CHICAGOWhen the US Supreme Court decided recently that patients have no inherent right to physician-assisted suicide, it neglected to help physicians decide how to respond to those exceptional cases involving real patients with real suffering, said Timothy E. Quill, MD, at the American Academy of Family Physicians annual meeting.
Dr. Quill, professor of medicine and psychiatry at the University of Rochester School of Medicine, Rochester, NY, was one of several parties who brought suit against a New York State law that prohibits what he called an open process of physician-assisted suicide. This case and a similar case in the state of Washington formed the basis of the Supreme Courts decision on physician-assisted suicide.
In commenting on the implications of the Supreme Court ruling, Dr. Quill said that the high court in essence gave a green light to states that wish to experiment with legislation regarding physician-assisted suicide. It also affirmed the practice of providing heavy sedation to patients at the end of life.
However, the courts decision also reaffirmed what Dr. Quill calls the arbitrary, secretive process we have now, which means its okay to assist a patient to die as long as you dont talk about it.
He noted that the physicians safest course of action from a legal point of view, should a patient ask for help in dying, is to walk away. You dont get in trouble by doing that, even though its the most morally bankrupt approach, he commented.
Dr. Quill said that dying patients need access to state-of-the-art palliative care and should be treated by clinicians who have expertise in delivering palliation and who can promise that they will see the patient through to the end of life.
He also emphasized, however, that dying patients and physicians should have a predictable way of responding when suffering becomes extreme despite good palliative care. Stopping life support is accepted; high doses of pain medication are accepted. If terminal sedation and stopping eating and drinking are going to be last resort responses of palliative care, they are better than no response at all, he said.
He nevertheless feels that physician-assisted suicide should be openly available because death is not the enemy; severe suffering and disintegration of the person are the enemies, and they should be treated as medical emergencies.
Perpetuating the status quo, which makes abandoning patients during the dying process the safest course for physicians to take, is unacceptable, he said.