Tuesday, July 21, 2015

Laws allowing assisted suicide can have far-reaching impact


The Oklahoman Editorial Board Published: July 20, 2015

AN effort to legalize “assisted suicide” in California has been put on hold. The rationales that caused California lawmakers to rethink the proposal deserve attention elsewhere.

This is especially true of arguments put forth by Dr. Aaron Kheriaty, a psychiatrist who is director of the Program in Medical Ethics at the University of California Irvine. Proponents of assisted suicide portray it as a humane solution for people in the last stages of painful, debilitating, terminal illnesses. But in a letter sent to California lawmakers, Kheriaty demonstrated that such laws can lead to death for a far wider, and often healthier, population.

“The desire to end one’s life, or the request for assisted suicide, is almost always a cry for help,” Kheriaty wrote. “It is a distress signal indicating that something in the patient’s situation is not adequately being attended to: an untreated clinical depression, fear or anxiety about the future or about one’s medical condition, untreated or under-treated pain, family or relationship strain or conflict, and so on.”

He noted that 80 percent to 90 percent of suicides are associated with clinical depression or other treatable mental disorders, “including for individuals at the end-of-life and individuals with a terminal condition.”

Yet in Oregon, where assisted suicide is legal, Kheriaty said just 5 percent of the individuals who died by assisted suicide were referred for psychiatric evaluation prior to their deaths, “and this number is decreasing every year.”

“Considering what we know about suicide risk factors, this constitutes a form of gross medical negligence,” Kheriaty wrote.

He also noted research shows there is a “social contagion” aspect to suicide. Publicity surrounding one suicide often leads others to kill themselves. In Oregon, suicide rates are 35 percent higher than the national average.

“The law is a teacher, and these laws send the message that under difficult circumstances, some lives are not worth living,” Kheriaty wrote. “This is a message that will be heard not only by terminally ill individuals, but by all vulnerable persons who are tempted to take their own lives.”

In short, even many seriously ill people who contemplate suicide would likely choose not to, provided their underlying mental health needs were addressed. And many others suffering from depression or other treatable, nonfatal maladies would be encouraged to commit suicide (with or without a physician’s assistance) by the existence of an assisted-suicide law.

The repercussions for a state like Oklahoma are not hard to imagine. Oklahoma is home to roughly 3.8 million people, and it’s estimated between 700,000 and 950,000 of those citizens need mental health or substance abuse treatment. Oklahoma is No. 2 nationally in the rate of mental illness among its populace.

Assisted suicide laws effectively establish a two-tiered system for treating suicidal people. Those with suicidal thoughts who don’t have obvious terminal illnesses will be given treatment. But those suffering from suicidal thoughts who have serious physical illnesses will be encouraged to kill themselves. Yet in both cases, suicidal thoughts are often a sign of distress that can be resolved without deliberately taking the patient’s life.

Last November, we wrote that the “strange new world of assisted suicide requires the blurring of moral lines beyond recognition.” Kheriaty’s analysis reinforces that conclusion, and demonstrates why Oklahoma and other states should not go down this dark path.