Physician-Assisted Suicide: Threat to Improved Palliative Care (2017)

Physician-Assisted Suicide: Threat to Improved Palliative Care

This document argues that legalizing physician-assisted suicide (PAS) can undermine rather than improve palliative and hospice care. It challenges the claim that assisted suicide is simply another end-of-life option and presents evidence suggesting that legalization may reduce incentives to invest in compassionate care for seriously ill patients.

The document's central thesis is that physician-assisted suicide may divert attention, resources, and medical creativity away from improving hospice and palliative care. It contends that the more ethical and effective response to end-of-life suffering is to expand access to comprehensive pain management, hospice services, and high-quality palliative care rather than legalize assisted suicide.

Key Points

• Better care, not assisted suicide, should address suffering. The document cites a position paper from the American College of Physicians emphasizing that society should improve access to humane, dignified care rather than resort to physician-assisted suicide. 
• States that legalized PAS did not show clear improvements in hospice or palliative care. 
  • After Vermont legalized PAS in 2013, concerns remained about its relatively low hospice utilization rates. 
  • Oregon, despite being an early leader in hospice care, experienced hospice growth rates that lagged behind national averages after legalization. Washington also had below-average hospice utilization. 
• Reports of pain and distress increased in Oregon after legalization. A study comparing periods before and after Oregon's assisted-suicide law found increased family reports of moderate or severe pain and distress among dying patients, suggesting that end-of-life suffering did not necessarily decrease. 
• National comparisons did not place Oregon at the top of end-of-life care. A 2002 report by the Last Acts coalition found that multiple states where assisted suicide remained illegal outperformed Oregon on various measures of hospice, pain management, and palliative-care services. 
• Alternative policies may strengthen palliative care. The document highlights evidence that states prohibiting assisted suicide while explicitly protecting aggressive pain management saw increased physician confidence in prescribing effective pain-control medications such as opioids for legitimate medical use.

Physician-Assisted Suicide: Threat to Improved Palliative Care