“13 Reasons Why”and Why Not

Today, it is hard to keep up with the constant stream of information coming not only from TV and movies but also from the social network. But to understand and hopefully to protect and help our children and others in today’s culture, it is important to keep up with current media and trends as much as possible.

This is why, after reading articles like “13 Reminders About Netflix’s ‘Thirteen Reasons Why’” about a popular Netflix series featuring a high school girl named Hannah who gruesomely kills herself and leaves 13 tapes for the people she blames for her suicide, I decided to watch this often acclaimed  and controversial TV series myself.

After watching several episodes, I recognized some of the factors that made “Pretty in Pink” and “The Breakfast Club” so popular when my children were teenagers. The characters are attractive and bright high school students who wrestle with problems of self-esteem, setbacks, hormones and popularity.  In the end, most of the characters in those older movies were happier and/or wiser.

But the story arc and characters in “13 Reasons Why” are much darker. So far in the episodes I have watched, these teenagers are apathetic about school, seem to have no sense of humor and they dislike or barely tolerate their parents. Their overwhelming self-absorption with real or perceived offenses often leads them to be thoughtlessly cruel even to their friends. The adults in the series fare little better as they struggle with their own anger, sadness and guilt in trying to understand the tragedy.

The main character Hannah sounds almost triumphant in the tapes while chronicling the deficiencies in the people she holds responsible for her suicide. The people hearing the tapes are understandably devastated but revenge seems to be Hannah’s goal.

Even worse, the series’ depiction of Hannah’s descent to suicide, making the tapes and the reactions of her classmates tends to sensationalize suicide with little to no insight about prevention and treatment. The big lesson seems to be that bullying and sexual assault can be life-threatening to vulnerable teens.

Because this deliberately shocking series is so accessible to young people and teen suicides are rising,  many schools are now concerned about this series as are mental health experts  who recognize the phenomenon of suicide contagion.

In response to complaints and concerns from as far away as Canada and New Zealand, Netflix has now issued the following statement:

 There has been a tremendous amount of discussion about our series 13 Reasons Why. While many of our members find the show to be a valuable driver for starting important conversation with their families, we have also heard concern from those who feel the series should carry additional advisories. Currently the episodes that carry graphic content are identified as such and the series overall carries a TV-MA rating. Moving forward, we will add an additional viewer warning card before the first episode as an extra precaution for those about to start the series and have also strengthened the messaging and resource language in the existing cards for episodes that contain graphic subject matter, including the URL 13ReasonsWhy.info  — a global resource center that provides information about professional organizations that support help around the serious matters addressed in the show.

As a nurse who has worked professionally and personally with suicidal people as well as the mother of a daughter who died by suicide, I am glad Netflix is acknowledging at least some of the problems with the series. However, this series and the plight of our young people growing up in an increasingly secularized, materialistic and divided world that rejects God demands more.

We need to give our young people hope and support as they navigate the often rocky road to adulthood. And we also need to show them that the real heroes are those people whose dedication, moral virtues, hard work, selflessness and idealism inspire all of us to make a better world where no one will want to watch the so-called “entertainment” of a “13 Reasons Why”.

 

My Submission to the AMA Opposing Neutrality on Physician-Assisted Suicide

Amid conflicting reports about whether or not the American Medical Association was going to consider a position of neutrality on physician assisted suicide, I was informed that the AMA’s Council on Ethical and Judicial Affairs was collecting data, position statements, etc. for consideration of assisted suicide and other topics before the June AMA Annual meeting. The deadline for submissions was February 15.

The following is my submission titled “Neutrality on physician assisted suicide also hurts nurses”

Dear AMA,

I have been a registered nurse since 1969. After working in critical care, hospice, home health, oncology, dialysis and other specialties for 45 years, I am currently working as a legal nurse consultant and volunteer as well as spokesperson for the National Association of Pro-Life Nurses. Over the years, I have cared for many suicidal people as well as people who attempt suicide.

I have served on medical and nursing ethics committees, served on disability and nursing boards. I have written and spoken on medical ethics-especially end of life issues-since 1984.

The dangers of the legalization of physician-assisted suicide are especially acute for us nurses. Unlike doctors, we nurses cannot refuse to care for a patient  in a situation like assisted suicide unless another willing nurse can be found which can be impossible. If we do refuse, that is considered abandonment and cause for discipline and even termination. And we are necessarily involved when the assisted suicide act occurs in home health, hospice or health care facility even though the doctor is not required to be there.

marievalko

Marievalko Picture of Marie Valko 1979-2009

As a nurse and the mother of a suicide victim (see picture above), I am alarmed by reports that the AMA is considering a position of neutrality on physician-assisted suicide. I beg you to uphold the legal and ethical standard that medical professionals must not kill their patients or help them kill themselves. Suicide is a tragedy to be prevented if possible, not a civil right.

MY DAUGHTER KILLED HERSELF USING AN ASSISTED SUICIDE TECHNIQUE

In 2009, I lost a beautiful, physically well 30-year-old daughter, Marie, to suicide after a 16-year battle with substance abuse and other issues. Her suicide was like an atom bomb dropped on our family, friends and even her therapists.

Despite all of our efforts to save her, my Marie told me that she learned how to kill herself from visiting suicide/assisted suicide websites and reading Derek Humphry’s book Final Exit. The medical examiner called Marie’s suicide technique “textbook final exit” but her death was neither dignified nor peaceful.

Marie was not mere collateral damage in the controversy over physician-assisted suicide. She was a victim of the physician-assisted suicide movement, seduced by the rhetoric of a painless exit from what she believed was a hopeless life of suffering.

SUICIDE CONTAGION

Adding to our family’s pain, at least two people close to Marie became suicidal not long after her suicide. Luckily, these two young people received help and were saved, but suicide contagion, better known as “copycat suicide”, is a well-documented phenomenon. Often media coverage or publicity around one death encourages other vulnerable people to commit suicide in the same way.

STUDY SHOWS LEGALIZING PHYSICIAN-ASSISTED SUICIDE IS ASSOCIATED WITH AN INCREASE RATE OF TOTAL SUICIDES

A 2015 article in the Southern Medical Journal titled “How Does Legalization of Physician-Assisted Suicide Affect Rates of Suicide?” came to these conclusions:

“Legalizing PAS has been associated with an increased rate of total suicides relative to other states and no decrease in nonassisted suicides. This suggests either that PAS does not inhibit (nor acts as an alternative to) nonassisted suicide, or that it acts in this way in some individuals but is associated with an increased inclination to suicide in other individuals.”

THE HEALTH AND ECONOMIC COSTS OF SUICIDE

My Marie was one of the almost 37,000 reported US suicides in 2009. In contrast, only about 800 assisted-suicide deaths have been reported in the past 16 years in Oregon, the first state to legalize physician-assisted suicide. According to the Centers for Disease Control (CDC) suicide was the 10th leading cause of death for Americans in 2012, with “More than 1 million people reported making a suicide attempt in the past year” and “More than 2 million adults reported thinking about suicide in the past year.” The CDC estimates that suicide “costs society approximately $34.6 billion a year in combined medical and work loss costs”, not to mention the emotional toll on families.

Obviously our real health-care crisis here is a staggering and increasing rate of suicides, not the lack of enough assisted suicides.

BRITTANY MAYNARD

There was a media frenzy in October 2014 when Brittany Maynard, a young newlywed woman with a brain tumor, announced plans to commit physician-assisted suicide on November 1 and raise money to have physician-assisted suicide legalized in all US states. There was an immediate and unprecedented media frenzy surrounding Ms. Maynard’s tragic story that routinely portrayed her pending assisted suicide as “heroic” and even counting down the days to her suicide. Personally, I thought this looked like a crowd on the street shouting for a suicidal person on a window ledge to jump.

In the end, Brittany hesitated for a day before she went through with her pledge to take the lethal overdose.

Now, assisted suicide supporters even deny that physician-assisted suicide is suicide, insisting that media stories use euphemisms like “aid-in-dying” and “death with dignity” in cases like Ms. Maynard’s to make assisted suicide more palatable to the public. However, this defies common sense when the definition of suicide is the intentional taking of one’s own life.

PHYSICIAN-ASSISTED SUICIDE AND MEDICAL DISCRIMINATION

I have been a registered nurse for 47 years, working in intensive care, oncology, hospice and home health among other specialties. Personally and professionally, I have cared for many people who attempt or consider killing themselves.

Some of these people were old, chronically ill or had disabilities. Some were young and physically healthy. A few were terminally ill. I cared for all of them to the best of my ability without discrimination as to their condition, age, socioeconomic status, race or gender. I will do anything to help my patients — except kill them or help them kill themselves.

Suicide prevention and treatment works, and the standards must not be changed just because some people insist their desire for physician-assisted suicide is rational and even a civil right.

My Trip to Georgetown University: The Inspiration of a New Generation

I was honored to be asked to give a talk at the annual Cardinal O’Connor Conference On Life at Georgetown University in Washington D.C. on January 28, 2017, the day after the annual March for Life. To be honest, I believe that I received more from the conference and students than I could ever contribute!

The title of my talk was “Killing or Caring? A Nurse’s Professional and Personal Journey”. I spoke about the progression of the Culture of Death through 4 professional and personal stories from abortion through assisted suicide. My stories included my 1982 fight to save the life of my newborn daughter with Down Syndrome and a severe heart defect against some lethal medical discrimination based on her disability. The second story was about how a young man in a car accident in the early 1970s “miraculously” recovered when we nurses refused to give up after the doctor initially predicted that the young man would at best be a so-called “vegetable” if he lived. The third story was about my daughter who died by suicide in 2009 at the age of 30 using an assisted suicide technique she read about and the tragedy of suicide contagion when assisted suicide is normalized and even glamorized. My last story was how I was almost fired from my ICU unit when I refused to participate in a withdrawal of treatment/terminal sedation euthanasia.

I was so moved by the enthusiastic response of the students to the message that the Culture of Death cannot be ignored or tolerated because evil will always expand until we stop it by demanding the recognition that every life is valuable and worthy of protection. I also loved getting a chance to talk to so many of the students after the talk. They inspired me!

Even on my trips to and from Georgetown University, I met two other inspiring young people. One was a lovely young African-American woman seated next to me on the flight to Washington, D.C. She told me about her career as a police officer patrolling the toughest area in Oakland, California. She also spoke about her passion to help the community and how she embraced the challenges of her choice. Who could not be inspired by that?

The Uber driver who drove me to the airport after my talk was similarly inspiring. It turned out that he was a young nurse who emigrated here from Ethiopia last year and was now studying for his national nursing exam to practice in the U.S. His story was fascinating and when he learned I was a veteran nurse, we had a wonderful discussion about nursing as a great career.

CONCLUSION

We sometimes hear the pessimistic opinion that our next generation is self-absorbed and only interested in money and the next cultural fad.

Based on my experiences in Georgetown, I think that our next generation may prove to be one of the best!

How Secrecy and Immunity Destroy “Safeguards” in Assisted Suicide Laws

Finally this November, a mainstream media source, the Des Moines Register, investigated some of the problems with legalized physician-assisted suicide in other states such as complications during the process, prolonged deaths,  non-existent or incomplete data in assisted suicide and even the “disputed meaning of ‘self-administer’” of the lethal overdose. This is crucial since Iowa is considering an assisted suicide bill in the legislature.

However, the Register’s reporting ignored one of the most dangerous legal problems in assisted suicide laws: immunity for doctors from “civil or criminal liability or professional disciplinary action for participating in good faith compliance” with the assisted suicide law.  In addition, the secrecy and often yearly destruction of even the minimal information self-reported by the doctors as well as  falsified death certificates listing such deaths as natural effectively destroys any pretense of an enforceable law.

This has made enforcement of so-called “safeguards” virtually impossible in states with legalized assisted suicide and affects even a state like my home state of Missouri that has a  law with penalties to prohibit assisted suicide.

THE MISSOURI EXPERIENCE

Missouri’s law against assisted suicide states:

A person commits the crime of voluntary manslaughter if he knowingly assists another in the commission of self-murder.
Mo. Rev. Stat. § 565.023.1

Yet despite years of failure, the pro-assisted suicide forces are again trying this year to get the standard assisted suicide bill passed in the Missouri legislature.

However, enforcement of the current Missouri law has been problematic. In the only case involving a health care professional, just a five years probation plea agreement was reached before a trial despite a nurse admitting she killed the patient, not assisting a suicide.

In 2001, Daillyn Pavia, RN  faced murder charges after she admitted giving a lethal dose of morphine to a new patient who had just had a stroke and was taken off life support.  According to police, Pavia admitted to co-workers that she had “without authorization and within a half-an-hour of taking charge of Julia Dawson as her patient … intentionally (given) Ms. Dawson 15 times the maximum dosage of morphine that had been prescribed” as well as Propofol, a strong sedative, that was not prescribed. The victim’s son defended the nurse’s action, saying it was done out of compassion and should not be prosecuted.

In 2003, 2 years later, nurse Pavia pleaded guilty to voluntary manslaughter and was sentenced to 5 years probation.  Nurse Pavia did not show up at a hearing before the Missouri State Board of Nursing which noted that Pavia was placed “on five years of supervised probation with the special condition that she surrender her nursing license.”

(Ironically, this decision followed on the heels of the decision not to prosecute Dr. Lloyd Thompson, then head of the Vermont Medical Society, for intentionally giving a paralyzing, “life ending drug” to an elderly woman with terminal cancer whose breathing machine had been removed. The family opposed prosecuting the doctor. Instead Thompson was reprimanded by the Vermont Medical Practice Board that required a monitoring and review of his care of all terminally ill patients.  10 years later, Vermont became the third state to legalize physician-assisted suicide.)

I could find only two other cases of people being charged with assisting a suicide in Missouri. One occurred in 1996 when Velma Howard, a woman with ALS died of suffocation in a motel with family members who admitted giving her sleeping medication, alcohol and a plastic bag. The prosecuting attorney later dropped charges against the family members.

The Jacob Runge assisted suicide case in 2010  resulted in a jury acquitting a young man who provided a gun to his emotionally disturbed friend in a self-described mutual suicide pact but said he could not go through with killing himself.

FALLOUT AND CONSEQUENCES

The fallout from these cases, like many others around the country, show that if someone-even a doctor or nurse-claims that they acted out of “mercy” it is unlikely that a person will face more than a slap on the wrist for ending or helping to end an ill or troubled person’s life.

In addition for those of us who are ethical and conscientious nurses, we feel the chilling effect discouraging us from even reporting other health care providers like nurse Pavia in such cases since we may face repercussions ourselves, including firing. There are apparently no real whistleblower protections for nurses (and thus the public) in such cases, especially since these cases routinely garner much media and public sympathy for the perpetrators and routinely result in minimal if any penalties. Conscience rights may not be enough to protect our patients and ourselves.

As a 2014 Medscape (password protected) article titled “Should Nurses Blow the Whistle or Just Keep Quiet?   by a nurse/lawyer author explains with regard to patient safety violations (which, of course, should include reporting the killing of a patient) :

Am I recommending that nurses adopt the “see nothing, hear nothing, speak nothing” attitude? No. I am saying that under current law, it is safer for a nurse not to report than to report. That surprises me, and it may be right- or wrong-minded, but it’s the way it is. (Emphasis added.)

This is exactly what pro-assisted suicide groups like Compassion and Choices could have hoped for when they fashioned the immunity protections and the secrecy of even the minimal self-reporting standards in their assisted suicide laws. Eliminating the possibility of future potential lawsuits or prosecutions is what keeps their myth of “no problems, no abuses” alive.

Unfortunately, that is also what puts all of us and our loved ones at risk, especially when we are at our most vulnerable. With legalized assisted suicide laws now quickly expanding to other states, we must step up our efforts to educate the public and fight against the well-funded and relentless Compassion and Choices machine.

And there is one significant effort that any of us can do.  Consider asking your own doctor or health care provider where he or she stands on assisted suicide and feel free to state your position. If your doctor is in favor of assisted suicide, you might want to consider asking for a referral to another doctor who refuses to provide assisted suicide. The life you save may be your own.

Physician-assisted Suicide Laws: Real Safeguards? No. Discrimination. Yes!

Many years ago before the first physician-assisted suicide law was passed in Oregon, I was asked to see a patient I will call “Eleanor” who was on the oncology (cancer) unit where I worked.

Eleanor was larger than life even when she became ill with cancer in her 50s. Spirited and feisty with a wicked sense of humor, Eleanor regaled us doctors and nurses with her tales about her event-filled life. But over some months when her cancer treatments failed to cure her, Eleanor’s mood darkened and she told me of her plans to commit suicide either with a “doctor” like Jack Kevorkian or by her own hand. She was insistent that she die before she became mentally diminished or physically dependent on others. I notified the doctor and spent time talking with her.

With treatment and especially by addressing her fears and the ramifications of a suicide decision, I was elated when Eleanor changed not only her mind but also her attitude. Once she decided against suicide, she embraced life fully and with gusto. She eventually died comfortably and naturally.

However, after Eleanor changed her mind about suicide and mentioned me, her friends tracked me down and threatened to get me fired because I was unjustly “interfering with her right to die”. Instead of being happy or relieved for Eleanor, these friends were instead outraged that we took the usual measures we would take with anyone to prevent a suicide.

I was shocked then but I am not now, especially after physician-assisted suicide was legalized in some states and one of its’ victims,  the late Brittany Maynard, became a celebrity.

HOW ASSISTED SUICIDE LAWS DISCRIMINATE IN TREATMENT FOR SUICIDAL PATIENTS

When a patient expresses thoughts of suicide, this is considered an emergency. As health care providers, we notify the doctors and an evaluation is done.

As the American Family Physician website states in Evaluation and Treatment of the Suicidal Patient:

“Important elements of the history that permit evaluation of the seriousness of suicidal ideation include the intent, plan, and means; the availability of social support; previous suicide attempts; and the presence of comorbid psychiatric illness or substance abuse. After intent has been established, inpatient and outpatient management should include ensuring patient safety and medical stabilization; activating support networks; and initiating therapy for psychiatric diseases. Care plans for patients with chronic suicidal ideation include these same steps, as well as referral for specialty care.” (Emphasis added)

However, physician-assisted suicide laws like Washington state’s “Death with Dignity Act” only  requires doctors to

 (e) Refer the patient for counseling if appropriate under RCW 70.245.060

and

If, in the opinion of the attending physician or the consulting physician, a patient may be suffering from a psychiatric or psychological disorder or depression causing impaired judgment, either physician shall refer the patient for counseling.” (Emphasis added)

Not surprisingly, very few people are referred for counseling since assisted suicide activists and some others consider such suicides “rational”.

HOW PHYSICIAN-ASSISTED SUICIDE LAWS DISCRIMINATE EVEN IN DEATH CERTIFICATES

While it can be painful to the family (as I personally know), when suicide is determined to be the cause of death, it must be reported as such on the person’s   death certificate.

However, the Washington State assisted suicide law actually forbids doctors from listing  suicide or assisted suicide as the cause of death: “(2) The attending physician may sign the patient’s death certificate which shall list the underlying terminal disease as the cause of death.

There are even detailed “Instructions for Physicians and Other Medical Certifiers for Death Certificates: Compliance with the Death with Dignity Act”:

“If you know the decedent used the Death with Dignity Act, you must comply with the strict requirements of the law when completing the death record:

  1. The underlying terminal disease must be listed as the cause of death.
  2. The manner of death must be marked as “Natural.”
  3. The cause of death section may not contain any language that indicates that the Death with Dignity Act was used, such as:
  4. Suicide
  5. Assisted suicide
  6. Physician-assisted suicide
  7. Death with Dignity
  8. I-1000
  9. Mercy killing
  10. Euthanasia
  11. Secobarbital or Seconal
  12. Pentobarbital or Nembutal

The Washington State Registrar will reject any death certificate that does not properly adhere to the requirements of the Death with Dignity Act.1 If a death certificate contains any reference to actions that might indicate use of the act, the Local Registrar and Funeral Director will be instructed, under RCW 70.58.030, to obtain a correction from the medical certifier before a permit to proceed with disposition will be issued.”(Emphasis added)

This flies in the face of the 2003 CDC’s Medical Examiners’ and Coroners’ Handbook on Death Registration and Fetal Death Reporting that states:

“The death certificate is the source for State and national mortality statistics (figures 1–3) and is used to determine which medical conditions receive research and development funding, to set public health goals, and to measure health status at local, State, national, and international levels.” (Emphasis added)

The Handbook also gives the distinctions between manners of deaths:

Natural—‘‘due solely or nearly totally to disease and/or the aging process.’’

Suicide—‘‘results from an injury or poisoning as a result of an intentional, self-inflicted act committed to do self-harm or cause the death of one’s self.’’

Why were the activists and lawyers who wrote this law not challenged when it was written to actually require doctors to lie on a legal document and add yet another layer of secrecy?

Again, as I wrote in my previous blog “Why Should Physician-Assisted Suicide Laws Grant Special Privileges?” , legislatures and the public need to know and challenge these outrageous provisions as well as being informed about the personal and societal dangers of assisted suicide itself. We must demand truth, transparency and accountability, especially when life and death are at stake.

My Submission to the New Zealand Parliment on Physician-assisted Suicide

On January 30, 2016, I wrote this submission to the New Zealand Parliament’s Health Committee. Today I received an email that it was accepted.

Here is my submission:

Please Reject Physician-assisted Suicide by Nancy Valko, RN ALNC

Nancy Valko, RN ALNC

I have been a registered nurse in the US since 1969. After working in critical care, hospice, home health, oncology, dialysis and other specialties for 45 years, I am currently working as a legal nurse consultant and volunteer. Over the years, I have cared for many suicidal people as well as people who attempt suicide.

I have served on medical and nursing ethics committees, served on disability and nursing boards. I have written and spoken on medical ethics-especially end of life issues-since 1984.

Submission

marievalko Picture of Marie Valko 1979-2009

As a nurse and the mother of a suicide victim, I am alarmed to learn that New Zealand is considering the legalization of physician-assisted suicide. I beg you to uphold the legal and ethical standard that the medical profession must not kill their patients or help them kill themselves. Suicide is a tragedy to be prevented if possible, not a civil right. I am also willing to make an oral submission to the New Zealand parliament.

My Daughter Marie Killed Herself Using an Assisted Suicide Technique

In 2009, I lost a beautiful, physically well 30-year-old daughter, Marie, to suicide after a 16-year battle with substance abuse and other issues. Her suicide was like an atom bomb dropped on our family, friends and even her therapists.

Despite all of our efforts to save her, my Marie told me that she learned how to kill herself from visiting suicide/assisted suicide websites and reading Derek Humphry’s book Final Exit. The medical examiner called Marie’s suicide technique “textbook final exit” but her death was neither dignified nor peaceful.

Marie was not mere collateral damage in the controversy over physician-assisted suicide. She was a victim of the physician-assisted suicide movement, seduced by the rhetoric of a painless exit from what she believed was a hopeless life of suffering.

Suicide Contagion

Adding to our family’s pain, at least two people close to Marie became suicidal not long after her suicide. Luckily, these two young people received help and were saved, but suicide contagion, better known as “copycat suicide”, is a well-documented phenomenon. Often media coverage or publicity around one death encourages other vulnerable people to commit suicide in the same way.

Study Shows Legalizing Physician-Assisted Suicide is Associated with an increased rate of Total Suicides

A recent article in the Southern Medical Journal titled “How Does Legalization of Physician-Assisted Suicide Affect Rates of Suicide?” came to these conclusions:

“Legalizing PAS has been associated with an increased rate of total suicides relative to other states and no decrease in nonassisted suicides. This suggests either that PAS does not inhibit (nor acts as an alternative to) nonassisted suicide, or that it acts in this way in some individuals but is associated with an increased inclination to suicide in other individuals.”

The Health and Economic Costs of Suicide

My Marie was one of the almost 37,000 reported US suicides in 2009. In contrast, only about 800 assisted-suicide deaths have been reported in the past 16 years in Oregon, the first state to legalize physician-assisted suicide. According to the Centers for Disease Control (CDC) suicide was the 10th leading cause of death for Americans in 2012, with “More than 1 million people reported making a suicide attempt in the past year” and “More than 2 million adults reported thinking about suicide in the past year.” The CDC estimates that suicide “costs society approximately $34.6 billion a year in combined medical and work loss costs”, not to mention the emotional toll on families.

Obviously our real health-care crisis here is a staggering and increasing rate of suicides, not the lack of enough assisted suicides.

Brittany Maynard

There was a media frenzy in October 2014 when of Brittany Maynard, a young newlywed woman with a brain tumor, announced plans to commit physician-assisted suicide on November 1 and raise money to have physician-assisted suicide legalized in all US states. There was an immediate and unprecedented media frenzy surrounding Ms. Maynard’s tragic story that routinely portrayed her pending assisted suicide as “heroic” and even counting down the days to her suicide. Personally, I thought this looked like a crowd on the street shouting for a suicidal person on a window ledge to jump.

In the end, Brittany hesitated for a day before she went through with her pledge to take the lethal overdose.

Now, assisted suicide supporters even deny that physician-assisted suicide is suicide, insisting that media stories use euphemisms like “aid-in-dying” and “death with dignity” in cases like Ms. Maynard’s to make assisted suicide more palatable to the public. However, this defies common sense when the definition of suicide is the intentional taking of one’s own life.

Physician-assisted Suicide and Medical Discrimination

I have been a registered nurse for 46 years, working in intensive care, oncology, hospice and home health among other specialties. Personally and professionally, I have cared for many people who attempt or consider killing themselves.

Some of these people were old, chronically ill or had disabilities. Some were young and physically healthy. A few were terminally ill. I cared for all of them to the best of my ability without discrimination as to their condition, age, socioeconomic status, race or gender. I will do anything to help my patients — except kill them or help them kill themselves.

Suicide prevention and treatment works, and the standards must not be changed just because some people insist their desire for physician-assisted suicide is rational and even a civil right

Could Brittany Maynard Have Been Saved?

This week, CBS’ “60 Minutes” TV show reported that FDA has just granted “breakthrough status” for an innovative treatment for glioblastoma brain cancer that was first reported by 60 Minutes on March 29, 2015.

Brittany Maynard had glioblastoma and died by physician-assisted suicide on November 1, 2014, just 5 months before the original TV segment aired.

Brittany Maynard was a young newly wed who, with enormous media publicity and the support of the pro physician-assisted suicide group Compassion and Choices, announced her intention to commit assisted suicide and asked for donations to the Brittany Maynard Foundation to raise money to help Compassion and Choices fight for legalization of physician-assisted suicide throughout the US.

Using Brittany’s story and foundation, Compassion and Choices was finally successful after years of failed attempts to get a physician-assisted suicide law passed in California.

Did Brittany, her doctors or Compassion and Choices know about the promising clinical trials for glioblastoma reported by “60 Minutes” before Brittany took her life with a physician ordered lethal overdose?

Although reported medical breakthroughs are frequent and often over-hyped or prove disappointing, information is available at ClinicalTrials.gov, a registry and results database of publicly and privately supported clinical studies of human participants conducted around the world. This service was developed by the National Institutes of Health and the Food and Drug Administration and made available to the public in February 2000.

The Decision to Forego Treatment

According to Brittany’s own words:

After months of research, my family and I reached a heartbreaking conclusion: There is no treatment that would save my life, and the recommended treatments would have destroyed the time I had left…

And

I probably would have suffered in hospice care for weeks or even months. And my family would have had to watch that.

No one is ethically obligated to try any experimental or unduly burdensome treatment for such conditions but many people do so not only for a possible cure but also to potentially gain more time or to advance medical research. I saw this when I was an oncology nurse and also in my personal life.

For example, a few years ago, a friend developed a usually terminal lung cancer and agreed to try  an unusual and massive combination of chemotherapy and radiation. As explained by her doctors, the side effects were very tough on her but today she is happy, active and enjoying her life and her grandchildren. Her cancer continues to be in remission. Success stories like this were unimaginable of when I first became a nurse.

But while treatment of a serious or terminal condition can be a personal choice, killing oneself-with or without medical assistance-must not be treated as just another valid treatment “option”.

Hard Cases Make Bad Law

“Hard cases make bad law” is an old legal adage that means that an extreme case is a poor basis for a general law that would cover a wider range of less extreme cases. This is particularly true when it comes to physician-assisted suicide where the slippery slope expanding the pool of potential victims has become a superhighway.

I also remember when AIDS, not glioblastoma, was the “hard case” used to justify physician-assisted suicide in the 1990s because it was also considered terminal.

But by 1998, the CDC issued the first national treatment guidelines for the use of antiretroviral therapy in adults and adolescents with HIV  Today, AIDS is no longer considered an automatic death sentence and those with AIDS can even achieve normal lifespans.

But how many despairing people in the 1990s resorted to suicide, assisted or not, when the treatment for AIDS was so close?

Conclusion

Hope can be life-enhancing as well as life-saving.

Sadly, as one brain tumor expert poignantly wrote, Brittany Maynard’s “suicide was a blow to fellow brain tumor patients who were living in hope”.

 

New Study: Suicide Contagion and Legalized Physician-Assisted Suicide

 

Even before my 30 year old daughter Marie died by suicide in 2009 using an assisted suicide technique, I was writing and giving talks on physician-assisted suicide (PAS) for years. Even then, I worried about effect of the mainstream media portraying PAS as a civil right and even “courageous”, especially since the existence of suicide contagion aka “copycat suicides” was well known. I was not surprised when after Marie’s death, at least two people close to her became suicidal. Thankfully, they were saved by treatment.

Now we have even more information about this from a Southern Medical Journal a medical journal article that was published at the same time Governor Brown signed the California’s PAS law. In the study “How Does Legalization of Physician-Assisted Suicide Affect Rates of Suicide?” , researchers meticulously examined suicide rates in Washington and Oregon after those states passed PAS laws.

The results are shocking. In those states, the researchers found a 6.3% increase in total suicide with a larger increase (14.5%) among individuals 65 or older. Moreover, there was no decrease in nonassisted suicides (people taking their own lives), despite the claims of PAS advocates that legalizing PAS would reduce the overall number of nonassisted suicides. Instead, the researchers found that “Rather, the introduction of PAS seemingly induces more self-inflicted deaths than it inhibits.”

On November 20, 2015, the Washington Post newspaper published an excellent op-ed article titled “The Dangerously Contagious Effect of Assisted-Suicide Laws “ by Dr. Aaron Kheriaty, an associate professor of psychiatry and head of the medical ethics program at the University of California at Irvine. Citing the medical journal study, Dr. Kheriaty concludes that:

“Debates about physician-assisted suicide raise broad questions about our societal attitudes toward suicide. Recent research findings on suicide rates press the question: What sort of society do we want to become? Suicide is already a public health crisis. Do we want to legalize a practice that will worsen this crisis?”

Is Suicide Really a Public Health Crisis?

The national Centers for Disease Control website reports the following statistics in a section titled “Suicide and Suicide Attempts Take an Enormous Toll on Society”. Here are some excerpts:

• Suicide is the 10th leading cause of death among Americans
• More than 40,000 people died by suicide in 2012
• More than 1 million people reported making a suicide attempt in the past year.
• More than 2 million adults reported thinking about suicide in the past year.
• Most people who engage in suicidal behavior never seek mental health services.

Costs to Society
The following estimates are based on 2010 CDC data and refer to people age 10 and over.
• Suicide costs society over $44.6 billion a year in combined medical and work loss costs.
• The average suicide costs $1,164,499. (Emphasis in original)

The toll on survivors, family member or friends of a person who died by suicide is also enormous, as I can personally attest:

• Surviving the loss of loved one to suicide is a risk factor for suicide.
• Surviving family members and close friends are deeply impacted by each suicide and experience a range of complex grief reactions including, guilt, anger, abandonment, denial, helplessness, and shock

.
Fighting Suicide Contagion

It is tragic that suicide prevention organizations ignore the PAS issue and the mainstream media is almost uniformly sympathetic to the PAS movement despite World Health Organization and national media guidelines for suicide reporting. This has allowed PAS groups like Compassion and Choices not only to press harder for universal PAS laws but also to even change the names of such laws to euphemisms such as “End of Life Options” or “Death with Dignity” to disguise the fact that physician- assisted suicide is obviously suicide.

However, Dr. Kheriaty in his Washington Post article also talks about a related phenomenon called the Papageno effect that:

“suggests that coverage of people with suicidal ideation who do not attempt suicide but instead find strategies that help them to cope with adversity is associated with decreased suicide rates.”

I have always maintained that our stories as suicide survivors, people with disabilities or terminal illnesses, etc. offer hope and inspiration while those about PAS promote despair and hopelessness. We need to tell our stories publicly.

All of us and especially people in states that are currently targeted by groups like Compassion and Choices for legalization of PAS, need to know and share the real facts about PAS as well as suicide prevention and treatment, including the national suicide hotline number (1 (800) 273-8255) and website (www.suicidepreventionlifeline.org).  Suicide prevention and treatment can work whether people are considering PAS or killing themselves.

Addendum: Ironically, just as I was finishing this blog, I was interrupted by a call from a man living in another state with an incurable, disabling condition. He was referred to me last month when he saw a segment on a celebrity’s suicide involving the same condition and decided that he wanted to go to California to use the newly passed PAS law. I talked to this man for quite some time.

I was elated when this gentleman now told me that the resources I recommended, the people he talked to and even just the fact that someone cared did change his mind and he no longer wants to end his life. He said he now wants to start actually living again.

This man’s story shows why we must not discriminate between suicide and physician-assisted suicide when it comes to suicide prevention and treatment.