February 5, 2007
To my colleagues deliberating on the question of doctor-assisted suicide in Hawaii.
I am an internal medicine physician, practicing in Portland, Oregon, and I would like to share with you a story about one of my patients.
Recently, I was caring for a 76 year-old man when I made the diagnosis of malignant melanoma, found a metastasis in his shoulder, and referred him to both medical and radiation oncologists for evaluation and therapy. I had known this patient and his wife for over a decade. He was an avid hiker, a popular hobby here in Oregon. As he went through his chemotherapy and radiation therapy, he became less able to do this activity, causing a depression, which was documented by his radiation oncologist.
At his final visit with his medical oncologist, he expressed a wish for doctor-assisted suicide. Rather than taking the time and effort to address his depression, or ask me to respond to his depression as his primary care physician and as someone who knew him, the medical oncologist called me and asked me to be the “second opinion” for his assisted-suicide. The oncologist told me that secobarbital “works very well” for patients like this, and had done this many times.
My reply was that assisted-suicide was not appropriate for this patient, and that I did NOT concur. I was very concerned about my patient’s mental state, and I told the oncologist that that addressing his underlying issues would be better that simply prescribing a lethal medication. Unfortunately, my concerns were ignored, and two weeks later my patient was dead from a lethal overdose prescribed by this oncologist. With the permission of his spouse, I obtained a copy of his death certificate. It listed the cause of death as melanoma.
The public record is not accurate. My patient did not die from his cancer, but at the hands of a once-trusted colleague. This experience has affected me, my practice, and my understanding of what it means to be a physician. What happened to this patient, who was weak and vulnerable at the end of his life, raised several important questions that I have had to answer, and that you in Hawaii need to understand as you deliberate this question for your citizens:
- Who can you trust? If you send a patient to a colleague and expect excellent care, do you have to specifically ask “Will you kill my patient when he becomes depressed at end of life?”
- What does the request for ‘assisted-suicide’ mean? Suicidal ideation used to be interpreted as a cry for help, and the only help my patient received was a lethal prescription, intended to kill him.
- What could I have done to help this patient? I had referred him on to specialty care, a person who I trusted, and the outcome proved to be fatal. My patient’s needs were not met. If my colleague had bothered to find out more about him, worked with him to treat his depression, and helped him find meaning and new ways to function, perhaps things might have turned out differently.
To the physicians and health care workers in Hawaii, is this where you want to go? Is this what you want to become? Please learn the real lesson from the Oregon experience of doctor-assisted suicide. Despite all of the so-called “safeguards” in our assisted suicide law, numerous instances of coercion, inappropriate selection, botched attempts, and active euthanasia have been documented in the public record. This, however, is not the worst of it. In my opinion, the tragedy of Oregon is that instead of doing the right thing, which is to provide excellent care, patient’s lives are being cut short by physicians who are not addressing the issues underlying patient suicidality at the end of life. This change in the direction of our profession, after 2400 years of “Do No Harm”, has me concerned. This should concern all Hawaiians as well.
Charles J. Bentz MD, FACP
Clinical Associate Professor of Medicine, Division of General Medicine and Geriatrics
Oregon Health & Sciences University, Portland Oregon
Department of Medicine Faculty Practice, St. Vincent Hospital and Medical Center
9205 SW Barnes Road, Suite 2800, Portland, OR 97225
phone: (503) 216-7496