Physician-assisted suicide at the forefront of Connecticut legislation — but why?

Should it be legal for a person to choose to die — commit suicide — not by more traditional means, but with guidance, permission and assistance from a clinician? This is the question at the heart of a widely controversial debate, one that has been presented to the courts, both in Connecticut and across the country, frequently in recent years.

Brittany Maynard was a young cancer patient who chose to end her own life.

Brittany Maynard, a 29-year-old terminally ill cancer patient, made headlines in 2014 when she moved from California to Oregon to pursue options in which she felt she could die with dignity. For many, Maynard became the standing representative for the debate surrounding the right to die. Her activism and forthright approach to the ways in which she controlled her own death brought the issue for the forefront of American society yet again.

Just a few months after Maynard’s death, another more nuanced right-to-die case cropped up, this time in Connecticut. Seventeen-year-old Cassandra C. had been diagnosed with Hodgkin’s lymphoma, and, with the support of her mother, sought the right to deny chemotherapy.

The case was taken all the way to the Connecticut State Supreme Court. In a released court opinion, Chief Justice Chase Rogers said due to Cassandra’s minor status, the court perceived she had an inability to make mature, sound decisions regarding her own health. Thus, the decision was made to allow for “forced chemotherapy” to continue.

Currently, four states — Oregon, Vermont, Washington and Montana — permit the option for physician-assisted suicide. California will soon follow, with a recently passed law set to take effect on June 9, 2016.

Proposals for similar laws have repeatedly failed in Connecticut since 1995, but aid-in-dying support groups have been consistent in pushing bills to the forefront of legislation since around 2013.

Sociologist and public health professional Dr. Suzanne Hudd said the controversial debate around physician-assisted suicide has trickled down from the Netherlands, where euthanasia and non-resuscitation upon request have become increasingly popular.

Hudd said there are a variety of psychological and sociological reasons why people feel so strongly about physician-assisted suicide. And she doesn’t see the issue going away anytime soon.

Q: Have you seen this framed as a social problem for a while now?

Suzanne Hudd: It goes way back to the Netherlands, and so I think it’s been around for quite some time. When you think about it, with medicalization, we’ve got all these drugs that I could take to control this, that or the other thing. It’s proliferating — that we want to be able to take a pill. Our system of healthcare seeks to find the magic bullet, and, to me, euthanasia is the magic bullet for this society that doesn’t want to age and doesn’t want to deal with a lot of the difficulties around aging.

Q: Physician assisted suicide can be applied so many different ways. If you’re terminally ill, it’s one thing, but if you’re terminally ill and old, it’s kind of like, should we just let you die naturally? If you’re terminally ill and young, people see it as a respectable decision that you want to die with dignity.

SH: I think a lot of it is weighted in terms of what the ramifications of the illness are, to some degree. Lou Gehrig’s [amyotrophic lateral sclerosis, ALS] is one where you hear about this issue a lot because it’s such a horrific way to die. And so we tend to be more tolerant when what I’m going to have to live through is really horrible.

But then the age factor comes into play, and we actually have a society where — I have elderly parents — I can be told routinely when we go see a doctor, “We might not do that at an 85-year-old.” So we actually are withholding treatment in many cases in a more passive, less dramatic way all the time for elderly people because we don’t want to spend the money on somebody who isn’t going to live that long.

Q: Maybe just the risks with an older person may not even be “worth it.”

SH: Exactly. So we do this routinely. It’s just how much the patient’s engaged or not engaged in it. We’re allowing medical authority, in many cases, to say, “Oh, it’s fine not to do this because they’re too old, and it will cost too much money, or it’s too risky” — whatever the reasons are. But when the patient asserts [him or herself], that’s where the question comes into play.

Q: People maybe are uncomfortable with the thought that someone can choose to set a time to die.

SH: [It’s] technological lag — the idea that our ideologies and our thinking lags behind what technology can do. And we’ve gotten to the point where we can keep people alive indefinitely almost, forever, on machines and things, and so the technology’s gone way ahead of our ability to process. And we don’t have the systems in place and the logic to say, “What would be the conditions under which ‘No, this isn’t a good choice’?”

Q: If people say, “Yes, it is legal for someone who’s 17 and dying of cancer and would rather just die before she gets too sick,” I wonder if that’s OK, but it has to be under certain conditions because we can’t just give a pill to anyone who feels like dying.

SH: I do think the key variable in physician-assisted suicide is [the] patient because, I think, routinely, people who are diagnosed with terminal cancer…you die of morphine overdose. They just give you so much morphine to prevent the pain from surfacing that you end up dying. Nobody ever does an autopsy on somebody like that, so we don’t know. Did they die from an overdose of morphine, or did they die from the cancer? But they were going to die from the cancer, anyway.

It’s now the patient inserting [him or herself], saying, “I want to pick the time. I want to be involved in the process.” That makes it a bit different in that sense because otherwise, it’s something we have historically done. We’ve limited access to treatment, and we’ve provided access to treatment for people we knew were going to die. The main difference between this and physician assisted suicide is now the patient’s involved in the decision. If I’m lying there unconscious with cancer, it’s my doctor doing it all.

Q: What about people with psychological conditions who are maybe suicidal for a few months or a year and in waves — maybe if they’re in a rut, and they go and tell a doctor, “I want to die today,” or, “I’d like to die this week,” then we just give these people pills — kind of like helping push someone off a bridge?

SH: That’s the culture of fear thing — that the doctor will suddenly abuse this power and, somehow, a patient would have so much ability to control things. But all of this seems to be premised on the idea that medicine is science, and I would argue there’s some art in the science — that no two people die the same way. If you have two people with exactly the same kind of cancer, they’re not going to die in exactly the same way. There [are] always exceptions to [the] rule, so it isn’t science in that sense. There isn’t a straight path that we can predict.

Q: Maybe that’s the problem with it. It’s not a black and white issue.

SH: “Physician assisted” puts the physician in a more passive role — that the physician is assisting the patient. And we don’t tend to think of physicians in that role. Just that terminology, alone, is kind of interesting because we think of the doctor in charge of that medical knowledge, not the patient.

Q: The groups who support this, they don’t call it “physician assisted suicide.” They call it “aid in dying” or “dying with dignity.”

SH: Right. They really put the patient out there in front.

Q: There’s this connotation with the word “suicide.” When you hear physician-assisted suicide, it’s like you can’t help but think gruesome, even if you are in support of it. It’s kind of this dark word.

SH: The Hippocratic Oath — you’re going to do everything you can to benefit the patient’s wellbeing, and you’re destroying the patient in that. So it’s fundamentally built into what a physician swears not to do, is some people’s argument.

Q: There’s such a human element to it where you can’t help but to sympathize with these people.

SH: Yeah. It’s interesting because I don’t know if I’d have the courage to do it, but the flipside is I believe in the right to do it. Just because I don’t have the courage doesn’t mean I should limit somebody else who does from being able to do it.

Q: It’s so interesting because you either help a person avoid suffering — you could look at it that way — or you’re helping a person die, which is like hurting them.

SH: We believe in technology and progress, and when you say, “I’m going to let someone take [his or her] life,” in essence, you’re saying the technology and the progress have failed; there is nothing for this person. So it’s giving up on one of those fundamental values. Freedom is the other value. That would be the argument — that I should have the freedom to do what I want. These values all sit in conflict, but I’m going to argue the linchpin of this whole thing is the aging of society that’s happening right now.

Q: It’s interesting because Brittany Maynard, I believe she just took a pill and was in her bed at home and had her family, but Cassandra — she wasn’t actively pursuing death. She was just passively just saying, “I don’t want the treatment, and I know this will probably lead to death.” So there are two different kinds of paths to take with it.

SH: I think we’ll, in relatively quick order, have the more passive form. The more active form is going to probably take a little longer. It violates the physician’s expertise if the patient is suddenly the expert. All those things we talked about make it more complicated.

Q: Do you think this issue is going to recirculate, especially in Connecticut?

SH: Yes. I have no doubt about that. I think aging, for sure, is going to do that. I do think this is going to keep coming to the fore because too many people now are also living through experiences where medicine has gotten us to a point, but we know life isn’t indefinite. There just comes some limit to what they can do, so I think that is also another issue.

The part of medicine that gets put in the media more often is the magic bullet part — that we’ll have a cure for cancer in five years kind of thing. Well, what you haven’t addressed is, do I want to live in a 120-year-old body just because I’m not going to get cancer, but who knows what my bones are going to be like?

And there’s also the mind part of it, you know. There’s mind and body, so, great, my body can be sustained, but if I’m totally [incapacitated from dementia], do you want me alive, sitting in a nursing home?

Q: Patients like that — can patients make the decision to engage in physician-assisted suicide, or would their caretakers make that decision? And who’s to say they’re in sound mind to consent?

SH: Yes. Mental health is a big part of this, for sure. Suicide has been this stigmatized thing. We don’t want people to kill themselves in the general sense. We have this whole negative association with the idea of killing [yourself.] It’s really asking us to flip this issue upside down — that it’s actually positive that I can take charge of my life and make that decision under certain circumstances, and it’s a good idea for that to happen. And that’s asking us to change the whole way we view this process.

This story was originally published on April 23, 2016.