Vest: Legal assisted suicides should be rejected

Instead of passing laws that allow assisted suicide, which can put vulnerable people at risk, we should direct our efforts toward improving access to comprehensive palliative and hospice care.”

Michael T. Vest is a resident of Hockessin.

The proposed Ron Silverio/Heather Block End of Life Options Law (House Bill 140) introduces significant risks that warrant serious discussion and analysis. After such discussion and analysis, it becomes clear that legalization of assisted suicide must be rejected.

While aiming to offer a choice for those facing terminal illness, experience in other states has shown that a much broader population is impacted. Vulnerable people, such as those living with disabilities or serious health conditions, might feel pressured to end their lives prematurely. Fear of being a burden to their families or society is not unusual in these populations and could lead them to choose assisted suicide even when they could benefit from proper care and support.

A 2023 study published in BMJ Supportive & Palliative Care (10.1136/spcare-2023-004292), which analyzed 2,454 deaths from assisted suicide over 25 years in Oregon, reported an increase in the proportion of deaths in which patients cited concern about being a burden and an increase in patients citing financial concern. Additionally, of these 2,454 deaths, less than 1% had a psychiatric assessment, which is a missed opportunity to diagnosis treatable disease. Similar to the law in Oregon, HB 140 does not have any provisions requiring psychiatric evaluation for patients seeking assisted suicide.

In 2022, in the Journal of Eating Disorders, a Colorado physician reported on several patients with anorexia (a treatable psychiatric disease) who she treated with assisted suicide. Subsequently, a 2024 systemic analysis published in Frontiers in Psychiatry (doi.org/10.3389/fpsyt.2024.1431771) identified 60 cases of patients with eating disorders treated with assisted suicide. These were not patients with terminal illnesses but rather patients with treatable psychiatric disease. This highlights the slippery slope that such legislation can create, where the criteria for eligibility expand in ways not originally considered, potentially endangering lives.

The adoption of assisted-suicide laws can overshadow or be seen as a substitute for the essential need for improved palliative and hospice care. In fact, some patients request assisted suicide because they do not receive appropriate palliative care. Palliative care focuses on alleviating pain, managing symptoms and providing emotional and psychological support for people facing serious illnesses. Hospice care extends this support, ensuring compassionate care in the final stages of life. By concentrating on enhancing and expanding these services, we can provide a more humane and supportive alternative to managing end-of-life pain and suffering. Importantly, the use of medications with the goal of alleviating symptoms, even if treatment hastens death, is not assisted suicide and is already legal.

Instead of passing laws that allow assisted suicide, which can put vulnerable people at risk, we should direct our efforts toward improving access to comprehensive palliative and hospice care. People facing terminal illnesses should receive the necessary support to maintain their dignity in their final days, without feeling pressured to end their lives prematurely.

Reader reactions, pro or con, are welcomed at civiltalk@iniusa.org.