Submitted by

David Stevens, MD, MA (Ethics)

Statement to the Tennessee Senate Standing Committee Health & Welfare

In OPPOSITION To The Amendment to SB 1362 – “aid in dying”

Wednesday, March 18, 2015

My name is Dr. David Stevens; I am a licensed physician in Tennessee and I hold a degree in bioethics. I am also the Executive Director for the American Academy of Medical Ethics, located in Bristol, which has 943 healthcare professionals from our state as members.

I am passionate about decreasing suffering. I practiced in a bush hospital for 11 years in Africa. I led a relief team in Mogadishu, Somalia for 10 months during the time of “Black Hawk Down.” I was in Sudan for 11 months during a civil war and famine while we wiped out an epidemic of relapsing fever that had a 40 percent mortality rate. I led a relief team in Rwanda during the genocide. I’ve seen more suffering than I ever wanted to see. Frankly, I’ve stood at patients’ bedsides and prayed that God would go ahead and take them.

But allowing doctors to give lethal prescriptions to their terminally ill patients is just too dangerous.

It is dangerous for physicians. It wrongly assumes physicians are always ideal moral agents. They are not. I know doctors I would refer my loved ones to, but I also know doctors I wouldn’t let treat my dog. Physicians are under increasing stress, workloads and costs pressures. It takes no great skill and very little time to write a lethal prescription, but it takes consummate skill and lots of effort to provide good end-of-life care. Allowing lethal prescriptions also gives the physician too much power. They would be judge, jury and assistant executioner in end-of-life cases. We don’t allow a single judge that amount of power, even in the trials of mass murderers. The power is not in the patient’s hands, despite signing a form and giving oral consent. In just how I describe a disease and its prognosis, I could convince someone that taking a lethal prescription was a good idea without ever saying the words “physicianassisted suicide.” Remember, suicide is not illegal in Tennessee and can be accomplished painlessly by running a car parked in your garage. This is not about giving patients the so-called “right to die” but giving physicians the right to kill.

It is dangerous for families. Could you imagine visiting your parent in a nursing home and finding their bed empty? When you ask, you find that their physician gave them a lethal prescription and they took it without saying anything to you. I know how I would feel: Guilty—didn’t I visit them often enough? Angry—how could their doctor do this without bringing me into the discussion? And I would feel profound sadness. The proposed law does not require family notification.

Allowing this will also cause enormous dissension in families, as had been documented in Europe. It also opens the door to worsening elder abuse. One elderly woman stated, “…when I started losing my hearing about three years ago, it irritated my daughter…She began to question me about my financial matters and apparently feels I won’t leave much of an estate for her… She became very rude…Then suddenly, one evening, my daughter said she thought it was okay for old people to commit suicide…So here I sit, day after day, knowing what I’m expected to do.” 2

It is dangerous for patients. The so-called “right to die” will become the duty to die. When my 87-yearold mother had problems living alone a few years ago, I encouraged her to move into our basement apartment. Like many elderly, she said to me, “Son, I don’t want to be a burden.” Many elderly will feel a duty to not be a financial burden, a time burden or even an inconvenience.

Did you know some bioethicists are already teaching there is a duty to die in our state? Dr. John Hardwig is a Professor Emeritus at UT. When he taught ethics at East Tennessee State University, some of the medical students gave me his handout in which he advocated that people have a duty to die so to not be a burden to the next generation. I went to one of his lectures and asked when that duty kicked in. Without hesitation, he said at age 75, whether you were sick or not.

Depression is the reason 95 percent of the elderly take their lives. Studies show that doctors recognize the signs of depression poorly, especially in the terminally ill, even though they respond well to antidepressant drugs. Yet, the so-called, “safeguards” proposed in this amendment don’t require a consultation by a psychologist or psychiatrist. In 2014, only 2 percent of the 155 patients in Oregon who killed themselves were referred for evaluation.

It is dangerous for patients because mental or physical suffering precludes rational decision-making. The medical definition for “suicidal” is “impaired cognition and distorted judgment” (incapable of thinking straight or making good decisions), but proponents claim there is such a thing as a “rational suicide.” That’s an oxymoron, like drinking a glass of “dry water.” If we deal with the physical and mental suffering, the suicidal ideation almost always resolves itself. We don’t have to kill the patient to kill the suffering.

The cheapest form of treatment for a terminally ill patient is a handful of lethal pills costing less than $100. That is dangerous in a healthcare system with enormous financial challenges. Half of your lifetime costs of healthcare happen in the last year or so of your life. We could handle the cost challenges of our aging baby boomers just by idealizing suicide at the end of life.

Oregon’s Medicaid program will not pay for any treatment that doesn’t promise a five-year, 5 percent survival rate. When a woman petitioned for access to a drug that could prolong her life for two or three years, the state program responded that they wouldn’t pay for it, but they would cover the cost of her suicide if she wanted to take that step.

Allowing doctors to give lethal prescriptions is dangerous for society. If suffering is the criteria, there is no logical place to draw the line. If the terminal patient can’t swallow, don’t they have a “right” for a doctor to give them a lethal injection? If we are going to allow it for a patient who will suffer for six months, how can we deny it for a chronically ill patient who will suffer more than six years? How can you deny this “right” to severely disabled newborns who will suffer for a lifetime? How could you say psychiatric suffering is any less than physical suffering? In fact, you couldn’t deny this “aid in dying” to someone who had no disease at all. In Europe and now Canada, all these people are included and they are working on a protocol to euthanize people on the operating table by harvesting their organs so at least “something good will come out of this.”

It is dangerous for society because the so-called “safeguards” don’t work. Predicting that patients only 3 have six months to live is impossible. A study in the journal Cancer revealed that two out of five patients with cancer lived longer than the six months predicted by their doctors. A study looking at The Netherlands revealed a second opinion was useless because doctors often work together as “consulting pairs” and rubber stamp each other’s assessments. The laws in Oregon, Washington and Vermont make the doctor almost immune to malpractice charges. They can miss the diagnosis or botch the suicide, but they only have to meet the lowest legal standard of “good intent.” In other words, “I didn’t mean for that to happen.” We don’t allow that flimsy standard anywhere else in healthcare.

There is shroud of secrecy around legalized physician-assisted suicide. There is no protocol or funding to investigate and identify abuses. Reporting is voluntary and any reports submitted are destroyed. Only a statistical summary is published. By law, doctors have to lie on the death certificate and say the patient died of the terminal disease. The only thing we really know in Washington and Oregon is that the doctors submitting the forms are filling them out correctly.

I had a friend who went to live in Ethiopia with his wife and young child. Their rented house was infested with rats he could not eliminate. Concerned their baby would be bitten, he complained to his landlord who promised a solution. The landlord showed up the next day with a cobra to put in the attic, assuring them the rats would be dead in a few days. What do you think my friend said? He refused. The solution would work, but it was more dangerous than the rats.

Physician-assisted suicide is that cobra. It is sure to eliminate suffering in the terminally ill, but along with the harms I’ve mentioned, it will literally destroy the foundation of the doctor-patient relationship – trust. It will cause much more harm than good. And you should know it is not a new idea; doctors before Hippocrates both cured and killed. The trouble was you didn’t know which one they would do to you. If someone paid them more, the doctor would kill you and no one would be the wiser. Hippocrates realized medicine could not thrive like that, so he required medical students to take an oath before their future colleagues and the community to promise how they would use the powerful knowledge their teachers would teach them. Over the next few hundred years, patients voted with their feet and Hippocratic medicine became the standard. It is the foundation on which Western healthcare has grown and prospered. Legalizing physician-assisted suicide would take us back 2,500 years.

We need to pour our efforts into eliminating the suffering—not eliminating the patient. We can do this through pain and symptom control research, better end-of-life care, more physicians with palliative care training and good drug laws, as well as coming alongside patients to support them emotionally, spiritually and physically in their last days. A handful of lethal pills is not compassion; it is an escape from the duty of compassion.

H.L Mencken summed it up, “There is always an easy solution to every problem—neat, plausible and wrong.” Let’s not go down the path of physician-assisted suicide. It is not only wrong; it is much too dangerous.