Overlooked Implications of Study on Physician-Assisted Suicide

By S. Van McCrary, Health Law & Policy Institute

A recent study of the frequency of physician-assisted dying by Dr. Diane E. Meier, published in the April 23 issue of the New England Journal of Medicine, found that only 3.3 percent of physicians surveyed reported writing at least one prescription to be used to hasten a patient's death, and that 4.7 percent of physicians surveyed reported administering a lethal injection at least once. This low prevalence of physician-assisted dying was reported by the media as surprising, given the increasing public support for the practice.

In an op-ed comment in the New York Times, 4-24-98, Dr. Meier took the position that the results of her study should not be used to justify legalization of assisted suicide. She noted that an era in which the population continues to age, and health care financing continues to pressure doctors to do less for their patients, is a particularly dangerous time for legal acceptance of the practice of medically-assisted death.

One portion of the study's results that was largely overlooked by the media was the type of drugs prescribed in cases where the patient was to self-administer the lethal dosage. The medications prescribed in 75 percent of reported cases were opioids (narcotic-type analgesics), while barbiturates (sedatives) were prescribed in only 25 percent of the cases. The disturbing factor in this result is that the most important clinical use for opioids is relief of severe pain. For many bioethicists, the more typical drugs envisioned when debating issues of assisted suicide are barbiturates. Under such conditions, opioids would generally be used only for relief of moderate-to-severe pain. It is unfortunate that the survey apparently did not ask the responding physicians whether the patients for whom opioids were prescribed were indeed suffering severe pain. If many of these patients were not appropriate candidates for opioids, the fact that opioids were used to produce their deaths can only complicate the legitimate use of such drugs to prevent suffering. This is especially true given the high level of pre-existing anxiety among health care professionals regarding the prescribing of opioids resulting from continuing threats from the U.S. Drug Enforcement Agency (see Doctors' Fear Causes Oregon Law On Assisted Suicide To Go Unused, posted 3-23-98).

Dr. Meier wrote in her op-ed comment that "Our society should not be reduced to offering patients a choice between inadequate care and suicide." Similarly, we should not allow a social debate on the merits of one controversial practice--medically-assisted death--to interfere with the provision of good pain relief for all. If physicians continue disproportionately to prescribe opioids, rather than barbiturates, for lethal dosages in patients without severe pain, the blurring of this (already unclear) line will be exacerbated. Many physicians are already very reluctant to prescribe opioids for any patient. It will be an extremely unfortunate result if persons whose suffering is only ameliorable by opioids are unable to obtain the drugs they need for legitimate medical purposes as a result of the controversy over physician-assisted suicide.