California Senate Bill 128
Physician-Prescribed Lethal Drugs are not “compassion” in Terminal Illness
Suffering and pain have a purpose that we cannot fully understand. The pain of a terminal illness does not justify the use of lethal drugs, which is an affront to human dignity and would make physicians explicitly violate their Hippocratic Oath by being active participants in killing.
None of us would wish suffering and pain on our loved ones. But it happens. There is no escaping it. And yet, SB-128, the “End of Life Option” Senate Bill, would propose that there comes a point when, in essence, “some lives are not worth living”, such as lives wracked with a painful, terminal illness. The bill proposes that in such instances, the terminally ill person may request physician prescribed medications for the purpose of ending his or her life. “Death with dignity” and “compassionate care” are terms used to describe such a seemingly merciful final disposition for the patient. But under the layers of this outwardly compassionate premise lies a bill that is deeply caustic and damaging for patients, society, and the practice of medicine.
The unspoken underlying working paradigm in all such legislation is that suffering has no meaning, no purpose. Comfort, convenience, and disposability are hallmarks of such thinking. Has our self-absorbed Western culture become so fixated on comfort-at-all-cost that we no longer see any purpose in suffering? Do we no longer see any Divine hand at all in the providential direction of our human lives, either good or bad? Is it so hard for us, so accustomed to micromanaging our world, to simply “give in” to the reality of our stage in life, to “give up” whatever suffering we endure to a Higher Power, which in some way will ultimately benefit – in ways we cannot fathom – ourselves and our world? Can we not trust that Someone knows better than we do? Human life, unlike much of our culture, is not disposable.
In witnessing the end stage of a loved-one’s life, surely we can all acknowledge that there are worthy and noble qualities that become inculcated into us. Qualities that are often not noticed above the din of our modern culture. Like patience, kindness and humility. Bravery, Love and compassion for the weak. A realization that it is not simply “all about us,” but about greater and more mysterious Truths. These are certainly qualities my family experienced on witnessing the two month long ordeal of my own mother’s terminal illness. Terminal illness teaches families, caregivers, and patients valuable lessons our disposable culture cannot.
The intrinsic worth of a human life cannot be as easily dismissed as our culture does without serious consequences occurring. Physicians have a vocation to protect and treat vulnerable and injured human lives, not destroy them. And the great physician Hippocrates knew this. The Hippocratic Oath – the same Oath that I and all my fellow classmates took on graduating from the UCLA School of Medicine in 1984 – states: “I will give no deadly medicine to anyone if asked, nor suggest any such counsel…” Incidentally, but not coincidentally, the Oath immediately continues “…furthermore, I will not give to a woman an instrument to produce abortion. With purity and holiness I will pass my life and practice my art.” The Hippocratic Oath asserts an uncompromising understanding of the dignity of all human life, from conception to natural death, and explicitly forbids physician participation in euthanasia and abortion.
Note well, SB-128 involves the physician in the aid-in-dying process, supplying the prescription for the lethal chemical, and providing for the physician to “dispense aid-in-dying medications directly.” We doctors are now asked by SB-128 to directly violate our Hippocratic Oath and participate in the killing of a patient under our care. This is not a road whose Pandora’s box outcome we want to pursue.
Making matters even worse is the specter of combining this bill with the recently enacted California Assembly Bill 2139. This statute, implemented in January of this year, requires by law that health care providers notify patients of their right to counseling regarding legal end-of-life options, which must be included in discussions of treatment options. Thus, SB 128, when combined with AB2139, mandates that physicians notify the patient of their "right" to terminate his or her life with the help of a physician. It literally mandates that physicians violate their Hippocratic Oath. It forces physicians to make a decision whether to violate their medical Oath or break the law.
SB 128 distorts the doctor-patient relationship, irreparably damaging patients’ trust of doctors and doctor’s undivided commitment to the healing of their patients. The ever-present question now thrust upon an already distraught patient now becomes "'Is my doctor comfortable with causing my imminent death? Can I trust my doctor to want me to live?”
We are indeed approaching a time when no one will be safe from having their “right to die” exercised. The push is subtle, but there. Oblique implications to a family that a loved one is using up valuable hospital resources. The relentless emphasis on conserving medical resources, as if some lives really are not worthy of protection. I see it every day.
Why does SB-128 limit the provision to the “terminally ill adult”? If we embrace the concept that end-of-life suffering is bad and must be eliminated at all cost, and that chemical-induced death is in a patient’s best interest, then why not provide a suffering, terminally ill child also with such “compassionate” care? Are we ready for that yet? The Bill also prevents a power of attorney, advance health directive, or conservator from making the request for such lethal medication. But this is only a short distance down the “slippery slope”, when the argument will made that incapacitated persons not capable to make their own decisions should be afforded the “compassionate care” that would speed their deaths and eliminate their suffering.
Making matters worse, SB-128 stipulates what can be called none other than a falsification of the death certificate. Section 443.7(b) states that the “cause of death listed on an individual’s death certificate who uses aid-in-dying medication shall be the underlying terminal illness.” But this is, in fact, false. It is a lie. The immediate cause of death is NOT the terminal illness. It is the lethal medication that has just causes the patient’s death. Shall the physician signing the death certificate now also be an accomplice to legalized fraud on a death certificate?
And what if we do pursue this ideal of physician-facilitated killing? In 1949, Dr. Leo Alexander, a medical consultant at the Nuremberg Medical Trials, wrote a chilling assessment in The New England Journal of Medicine of how these crimes achieved their foothold. It remains a dire warning for us.
“Whatever proportions these crimes finally assumed, it became evident to all who investigated them that they had started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as life not worthy to be lived. This attitude in its early stages concerned itself merely with the severely and chronically sick … it is important to realize that the infinitely small wedge-in lever from which that entire trend of mind received its impetus was the attitude toward the nonrehabilitable sick.”
From the perspective of patients, families, physicians, and society at large, SB-128 is bad legislation. The physicians oath and uncompromising purpose is to protect human life at all stages, including the frail and terminally ill.
Rancho Palos Verdes, CA
Cardiothoracic and Vascular Surgery
Torrance/Long Beach/Los Alamitos/Lakewood
Clinical Attending Harbor-UCLA
Physician Reviewer Medical Board of California