Real Aid in Dying Means Caring for the Dying, Not Helping Them to Die
I have worked in the field of bioethics for more than 20 years. My introduction to bioethical questions came in December 1997, when my mother-in-law entered hospice at 59 years of age. She had been diagnosed 10 months earlier with breast cancer that had metastasized to her bones. As this was her second round with breast cancer, the prognosis was poor, and she died in January 1998.
During the six weeks she was in hospice, my wife and I were able to live with my in-laws and help care for her. This experience raised significant questions for me regarding suffering at the end of life; she was in terrible pain whenever she was awake. Why? Isn’t there anything that can be done? Can’t this simply end?
These are among the questions that have led to the legalization of assisted suicide in 10 U.S. states and the District of Columbia. As state legislatures convene for 2024, 18 states have had assisted-suicide-enabling legislation introduced, or have it pending from last year, when such legislation was introduced in 15 states.
Arguments will be made that the prospect of pain at the end of life means assisted suicide should be legal. It is worth asking, however, whether legalizing assisted suicide is wise public policy. I submit that it is not, and here are four reasons why.
First, legalizing assisted suicide increases overall suicide rates. To say it another way, suicide contagion is real. A 2015 study published in Southern Medical Journal found a 6.3 percent increase in all suicides following a state’s legalization of physician-assisted suicide, and for those over 65 years of age, the increase was 14.5 percent. This puts those struggling with thoughts of suicide, clearly, even those who are not approaching the end of their lives, at increased risk.
Further, in 2022, suicides in the U.S. set a record high. In July of that year, we witnessed the implementation of the 988 Suicide & Crisis Lifeline, demonstrating our society’s rightly placed concern for those who are at a potentially high risk of suicide. Legalizing assisted suicide when we know that it increases overall suicide rates counteracts these and other important efforts.
Second, every dollar spent trying to enact assisted suicide laws is a dollar that could have gone toward improving patient care at the end of life. Overall, our hospice experience was very good; even though my mother-in-law’s pain was barely manageable, it was managed as well as it could have been. Moreover, pain is not one of the top reasons people request assisted suicide in states where it is legal. Reports often aggregate experiencing pain and fear of experiencing pain, so it is difficult to know how many people actually endure barely manageable pain. Twenty-six years after my mother-in-law died, both hospice and palliative care have come a long way in providing comfort and easing physical suffering at the end of life.
According to a 2018 study by the Center to Advance Palliative Care, The prevalence of hospitals (50 or more beds) with a palliative care team increased from 658 to 1,831 — a 178% increase from 2000 to 2016. While this represents tremendous growth, the American Hospital Association reports that there are over 6,000 hospitals in the United States. There is a great deal more work to be done to make palliative care accessible to everyone.
Third, assisted suicide laws put those with disabilities at risk. A 2019 report from The National Council on Disability titled, The Danger of Assisted Suicide Laws, found that while assisted suicide laws do include safeguards, those safeguards do not, in fact, work. The report detailed several ways such protections fail, including insurance denials of treatments alongside the provision of assisted suicide drugs, misdiagnosis leading to false concern about immanent death, demoralization of those with disabilities, and pressure on those who feel that their care is burdensome on others. This is why all national disability rights organizations with a position on assisted suicide legislation oppose it.
Lastly, assisted suicide is out of step with the fundamentals of the practice of medicine. In news that has received scant attention, the American Medical Association in November 2023 reaffirmed its opposition to physician-assisted suicide. Their code of medical ethics thus continues to read, Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.
The way to provide aid to the dying is to invest additional resources in hospice and palliative care. This is in keeping with the historic practice of medicine, and it protects those at risk for suicide and those living with a disability. Even in the face of painful end-of-life situations, our society would be much better off if we provided more resources for caring well for each other at the end of life rather than focusing on enacting assisted suicide laws.
Suicidal thoughts or actions (even in very young children, older adults, and people with life-threatening illness/disability) are signs of extreme distress and should not be ignored.
If you or someone you know needs immediate help, call, or text the National Suicide Prevention Lifeline at 988.
Learn more about ways you can help someone who might be at risk for self-harm.
F. Matthew Eppinette, MBA, PhD, is the executive director of The Center for Bioethics & Human Dignity in Deerfield, Ill.
