"Death with dignity", they call it. I see the death, but not the dignity, behind a ballot question coming on Tuesday in Massachusetts.  It will allow for physician-assisted suicide, and, if passed, Massachusetts will be the third state in the country to have passed such a law.  A difference between this proposal (called Question 2, which allows for physician-assisted death if a terminal illness is diagnosed with a prognosis of less than six months of survival) and some others is that there is no requirement for evaluation by a psychiatrist for depression before the lethal medication dose is administered. 

This itself is a fatal flaw.  

I know many liberal-minded people automatically are attracted to the concept of death with dignity; such persons are always in favor of individual choice and autonomy. Doctors should do what we want, not what the doctors want.  This liberal attitude (which I generally share) perhaps is heightened in some by awareness that opponents of proposals like Question 2 tend to include conservative pro-life religious groups and the Catholic church.  Supporters include Rep. Barney Frank and gay rights groups. 

Now, readers of my blog will know that I am anything but a political conservative. I tend to take constant flak from conservative readers. But there is a reason why the Massachusetts Medical Society opposes this question. There is a reason why most physicians consistently oppose this kind of idea. 

Let me explain, first, specifically, in relation to Question 2, and then more generally: 

First, as an expert in depression, this needs to be clear about this ballot question:  

Many persons who become medically ill become depressed; severe depression involves seeing things more negatively than they really are.  If there is uncertainty about the prognosis of an illness, a depressed person will be inclined to see the worst scenario. If this means possibly less than 6 months, this law would allow such persons to legally get doctors to kill them, without any psychiatric evaluation for depression by a specialist.  This is dangerous.   

More generally, let me tell a story about why the whole concept of physician-assisted suicide is wrong-headed: 

As a young medical intern, one of the most important things I learned occurred when I had been too aggressive trying to treat a man hospitalized with terminal prostate cancer; his personal doctor told me, "Nassir, you can't save his life; sometimes, being a good doctor means learning to help people die."

I still remember the earnest look on that doctor's face.  I had never received that advice previously, after four years of medical school.  I felt as if a huge load had been taken off my back. I stopped worrying about my patient's arterial blood gases, and started worrying about whether he felt any pain.  I started talking to and consoling his wife, and children, and grandchildren. Helping him die meant helping him be comfortable and out of pain.  It didn't mean giving pills that would kill him within minutes.  This is not a morally or scientifically legitimate role for a doctor.  

And, given the predictable fact that some patients will make a mistake, out of depression, in their judgments on how long they will live, it is not something which patients themselves can decide with moral or scientific certainty.

When my patient died, I went to his memorial in his home, and his family thanked for helping him die with dignity. Doctors already do this; we don't need to be told to provide fatal prescriptions instead.   

Life and death are uncertain propositions; no law can remove that uncertainty. 

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