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We deserve competent,
dignified end-of-life care,
not doctor-assisted death

Much has been written about the public's right to have physicians assist in the intentional killing of their patients. Unfortunately, this right is often confused with being the same as the right to die with dignity.

As a physician who treats cancer patients, including those at the end of life, I endorse the right to die with dignity. It is an indisputable right. While sometimes challenging in our current health care system, it is achievable without the need for physicians to assist in the killing of their patients. The incompetence of our health care delivery system with respect to end-of-life care should not be corrected this way.

Patients, families and health care providers need to be better educated about end-of-life issues. It is also important to recognize that effective communication and coordination of multiple services for both patients and loved ones underpin competent end-of-life care. Oftentimes this is extremely challenging, with complexities that require considerable health provider time and associated expense. In this setting, physician-assisted death might appear to be an attractive option for the wrong reasons. We need to make more effort to improve end-of-life care, not end life to reduce the effort and expense required for competent care.

Patients, loved ones and health care providers should form contractual agreements as to what will be done in the end-of-life setting. To relieve all suffering may require methods that will hasten death, but the important distinction is that these methods are used with the primary goal of relieving suffering. Death is foreseen but is not the primary intention. At a certain time in their illness, patients may decide to be continually sedated and may elect not to take any fluids or food by mouth, nor be administered any fluids or nutrients after they have slipped into a coma. This is a dignified and peaceful way of dying used by a great many. The important distinction is that these methods, which are available and legal, are primarily to relieve suffering and not to cause death even though death is foreseen as a consequence.

To those who advocate for new laws to permit physicians to intentionally kill patients, I plead that this well-meaning but misplaced advocacy instead be applied to seeking new laws that will encourage cohesive integrated care at the end of life. We need to stop the disgraceful fragmentation of care in our system due to nonsensical health insurance reimbursement policies, which limit access to hospice and other competent care for patients when cure is not an option. Other countries, such as Britain, Australia and New Zealand, are well ahead of us in providing competent, integrated care at the end of life. Please help change our system so that the right to die with dignity through competent end-of-life care is accessible to all.

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