Everyone at all stages of life should have as many options available to them as possible. However, nothing limits one’s options as much as death.

It’s easy to argue for legalizing suicide when we imagine one individual, otherwise fully coherent, and in the throes of extreme pain. But when we create laws, we must consider the future of our society as a whole.

What happens when we tell our most vulnerable that it’s OK for them to kill themselves?

As a medical director at some of the best nursing homes in southern Maine, I’m glad that our state considers physician-assisted suicide illegal. I don’t want my livelihood jeopardized when I opt for not killing my patients.

I’m sure that my excellent employer wouldn’t force me to do anything I consider unethical. However, my administrators may some day decide to let me go in favor of another physician who seems “easier to work with.” Either that, or nursing homes may choose to acquire their physicians from another agency that has “more agreeable” providers.

The slippery-slope argument that columnist M.D. Harmon hasmade is not far-fetched. I’ve encountered more than one instance in which the hospice benefit is abused. Patients with a qualifying diagnosis stand to get taxpayer-subsidized medicines or durable medical equipment with the understanding that the patients have less than six months to live.

I was surprised one day while performing a house call in rural Texas to find that my patient was on hospice. One of his diagnoses was congestive heart failure, but his ejection fraction (a measurement of how well his heart was pumping) was only 50 percent (55 to 75 percent is considered normal), and he actively maintained his farm. Almost any medical provider would say that he had many more months, if not years, to live.

And yet one of his relatives, who happened to work in a hospice company, found a doctor who signed off on the hospice admission. Finding a physician who will sign paperwork is not difficult, as the current narcotic epidemic also testifies.

Yet in over two decades of medical practice, I’ve never witnessed a single case of physician-assisted suicide. Perhaps this is because every state I’ve worked in would have considered it murder.

Much that I’ve read regarding L.D. 1270 assumes that everyone who dies becomes “consumed by pain,” as stated in a recent editorial in this newspaper, “Our Opinion: Dying Mainers deserve right to make final choice in life.”

This is simply not true. With good and appropriate medical care, many patients live out their final days and minutes without any evidence of pain or anxiety persisting more than about 15 to 30 minutes.

Another misstatement in the same editorial: “The seriously ill deserve to maintain their autonomy.” But the definition of death is the losing of one’s autonomy. Suicide doesn’t make this any less true.

And there are already ways to assert one’s autonomy well in advance of becoming incapacitated. These include an advanced directive, a physician order for life-sustaining treatment form (see www.polstmaine.org) or hospice — not to mention straightforward and important discussions with one’s closest family members and friends.

In the online comments on the editorial, a man expresses his support for L.D. 1270 so that he can avoid becoming a burden on his loved ones when he can no longer “live life to its fullest.” His honest sentiments end up arguing forcefully for keeping assisted suicide illegal.

First, who determines when someone’s life is no longer being lived “to its fullest”? I’ve met many people living in assisted-living and long-term care facilities who continue to find enjoyment in their remaining days.

Even more important: Why must older patients worry about becoming a financial burden?

What if we were having this discussion in the mid-1960s? We could have let President Johnson off the hook and he wouldn’t have had to enact Medicare. We could have all just asked for death as soon as we became ill after retirement.

L.D. 1270, if passed, would be a morbid financial solution. It would pile guilt onto the heavy burden an individual suffering at the end of life is already carrying.

And since terminal illnesses get more common as we age, many older individuals, feeling they are no longer productive members of society, would have the added internal conflict of whether to end their lives. In other words, the law would magnify the sense of shame for being disabled, either physically or mentally, and yet choosing to continue to live.

Suicide is wrong, especially because of its effect on those closest to the one lost — but also because of its effect on society. If passed, L.D. 1270 would require an individual’s physician along with others to choose whether they will be accomplices in that person’s undignified way out.

Bill Burge, M.D., is a family physician specializing in geriatric medicine and a resident of Portland.

filed under: