Death Panels on Steroids

Original Article

If you want to see what direction health care is going, just read the July 12 issue of The New England Journal of Medicine (NEJM).

Of course, reading a medical journal isn’t on most people’s “to do” lists. Even medical professionals who do read journal articles rarely do so to gain insight into the latest shifts in the cultural or political winds.

That’s a mistake. These days, radical trial balloons are often launched from such “venerable” publications — which is especially disturbing because the imprimatur of the medical intelligentsia provides respectability to ideas that otherwise would be dismissed out of hand. The mere fact that an idea appears in what The New York Times describes as “perhaps the most influential medical publication in the world,” places that concept firmly within the realm of respectable debate.

Which brings us back to the NEJM.

On its pages, the NEJM has long featured articles favoring euthanasia and assisted suicide as well as health care rationing. Indeed, two of its former editors, Dr. Arnold Relman and Dr. Marcia Angell, are vocal advocates of eliminating the private health system and replacing it with a single-payer, government-controlled health system. And both are among the 14 subscribing petitioners on a doctor-prescribed suicide initiative that will appear on the November 2012 ballot in Massachusetts.

Angell is so enamored with the concept of assisted suicide that, in a 2004 article, she decried the fact that too few people were availing themselves of Oregon’s doctor-prescribed suicide law. She expressed concern that the law was too restrictive.

Now, the NEJM has given a platform for Dr. Lisa Lehmann, director of the Center for Bioethics at Brigham and Women’s Hospital in Boston, and researcher Julian Prokopetz to lay out a proposal for facilitating what they call “assisted dying.” In their article, “Redefining Physicians’ Role in Assisted Dying,” the authors address what they see as a real problem: There aren’t enough doctors willing to participate in assisted suicide.

As the authors state, “Many medical professionals are uncomfortable with the idea of physicians playing an active role in ending patient’s lives.” Furthermore, they explain that the American Medical Association and various state medical groups oppose legalization.

It should be noted that when Washington and Oregon changed their laws to permit assisted suicide, they did not make all assisted suicide legal. For example, one’s mechanic, plumber, attorney, professor, or spouse is not given the authority to assist suicide. Essentially, what was made legal in those states — and what is funded by state and private insurance — is one type of assisted suicide: doctor-prescribed suicide.

It is the necessity of a doctor who will prescribe the deadly dose which presents a stumbling block that Lehmann and Prokopetz seek to address. As they explain, “We believe there is a compelling case for legalizing assisted dying, but assisted dying need not be physician-assisted.”

And how do they suggest that this hurdle between diagnosis and prescription be overcome?


Take the doctor out of doctor-prescribed suicide by setting up a government-facilitated process that will make it easier for patients to cross the River Styx. As they explain:

We envision the development of a central state or federal mechanism to confirm the authenticity and eligibility of patients’ requests, dispense medication, and monitor demand and use. Such a mechanism would obviate physician involvement beyond usual care.

They see this as a way of overcoming the reluctance of most doctors to assist in suicide, while they remain oblivious (or indifferent) to protecting the lives of vulnerable patients.

As they accurately explain, under Oregon’s and Washington’s laws, the patient’s doctor confirms the prognosis, explains alternatives for treatment and care to the patient, and then writes the lethal suicide prescription. In their plan, the doctor would bow out of the process before writing the prescription: “Prognosis and treatment options are part of standard clinical discussions, so if a physician certifies that information in writing, patients could conceivable go to an independent authority to obtain the prescription.” At that point, the patient could simply go to a suicide-prescribing clinic. “Patients could also provide an independent authority with their medical record as proof of their prognosis.”

Could this work?

Yes, without question.

Many states already permit nurse-practitioners to prescribe barbiturates (the same drugs prescribed in intentionally lethal amounts for suicide in Washington and Oregon). Removing the requirement that the prescription for suicide be doctor-prescribed would certainly be possible.

While there might be initial objections to leaving the doctor out a crucial step in the process, it should be noted that state-issued annual reports in both Washington and Oregon indicate that reported assisted-suicide cases do not involve the close doctor-patient relationship that advocates of the practice promised would occur.

For example, in Oregon, the length of time for the doctor-patient relationship before writing the lethal prescription has been under one week in some reported cases. Even in cases where the patient has been in the care of the prescribing doctor, once the prescription is written, the doctor may have no further contact with the patient. Prescribing doctors have been present at the time of the patients’ death from the prescribed overdose in fewer than seven percent of reported cases.

Details of how the newly proposed system would work were revealed by Dr. Lehmann in an interview with ABC News. She explained that doctors would only be responsible for making the diagnosis of a terminal illness. Then, the patient should be able to pick up the lethal drugs from a government-authorized, all-purpose location where a government bureaucrat would determine the patient’s eligibility for a death prescription.

In addition to soothing the sensibilities — and deadening the consciences — of doctors, moving physicians into the background would have another effect. It would increase the number of assisted suicides.

Let’s consider this for a moment. Do we really think that a government that is constantly looking for ways to contain health care costs will be likely to deny death eligibility? Do we think that government death-control officials will do the right thing — or the cheap thing?

Take this proposal, coupled with government-run health care, and you have “death panels on steroids.”

Like we said, if you want to see what direction things are going in health care, just read the professional journals.

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Wesley J. Smith

Chair and Senior Fellow, Center on Human Exceptionalism
Wesley J. Smith is Chair and Senior Fellow at the Discovery Institute’s Center on Human Exceptionalism. Wesley is a contributor to National Review and is the author of 14 books, in recent years focusing on human dignity, liberty, and equality. Wesley has been recognized as one of America’s premier public intellectuals on bioethics by National Journal and has been honored by the Human Life Foundation as a “Great Defender of Life” for his work against suicide and euthanasia. Wesley’s most recent book is Culture of Death: The Age of “Do Harm” Medicine, a warning about the dangers to patients of the modern bioethics movement.