Gathering Place

Roland L. Halpern

Assisted dying isn’t
about pain, it’s
about autonomy

Opponents of physician-assisted dying frequently argue that pain is the real reason patients seek a hastened death, and that if we can control pain the requests for physician-assisted dying will disappear.

Not so, according to a study published last week in the Journal of Palliative Medicine. The study, lead by Linda Ganzini, a psychiatrist at the Oregon Health & Sciences University, again confirms that it is loss of autonomy, not pain, that motivates terminally ill patients to explore assisted dying.

One physician noted, "It was a control issue, not a pain issue. (The patient said) 'I want to do it on my terms. I want to choose the place and time. I want my friends to be there. I don't want to linger and dwindle and rot in front of myself -- I want to go out with some dignity.'"

Another physician said some patients are unwilling even to consider alternatives until assisted dying has been addressed.

Once this hurdle has been overcome, patients are more receptive to discussing other options. "It is almost a kind of condition for them to get palliative care to know that there is something to let them out of it if they get stuck," Ganzini says.

The numbers bear this out. Almost half of patients initially seeking a hastened death ultimately choose an alternative treatment, comforted in the knowledge that if all else fails they still have one final option.

Let me be the first to acknowledge that Hawaii needs better pain management. The state recently received two black eyes. First, last November the Last Acts national study gave Hawaii an "E" (the lowest grade) for failing to have any pain-management policy. In March, Public Citizen ranked Hawaii last for failing to have adequate disciplinary oversight of physicians.

Ironically, in Oregon, where physician-assisted dying has been legal for five years, it was the very passage of the law that catapulted that state into improving its overall end-of-life care. Even opponents admitted that, absent the law, significant improvements would have been slow in coming, if at all.

As revealed in the Last Acts report, a third of Hawaii's nursing-home residents are dying in persistent yet treatable pain. If this hasn't been enough to motivate the "cure the pain" believers into action, what will it take?

An assisted-dying law will improve pain management, if for no other reason than jolting the moralists into bending over backward to prevent anyone from seeking death. The number of patients considering assisted dying would decrease and those still insistent on having a legal option would be able to exercise it, when and if they decide that enough is enough.

Roland L. Halpern is executive director of Compassion In Dying of Hawaii.


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