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

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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.