Aid in Dying: A Good or a Harm?

http://www.nytimes.com/2016/04/30/opinion/aid-in-dying-a-good-or-a-harm.html

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To the Editor:

Re “Aid in Dying in Canada” (editorial, April 24): You note that this option “can offer the terminally ill a measure of dignity and control.” It can also be the best option for the very small number of people who actually take the prescribed medicines.

Aid in dying has been legal for 18 years in Oregon. Only about 3 of every 1,000 people who die each year use aid in dying. It results in a peaceful death, usually within half an hour.

You assert that there is a “need to provide broader access to palliative and hospice care so patients do not choose death because pain relief is unaffordable.” But more than 90 percent of those patients who choose aid in dying in Oregon are receiving hospice care.

Pain is not a major reason the choice is made (only about 25 percent who choose aid in dying in Oregon cite pain as the reason). There are many other causes of suffering. There is no evidence that the choice is made because pain relief is unaffordable. There is a great need for more palliative and hospice care, but that issue is not connected to aid in dying.

Aid in dying has proved to be a safe and rarely used option for those suffering from loss of control and autonomy, among other things, at the end of life. Polls show overwhelming public and physician support. It should become a legal option across the country.

DAVID C. LEVEN

Pelham, N.Y.

The writer is executive director of End of Life Choices New York.

To the Editor:

You equate the Canadian physician-assisted suicide proposal with the Oregon, Washington State and Vermont laws. The differences show how far down the assisted-suicide slippery slope we have gone.

First, Canada does not require a diagnosis of a terminal illness or condition, but only suffering that the patient finds “intolerable.” This certainly takes the physician off the hook. A spurned young lover thinks that life is over. Do we really want society to assist him to end his life?

Second, Canada does not require a physician to predict death within six months, but only that death is “reasonably foreseeable.” As subjective as the requirement in American states with aid in dying laws that death be expected within six months, Canada loosens it much more. Let’s hope that the assisting physician is prescient.

Third, there is no mandate for a physician to require treatment or palliative care. What’s next in this slope?

STEPHEN F. GOLD

Philadelphia

The writer is a disability rights lawyer.

To the Editor:

The cultural shift to compassionate choices about death is to be welcomed, overdue as it is. But articles like your editorial leave a gap, one that proponents never mention. It’s in the details.

Victims of injury or illness who become paraplegic or completely paralyzed, unable to control their hands, are unable to self-administer the lethal cocktails that licensed physicians may not administer legally. In addition, the prognosis of death within six months is an artificial barrier; for those who have struggled for years, having lost personal autonomy in countless ways, the day seldom arrives when a doctor can determine that the six-months-to-live threshold has been passed.

For these heroic people, Canada’s efforts, as well as those in Oregon and other states, provide little relief and in fact confirm that they are the outcasts, easily overlooked by our well-meaning society.

DONALD W. LIEF

Portland, Ore.

To the Editor:

Physician-assisted suicide should be available to mentally competent patients who have failed medical therapy and whose suffering can no longer be palliated.

They wish to spare themselves and their loved ones the cruel suffering that attends so many slow deaths, and they know better than we do that the prolongation of suffering in the vain pursuit of another day is not the extension of a quality life.

The Hippocratic oath counsels doctors to do no harm. We must recognize that extending a period of intolerable suffering against a patient’s express wishes is harmful.

PAUL BLOUSTEIN

Cincinnati

The writer is a retired pathologist.