Once again, proponents of physician-assisted suicide have brought forth a bill in the Nevada Legislature trying to legalize this dangerous practice in our state. Let me summarize some of the many concerns that I and like-minded medical professionals have with this proposal.
The bill has many flaws, just like the laws that legalize the practice in other states. Eligibility would be open to anyone who has been diagnosed with a terminal condition and without treatment, is likely to die within six months. This is a major problem because physicians have a very difficult time predicting when most diseases become “terminal,” and the timing of death is even more difficult to determine. My family has personal experience with this: My father was diagnosed with a malignant brain cancer (glioblastoma) and given a prognosis of less than six months to live. He survived for almost four years after his diagnosis. This is also well documented in medical literature. A study of hospice patients in the Chicago area showed that of 468 predictions of timing of death, only 20% were accurate. Inaccurate diagnoses or prognoses, coupled with physician-assisted suicide, would result in the deaths of patients who would otherwise have years of life remaining.
Next, many elderly and terminal patients feel they are a burden to loved ones, and this law would encourage suicide as an answer to this flawed perception. The 2020 statistics from Oregon, which was the first state to legalize physician-assisted suicide, are clear that the reasons stated for obtaining a lethal prescription are not pain-related concerns. The most frequently listed reasons include: decreasing ability to participate in activities that made life enjoyable (94%), loss of autonomy (93%) and loss of dignity (72%). These are all disability-related concerns that ought to be treated with proper medical care, not a hastened death.
Thirdly, many patients diagnosed with a terminal condition are depressed, and this law includes no requirement to refer to psychiatry or counseling. The Oregon statistics show that only three out of 370 patients receiving lethal drugs were referred for psychiatric evaluation. This is shocking, as a 2006 study found that 25% of patients requesting assisted suicide were clinically depressed. Depression is a treatable condition; obviously, a completed suicide is not treatable.
There are other reasons to oppose this legislation, including: lack of oversight by any watchdog organization due to patient privacy laws; lack of adequate government oversight; the fact that it will always be cheaper for an insurance company to pay for assisted suicide over expensive treatments. The so-called “safeguards” touted by proponents are inadequate, making it easy for abuses to occur, but also hard to track.
We have been successful in defeating previous bills like this in multiple legislative sessions. I urge state legislators to look into the facts and think about the unintended consequences of this law. The pandemic has brought so much death to our state. Now is the time to expand access to quality medical care, not pass laws that institutionalize death. Let’s work to give people the care they deserve at the end of life, not physician-assisted suicide.
Kirk Bronander, MD FACP, is a hospitalist and internist with UNR School of Medicine, where he is the academic hospitalist director and professor of medicine.