One night several years ago, my terminally ill patient David chose the time of his own death by shooting himself in the chest. I believe he picked that method because he knew I would be angry if he chose to end his life more peacefully by simply taking an overdose of the pills I prescribed him. I have been angry at myself ever since for having given him good reason to think so.
The upshot of that gunshot was that it’s echo has been banging around my head since it rang out, often when I am trying to fall asleep at night. It has led me to rethink what I had always thought about physician-assisted suicide: that the price to be paid for the liberty of some to choose it carefully and appropriately would be others who chose it prematurely and unnecessarily, a price too steep to be paid. Several years later, I think what I thought was wrong, and I figured I owed it to David to say so.
Patient experiences often change the people who care for them. The emotional heat of patient pain and suffering can blister the paint off carefully laid planks in the platforms of the caregivers’ personal beliefs, exposing them to the harsh elements of other truths and different perspectives. With the protective paint of our untested assumptions gone, honest and thoughtful openness to new information and points of view different from the caregivers’ own can warp those planks, spring them loose, and sometimes forces their replacement for intellectual rot.
New data — evidence from actual experience delineated in careful medical studies — can be such an element leading to change. In the case of physician-assisted suicide it comes from the growing experience of states such as Oregon and Washington, where it is legal. Evidence from both states suggest that physician-assisted suicide is used less often than was feared, with fewer than 600 in Oregon over 15 years, and only 156 in Washington since it became legal there in 2009.
Both states have found that the liberty can be carefully overseen by the medical profession so patients are not using it for the wrong reasons (depression, lack of support, etc.), and that one in three patients who have their physician’s support for dying that way choose not to use it.
The data suggests much of what I and others feared would result from the legalizing of physician-assisted suicide does not happen when the medical profession works with the political profession to craft, implement and oversee a good law that makes a reasonable liberty available to an intelligent public. Go figure.
So with that new data from Washington and Oregon factored in, I recently did something I have done many times before without changing my mind; put myself back in David’s place, and not just in the place of his pain but in the place of his arduous, painful, terminal condition dragged out over months and years.
For that is the best place to examine what you believe; not from the dust of dry data, or someone else’s shoes, but rather, from someone else’s suffering over the long haul. Even a foundation of belief set in stone can be worn away by the grinding sands of a different and permanent reality, and the wearing waves of ceaseless misery.
I thought again about what I would want the right to do if I was David, argued with myself back and forth about what I should have the right to do, and finally wondered what I will want the right to do when my time comes.
I tried to keep the old plank of my opposition in place, hammering the previous arguments home again and again, but this time the nails would not hold in the decaying wood. This time I found myself wanting what should have been David’s right, to end my dying days in a peaceful manner at the time of my own choosing.
It is only a matter of time until proposed laws to allow physician-assisted suicide in other states are put forward. When that happens in Maine, this time I will be there for David.
Erik Steele, a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems.