There’s an old joke that goes something like this:
“What do you call the student who graduates dead last in his class at medical school?” “Doctor.”
I bring up that old saw because of a recent story out of California, where assisted suicide has just been legalized. Lonny Shavelson, a Berkeley emergency-room doctor who hasn’t practiced medicine for two years—and a long-time advocate of assisted suicide, as author of A Chosen Death—made headlines with the announcement that he is opening a death-doctor practice. For a $200 consultation fee, and $1800 more if he is retained, Shavelson will evaluate and certify people who come to him—I refuse to call them his “patients”—as eligible for death, prescribe the lethal drugs, fill out the required bureaucratic forms, and presumably attend their deaths.
Think about this for a moment: Would anyone in their right mind trust an ER doctor to properly palliate the pain of terminal cancer or treat lethal congestive heart failure? Of course not! The ability to provide excellent care for terminally ill patients requires medical specialization and ongoing professional education in the particular disease. That is why no ER physician worth his salt would assume responsibility for the medical care of terminally ill patients outside of a temporary emergency-room or crisis context.
But death doctoring isn’t about providing professional treatment for patients. Indeed, the suicide MD need not have any specialized training in terminal illnesses or be schooled in how to support such patients medically. He or she just needs to be the “attending physician,” defined in the new California statute as a doctor having “primary responsibility for the health care of an individual and treatment of the individual’s terminal disease.”
Note that the law does not require the attending physician to be a certified specialist in the terminal disease. Since any patient can give any physician primary responsibility for providing healthcare for any condition, any licensed doctor—even the most inept or lackadaisical—can become the attending physician. And if licensed to dispense the controlled substances used in assisted suicide, that doctor can prescribe lethally.
We saw this bottom-of-the-barrel phenomenon with Jack Kevorkian. As a pathologist, Kevorkian had not treated a living patient after attending medical school in the early 1950s. Yet, forty years later, he was lionized for assisting the suicides of about 130 despairing, and mostly not terminally ill, people who came to him for death by carbon monoxide or drugs from his suicide machine.
Kevorkian was ultimately convicted of murdering an ALS patient by lethal injection. He repeatedly said that life-ending actions for people with ALS were justified because such patients fear dying from “choking on their own spit.” Kevorkian either didn’t know or didn’t care that ALS patients do not suffocate or choke to death when they receive proper medical care from doctors who know how to ameliorate the symptoms of the disease. Indeed, the founder of the hospice movement, the late Dame Cecily Saunders, stated that she had treated hundreds of ALS patients and not one died of choking.
This pattern of death doctors killing patients outside their areas of expertise has also been observed in the Netherlands. In Dancing with Mr. D, nursing-home doctor Bert Keizer writes of euthanizing a patient who he thinks has lung cancer, even though the diagnosis isn’t certain. When asked, “Is he really suffering that badly?” Keizer responds angrily: “Is that for us to answer the question? All I know is that he wants to die more or less upright and that he doesn’t want to crawl to his grave the way a dog crawls to the sidewalk after being hit by a car.” The next day, as he is about to do the deed, Keizer thinks, “If anyone so much as whispers ‘cortisone’ or ‘uncertain diagnosis,’ I’ll hit him.”
Based on the information in his book, Keizer seems unaware that lung-cancer patients don’t have to die like a dog struck by a car. Moreover, any doctor who would treat cancer pain with cortisone—an anti-inflammatory drug—should have his license stripped!
To make matters worse, the standard of practice required of death doctors is lower than that required of physicians treating and palliating the symptoms of diseases. For example, treating doctors can be sued for malpractice if they breach the “standard of care” required of all doctors in a particular medical situation. Not death doctors. All they have to demonstrate is that they acted in “good faith.” Here’s the relevant text from the California statute under which Shavelson and other death doctors will be operating (my emphasis):
443.14. (c) Notwithstanding any other law, a health care provider shall not be subject to civil, criminal, administrative, disciplinary, employment, credentialing, professional discipline, contractual liability, or medical staff action, sanction, or penalty or other liability for participating in this part, including, but not limited to, determining the diagnosis or prognosis of an individual, determining the capacity of an individual for purposes of qualifying for the act, providing information to an individual regarding this part, and providing a referral to a physician who participates in this part.
A “good faith” legal standard is a very low bar. For example, what if the death doctor mistakes a nonterminal condition for a terminal one and writes a lethal prescription? As long as that lethal mistake was made in good faith, under the provision quoted above, it would seem not to be actionable. Make the identical mistake as a treating doctor for the same patient, and prepare to meet your lawyer!
Advocates for legalizing assisted suicide assure us that such laws protect vulnerable patients. But that’s a mirage. The fact that doctors are free to prescribe lethally for people with illnesses outside their areas of medical specialization—and to do so secure in the knowledge that they are legally less accountable than if they were treating the same patient—demonstrates the folly of legalizing doctor-prescribed death.