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A Doctor's View: Legalizing assisted suicide undermines real health care

Assisted suicide is picking up steam. Colorado and Washington, D.C., legalized the practice this fall, joining four other states where it already was legally permissible for physicians to prescribe lethal dosages to eligible patients.

Assisted suicide’s next stop? It could be Minnesota. In March, a bill to legalize the practice was introduced in our state Senate’s Health, Human Services and Housing Committee. It didn’t make it out of committee, but its proponents promised to be back.

As a doctor who has devoted my life to providing care and healing, I bristle at the possibility of practicing medicine in a state where assisting in someone’s suicide could be considered “health care.” Not only is assisted suicide not authentic health care, it actually undermines the ethical norm at the heart of the medical profession — the Hippocratic oath, which transformed medicine into an art of healing, dedicated to caring about the patient’s interests rather than the interests of others. Everyone knows doctors are taught to “first do no harm.”

This is the basis on which the trust between a physician and a patient rests: the certainty that I will do everything in my power to heal my patient and, in those cases where a cure is not possible, to comfort and walk alongside him or her. A doctor’s commitment to the patient should be unaffected by societal pressures, insurance companies and even the diagnosis itself.

If we allow assisted suicide to become a legal, viable option, the basis of that trust will be distorted.

Furthermore, as someone who wants to ensure we’re providing the best possible care to the people of our state, I can’t but help but be alarmed at what assisted suicide likely would do to our health care system. Minnesota already has significant disparities in the receipt of health care between the haves and have nots. Given the market dynamics that characterize our system, legalizing assisted suicide undoubtedly would make those disparities grow. In most cases, ending a patient’s life would cost insurance companies less than keeping the same patient alive — challenging caregivers to justify continued treatment in many cases.

We’ve already seen this in states where assisted suicide is legal. Shortly after California legalized assisted suicide, a wife and mother of four who was terminally ill was denied chemotherapy by her insurance company — but was told assisted suicide would be covered. In Oregon, Randy Stroup was told the chemotherapy his doctor requested would not be covered, but that assisted suicide would be.

These stories reveal a hard truth. Although its proponents celebrate assisted suicide as a triumph of autonomy, legalizing the practice expands options for providers and insurance companies while shrinking them for the poor, the vulnerable, the elderly and the disabled. There would be no real choice when care is expensive and death is cheap.

Instead of legalizing assisted suicide, Minnesota’s lawmakers and medical professionals should pursue better care options over the abandonment of care. One clear way to do this is to expand palliative and hospice care, which are proven effective ways of managing pain and discomfort at the end of life. As Dr. Cory Ingram, a palliative care specialist at Mayo Clinic, has stated regarding the effectiveness of this treatment, “People who at one moment voice the desire to die often later say how grateful they are to still be alive once their symptoms are under control.”

Yet palliative and hospice care remains underutilized. How can we legalize assisted suicide when we haven’t exhausted all other options? Let’s focus on advancing real care instead of legalizing a dangerous, risky practice that limits authentic choice in medicine.

Dr. Steven C. Bergeson is a family physician in Shoreview, Minn., and a member of the Minnesota Alliance for Ethical Healthcare, a new group opposed to assisted suicide in Minnesota.