By Dr. Omega Silva, MD, MACP
Ten years ago, in 2007, the American Medical Women’s Association became one of the first national medical organizations to adopt a policy supporting laws that allow terminally ill adults to voluntarily request medical aid in dying to peacefully end unbearable suffering.
At the time, Oregon’s Death with Dignity Act was the only such law in the nation. These laws authorize doctors to write a prescription for medication for mentally capable, terminally ill adults who request it, so they can decide whether to take it to end unbearable suffering, by dying peacefully in their sleep, at home, surrounded by their loved ones.
Since 2007, more than 20 national and state medical associations have either endorsed medical aid in dying or dropped their opposition to this end-of-life care option and adopted a neutral position, leaving it up to each terminally ill person, in consultation with their doctor, family and faith leader or spiritual guide, to make this or any end-of-life care decision.
In addition, five other states have authorized medical aid in dying, Washington (in 2008) Montana (in 2009) Vermont (in 2013), California (in 2015) Colorado (in 2016) as well as the District of Columbia (as of Feb. 2017). Oregon and these six other authorized jurisdictions comprise 18 percent of our nation’s population.
Since January, legislation authorizing this end-of-life care option has been introduced in 25 states: Alaska, Arizona, Connecticut, Hawaii, Indiana, Iowa, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Utah, and Wisconsin.
National and state polling consistently shows the vast majority of physicians and other Americans across the political and religious spectrum support medical aid in dying.
Unfortunately, President Trump’s nominee to the Supreme Court, Colorado appeals court Judge Neil Gorsuch, repeatedly dodged opportunities during his confirmation hearings last week to renounce his opposition to medical aid-in-dying laws. Instead, Judge Gorsuch kept making statements consistent with those in his 2006 book in which he criticized medical aid in dying. Here is just one example:
Sen. Dianne Feinstein (Calif.): “California just passed an End of Life Option Act…so tell us what your position is in the situation with California’s End of Life Option Act,” asked.
Judge Gorsuch: “…the position I took in the book on that was anything necessary to alleviate pain would be appropriate and acceptable, even if it caused death, not intentionally but knowingly. I drew a line between intent and knowingly.”
In fact, Judge Gorsuch suggests in his book that a physician who medicates a terminally ill patient into a coma and withholds nutrition and fluids until the person dies is not intending to facilitate their death, even though this practice is often called “terminal sedation.” Paradoxically, he says providing aid-in-dying medication to terminally ill adults so they have the option to take it to end unbearable suffering is not for that purpose, but to intentionally kill them.
This stance should trouble anyone who values freedom and privacy to make their own decisions about end-of-life care.
Full disclosure: This issue is personal for me because I live with three cancer diagnoses. I will never forget one of my best doctor friends, who was dying from uterine cancer and breast cancer. She looked at me as I was trying to comfort her one day, and she said: “This is taking too long.”
Unfortunately, I am all too familiar with this kind of agonizing dying experience during my decades’ long career as an internist and endocrinologist. I have seen palliative care and hospice programs provide extraordinary care to patients. They work wonders for many dying people and their loved ones. But there are times even the best palliative care cannot alleviate pain and suffering. Patients may suffer from physical and emotional pain, from a loss of autonomy, and from an inability to engage in enjoyable activities. These issues are legitimate.
I love my work…and my life.
But if the time comes that I have no hope for a cure and my suffering becomes unbearable, I would want physician medical aid in dying as an option for myself, and for the sake of my loved ones.
That is why, as a physician and as a patient, I urge my fellow members of the American Medical Women’s Association to adopt a position opposing Judge Gorsuch’s confirmation before the Senate votes on it in early April. I also urge each AMWA members to tell their two U.S. Senators to reject Judge Gorsuch’s nomination.
I believe the medical aid-in-dying option is consistent with the Hippocratic Oath. Though medicine has changed dramatically in the 2,500 or so years since Hippocrates, the concept remains valid today: Do what is right for the patient.
Dr. Omega Silva was the first woman president of the Howard University Medical Alumni Association and is a former president of the American Medical Women’s Association.