It is no surprise that two organizations of my fellow oncologists – doctors who deal every day with the gritty reality of fatal disease – have contradicted the California Medical Association, the large doctors’ lobby that has declared its neutrality to the passage of the bill. Indifference – how very telling.
I urge Californians not to be indifferent, but to tell their legislators of their firm opposition to SB 128.
I have been an oncologist for more than 30 years. I have also been a cancer patient. I have treated hundreds of patients for depression complicated by thoughts of suicide. And I, too, have sought treatment when I developed that illness. Thus, I have had ample opportunity to consider death, suicide and assisted suicide from both sides of the stethoscope. Let me tell you what I’ve learned.
People with terminal illnesses do not seek suicide, assisted or otherwise, because of pain. Patients in pain seek pain control, not death. Fortunately, modern medicine can reduce pain to ordinary levels that we all have experienced. The terminally ill do not seek suicide, assisted or otherwise, because of the burden of treatment. Patients who find treatment burdensome rightly have the option of simply discontinuing treatment.
Rather, without exception, those patients who have asked me to hasten their death did so out of despair. They despaired of having lives of value, of being the object of the loving care of others. They mistook being dependent for being a burden, or mistook being a burden for being contemptible. They were sick and weak, and mistook uselessness for worthlessness. Despair is indeed the sickness unto death.
My job as their physician is to help them through this existential crisis, to help them recognize the intrinsic value that remains within them despite their advanced illness.
I remember one particularly challenging case. A middle-aged man with recurrent cancer and a few weeks to live, a petty criminal estranged from his family, asked me why God was still keeping him alive when all he wanted was to die. Such conversations demand bracing honesty. I told him that I really didn’t know, and suggested that it was his job to discover the reason. A few weeks later, shortly before his death, he told me that he had taken my counsel to heart, and had re-established rapport with his son. He thanked me for having refused his earlier request for assisted suicide, and tearfully told me that these had been the best weeks of his life.
A doctor whose response to a request for assisted suicide is a scribbled prescription for a lethal drug does his patient the terrible disservice of abandonment. It is a tacit admission that the doctor agrees that the patient’s life is of no value. It is hard to imagine a more contemptuous act.
In the relationship with a sick and despairing patient, the doctor is already too powerful. This is true of patients from the upper crust of society and more true of patients who are poor, disabled, immigrant or ethnic minorities. Assisted-suicide laws empower the same physicians who have diagnosed – or misdiagnosed – their patients as having a life-limiting disease to give them a prescription for a lethal drug, instead of honestly attempting to relieve their despair.
Eric Chevlen is an oncologist and pain medicine specialist in Youngstown, Ohio, who spent half his career practicing in Northern California.