying people.”
The repercussions of adding assisted suicide to the list of “medical treatment options” available to the seriously ill and disabled could be devastating to these communities.
The top five reasons why people choose PAS, as reported in Oregon’s 2017 Data Summary, are loss of autonomy, less ability to engage in activities, loss of dignity, losing control of bodily functions, and being a burden on family, friends, and caregivers. People with disabilities often face these challenges and concerns regularly.
At the same time, so much determining power is given to the physician, who must predict how long a patient has to have to live and decide whether or not their request is rational. As Not Dead Yet explains:
“In judging that an assisted suicide request is rational, essentially, doctors are concluding that a person’s physical disabilities and dependence on others for everyday needs are sufficient grounds to treat them completely differently than they would treat a physically able-bodied suicidal person.”
Subsequently, this leads to a “two-tiered system that results in death to the socially devalued group. This is blatant discrimination.”
But this is not the end of the story.
After the lethal drugs have been prescribed and issued by the pharmacy, there is no supervision of the drugs, the patient, or the administration from there on out. As Dr. Fred Deutsch explains in his write-up for USA Today, this sets up the perfect situation for crimes and elder abuse. What’s more is there is no requirement for a witness to be present, and the patient’s cause of death will be recorded as “terminal disease” on the death certificate, without actual information of what really happened at the time of death.
Physician assisted suicide and euthanasia alike drastically change the culture of medicine. Essentially, doctors are forcibly transformed from healers to killers, destroying the sacred patient-doctor relationship.
What can we conclude?
Doctor assisted suicide is not “health care.” It is not the “compassionate choice.” It is not a “death with dignity.”
It is what it is: suicide – the tragic loss of the life of a human being who doesn’t feel loved and valued as they are, and doesn’t see the intrinsic beauty and worth of life anymore.
The intentional and systematic end of human life through physician assisted suicide, euthanasia, abortion, and criminal homicide is always a tragedy, and should never be disguised as treatment or something good. Acceptance of such a practice sets a poor standard of morality in society, reflecting a dangerous lack of respect and dignity for life overall, leading only to further abuses later on.
If you or someone you know is contemplating doctor assisted suicide, please call us at 312.422.9300 or email us at [email protected].
We’re here to listen. We’re here to help. You have value and you are loved, from the beginning to the end. Life is beautiful.
Watch, listen, and learn.
A practicing physician in the state of Oregon, Dr. Charles Bentz has experienced the legalization of doctor assisted suicide (DAS), first-hand. Having cared for patients nearing the end of life or suffering from terminal conditions, he’s received requests from patients for physician assisted suicide. Sharing his knowledge and personal experience with PAS, we will come to understand the reality and ramifications of this practice.