By many indications, support for the legalization of physician-assisted suicide [PAS] is increasing. On November 8, 2016 Colorado voters passed Proposition 106, “Colorado End of Life Options Act,” by a 65% to 35% margin, making Colorado the sixth state to legalize PAS, joining Oregon, Washington, Montana, Vermont, and California. The following question appeared in a 2015 Gallup poll: “When a person has a disease that cannot be cured and is living in severe pain, do you think doctors should or should not be allowed by law to assist the patient to commit suicide if the patients requests it?” 68% of respondents answered “should” while only 28% answered “should not.”
That to which people are saying “yes,” however, does not always match the reality of the practice of PAS in the states in which it has been legalized. Note the wording of the question in the Gallup poll. The question pictures a medical situation in which: (1) The disease is incurable; (2) The patient makes a voluntary request; and (3) The patient is “living in” severe pain, which suggests constant, relentless, and untreatable pain.
Most likely, in my judgment, people are prompted by mercy in saying “yes” to PAS because they think that a large percentage—perhaps even a majority—of patients suffer unrelenting and untreatable pain, making PAS a compassionate option. If this is indeed what respondents are thinking, they are mistaken in large measure. Granted, pain is intractable and difficult to manage for some dying patients, but certainly not for the majority of patients, thanks to advancements in palliative care. Even the patients who avail themselves of legalized PAS tell us that. According to the official 2015 report on Oregon’s Death with Dignity Act, patients requested medical assistance in dying for these top three reasons: (1) Decreasing ability to engage in activities making life enjoyable (96.2%); (2) Loss of autonomy (92.4%); and (3) Loss of dignity (75.4%). “Inadequate pain control or concern about it” was in sixth place, mentioned by 28.7% of patients. Yet, even here, it is difficult to break down the percentage of patients who were actually experiencing inadequate pain control from the percentage of patients who were merely concerned they might. It seems likely that some patients request PAS on the basis of what they might experience in the future, not on the basis of what they are experiencing in the present.
Motivated by mercy, a majority of Americans are beginning to say “yes” to PAS. I wonder if the level of support would change if respondents realized that, in the vast majority of cases (though admittedly not in all cases), pain can be effectively managed. In no study that I’ve read has “relief from pain” been a top-tier reason patients give for requesting PAS in states in which it is legal. That to which respondents are giving a merciful “yes” does not seem to match the reality.