May 2019 – Article 4:
From the Reno Gazzette Journal
By Kirk Bronander
Published 3:50 p.m. PT April 22, 2019 | Updated 1:14 p.m. PT April 23, 2019
Physician-assisted suicide a flawed process, says professor of medicine
A bill legalizing physician-assisted suicide (PAS) was introduced in the 2019 Nevada Legislature. As an internal medicine physician in Nevada, I see many problems with this law and urge lawmakers to reject it.
This bill would make patients eligible for PAS if they have been diagnosed with a terminal condition and are likely to die within six months. The fact is that physicians frequently make errors with diagnosis and predicting timing of death in terminal conditions. My family has personal experience with this: My father was diagnosed with a malignant brain cancer (glioblastoma) and given a prognosis of less than six months to live. He survived for almost four years after his diagnosis. This is also well-documented in the medical literature: A study of hospice patients in the Chicago area showed that of 468 predictions of timing of death, only 20 percent were accurate. Inaccurate diagnoses or prognoses coupled with PAS will result in patients dying that may have years of life remaining.
The law will allow any doctor with a license in Nevada the power to prescribe lethal drugs to end a patient’s life. I trust many of my colleagues but there are always going to be some physicians that are unscrupulous, incompetent or unethical. That means this type of law can easily be abused. In Reno, Dr. Robert Rand contributed to the death at least one patient by overprescribing opioids. He did this for years even though opioids are the most highly regulated medications we can prescribe. The lethal drugs used for suicide will be much less scrutinized since there is no requirement for the federal government to monitor them. The law itself will protect the identity of the prescribing doctor, so no one will ever be able to determine if abuse is occurring. Do you trust every physician in Nevada?
Unfortunately, many elderly and terminal patients feel they are a burden to loved ones and this law will encourage suicide as an answer. The statistics from Oregon in 2017 (which has a similar law to the one proposed in Nevada) are clear that the reasons stated for obtaining the lethal prescription are for reasons other than pain. “Losing autonomy” is No. 1 and “burden on family, friends/caregivers” is a more frequent reason than “inadequate pain control,” which is sixth on the list.
Many patients diagnosed with a terminal condition are depressed and there is no requirement to refer to psychiatry or counseling in the law. The Oregon statistics show that only 3.8 percent of patients receiving lethal drugs were referred for psychiatric evaluation while a 2008 study conducted in Oregon found 25 percent of patients requesting assisted suicide were clinically depressed. Depression is a treatable condition; obviously a completed suicide is not treatable.
For these reasons and others, the two largest physician organizations, the American Medical Association and the American College of Physicians, have written separate statements opposing the practice of PAS. The AMA opinion 5.7 states: “Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.”
Nevada lawmakers should prioritize the protection of vulnerable patients and reject this dangerous public policy.
Kirk Bronander is a professor of medicine at the University of Nevada, Reno School of Medicine and director of academic hospitalists for UNR Med.
The views expressed by this author are his own and do not necessarily reflect the views or positions of the University of Nevada or the University of Nevada, Reno School of Medicine.