LOS ANGELES — “Rare” isn't good enough — especially if it refers to how often doctors are involved in assisting suicides. Though often couched in compassionate-sounding rationalization, assisted suicide is murder, clear and simple. And the horrifying reality is that doctors are participating in it, even doctors at Catholic hospitals.
The encouraging news is that physician support of so-called mercy killing is decreasing, in spite of increased public support for legalized termination of life and increased obstacles to provide adequate care for the terminally ill, referred to as palliative care. Still, the statistics are alarming.
In 1995, Mary Therese Hellmueller's 90-year-old, healthy grandmother was taken to an emergency room to reset a broken bone sustained in a fall. She required surgery and an overnight stay to realign the bone and apply the cast. Instead of being released, though, the woman was dead within four days; the result of a lethal injection of a seizure medication known as Dilantin.
The fatal injection had been administered after Hellmueller's father was told that his mother-in-law was suffering seizures and had experienced a stroke, and after he was pressured into signing both DNR (Do Not Resuscitate) and DNI (Do Not Intubate, insert a breathing tube) orders. With his wife and daughter, both nurses, out of town and in daily contact by phone, there was no viable double-check of the information he had been given. The grandmother died within 10 minutes of the fatal injection. Subsequent examination of the medical records revealed that a stroke never occurred and that the patient was in fact in a medication-induced comatose state.
Several months ago, in a small hospital in Merced, Calif., a similar order — this time from a head nurse — was given to inappropriately increase oxygen to a patient who was not in pain and whose history and condition indicated sensitivity to high doses of the substance. The event never made the newspapers. In many ways, it was just a routine request among the onslaught of daily nursing demands placed on an under-staffed facility. But the attending nurse, who asked to remain anonymous, questioned the orders and called the physician to confirm them. Unlike the case of the Hellmuellers, the doctor stopped the orders — and the killing. A less experienced nurse, or a non-nurse assistant, could easily have missed detecting the fatal consequences of administering such a routine order.
Another veteran nurse, Mary E., explains that through orders given for pain control and the comfort of a patient, or for what an attending nurse assumes is pain from the charts, doctors can increase a medication dose to put a patient into such profound sedation as to bring about respiratory arrest. “It's like anesthesia, said Mary. “Respiration stops because a patient is too sedated, then the heart stops because it's not getting enough oxygen.”
Mary's 20-year nursing career encompasses work in Kansas and California, the last eight of which have been in an oncology center where she is director of the nurses in the clinic and working daily with the terminally ill.
“I know [doctor-directed euthanasia] happens,” she said, “but I don't know how often. I would say it happens in Catholic hospitals too.”
Sheryl Gay Stolberg reported in an April 23, 1998, New York Times article that public opinion polls consistently indicate that 60% to 70% of Americans support legalized assisted suicide for patients who are mentally competent and have less than six months to live. So far, Oregon is the only state to legalize such a procedure, but several surveys among doctors reveal that the practice is “rare” and that support for it is diminishing among medical professionals, even though more doctors would administer lethal injections or doses if it were legalized.
An April 1998 New England Journal of Medicine survey found that 18% of physicians of all specialties surveyed had received a request for assisted suicide and that 3.3% had acceded to the request. Eleven percent had received a request for euthanasia and 4.7% had acceded. In total, this survey showed 6% of doctors surveyed had complied with termination of life requests at least once.
A May 1998 American Society of Clinical Oncology (ASCO) survey of more than 3,200 oncologists produced similar results and, in addition, pointed to a decreasing trend among cancer doctors to support the procedure. In this survey, 22% of oncologists said they supported physician-assisted suicide for terminally ill patients in unremitting pain, a significant decrease from 45% in a similar national survey conducted in 1994-95. Only 6.5% supported euthanasia, compared to 22% in the survey three years ago. Sixty-four percent reported receiving requests for euthanasia or physician-assisted suicide, 13% reported acceding to such requests during their careers and only 4% reported doing so within the last year.
The ASCO survey, which was primarily authored by Dr. Ezekiel Emanuel of the National Institutes of Health, also revealed that the strong decrease in doctor support for so-called mercy killing was offset by the increasing difficulty in obtaining adequate doctor education and patient care for the terminally ill. The survey showed that most recent medical school graduates do not learn about end-of-life care, that 56% of American oncologists report difficulty in obtaining palliative care services for their terminally ill patients, that nearly 50% of oncologists do not feel competent to manage depression among dying patients and that role models are the most effective teaching method to educate about end-of-life care.
“Education of physicians and access to palliative care services remain the greatest obstacles to providing high-quality end-of-life care,” said Dr. Robert Mayer, president of ASCO, who has made improving end-of-life care of cancer patients a major focus of his tenure. “The less access physicians have to such services, the more likely they are to grant requests for physician-assisted suicide and euthanasia. We must continue to improve palliative care in order to render euthanasia and assisted suicide unnecessary.”
ASCO isn't the only group to focus on providing better education and more accessible resources to help physicians deal with end-of-life care. On May 11, the American Medical Association (AMA) began a widely publicized two-year campaign to educate the country's physicians on how to better care for terminally ill patients. This campaign, Education for Physicians on End-of-Life Care, will attempt to reach every doctor in the United States in a “grassroots, train-the-trainer program” to be funded in part by the Robert Wood Johnson Foundation. Dr. Robert Reardon, AMA board chairman, called it one of the most important initiatives in which the AMA has ever been involved.
Other groups such as the Michigan Circle of Life are offering clinical training, pain management and public information programs to address end-of-life issues.
James Haveman Jr., director of the Michigan Department of Community Health says that the group “will encourage more families to take advantage of the planning tools and resources that are available to help assure quality care and compassion when it's needed most.” One of the new pain management tools being introduced in collaboration with Michigan State University and developed at the university's Communication Technology Laboratory, is an interactive CD-ROM, Easing Cancer Pain, to help patients who suffer from cancer pain understand their situation and effective treatments.
The software features personal stories, describes pain assessment, and barriers to pain relief as well as offering detailed information on treatment options. More than 10,000 copies of the CD will be distributed to physicians, hospitals, hospices, nursing homes, and libraries. On May 1, the Michigan-based group also began an aggressive public service announcement campaign to inform Michigan residents that resources are immediately available to offer hope and non-euthanasia solutions to endof-life issues.
“We are the stewards, not owners, of the life God has entrusted to us. It is not ours to dispose of,” reads the Catechism of the Catholic Church regarding suicide. “Suicide contradicts the natural inclination of the human being to preserve and perpetuate his life. It likewise offends love of neighbor because it unjustly breaks the ties of solidarity with family, nation, and other human societies to which we continue to have obligations.”
Indeed, “rare” isn't good enough when considering the participation of our nation's healing profession in assisting suicides. As Christians there is genuine hope in the agony of the cross and it's our duty to foster that hope among those who are terminally ill and among those dedicated medical professionals who care for them.
Karen Walker writes from Corona del Mar, California.