In Response: Don't buy false claims, respect end-of-life wishes
Dr. Steven C. Bergeson has a right to his opinion. I respect his right to decline providing medical aid in dying to his terminally ill patients. The legislation proposed in Minnesota, like all six states that authorize the practice, permits providers to opt out.
However, I took issue with what I felt was misinformation in Dr. Bergeson's commentary in the News Tribune on Dec. 22, headlined, "Legalizing assisted suicide undermines real health care."
Medical aid in dying refers to a practice in which a mentally capable, terminally ill adult with less than six months to live may request medication for self-administration to bring about a peaceful death if their suffering becomes unbearable. Factually, legally, and medically speaking, it is inaccurate to equate medical aid in dying with assisted suicide.
Bergeson suggested, based on a few anecdotal stories, that insurers will deny care when medical aid in dying becomes legal, targeting the poor and disabled. But health insurers commonly deny payment for futile care unrelated to the availability of medical aid in dying. In fact, research indicates that medical aid in dying does not result in substantial cost savings. The vast majority, 90 percent, of individuals who choose medical aid in dying are already in hospice at the time of the request. They have pursued every option to prolong their lives and already have discontinued expensive, life-prolonging treatments. Medical aid in dying is an option when even what the best hospice has to offer is not enough.
The real truth is that in more than 30 combined years of experience with medical aid in dying in authorized states, there has not been a single instance of documented abuse. Almost two decades of rigorously observed and documented experience in Oregon demonstrates the law works as intended with none of the problems opponents predicted. Peer-reviewed medical journals and public watchdogs groups agree and attest to these facts.
Dr. Bergeson took a simplistic approach to modern medical ethics. The Hippocratic Oath is an ancient Greek document no longer used at any U.S. medical school graduation ceremony. It begins by asking for allegiance to Apollo and other mythical gods and goddesses. However, like the U.S. Constitution, many of its important principles endure, while the application of those ideals has evolved over time. The standards of 21st-century medical ethics can be found within it: patient autonomy, beneficence, non-maleficence and social justice.
As medical professionals, one of our greatest challenges is to respect our personal commitment to do no harm in the face of the ambiguities resulting from advanced medical technology. While physicians can now prolong and extend life almost indefinitely, shared medical decision-making obliges the doctor to embrace fully informed, patient-centered care, especially in care at the end of life. Physicians can no longer simply fight disease at any cost but must help patients weigh risks, benefits and quality of life as they make their medical choices.
The movement for access to medical aid in dying has been driven by terminally ill individuals and their families across the country and in Minnesota. Desperate for control in the face of suffering, they have been calling on lawmakers and physicians to expand their end-of-life options. It is time for us to listen.
Rebecca Thoman is a doctor who resides in Minneapolis.